Are Psychiatric Hospital Admissions Always Needed for the Person With Alzheimer's Behaviors?

I received an email from an adult child of a client recently who is "at the end of the rope with a parent's behaviors, suggesting an admission to a psychiatric hospital so she could be seen by a doctor daily who will manage medications on site".  Sometimes adult children have simplistic solutions that don't always work out for their parents.  Case in point......At the beginning of my work with Alzheimer's patients of a local psychiatrist, I witnessed a delusional episode which proved just how the system worked against an elderly individual with an Alzheimer's related disorder.

A number of years ago, while visiting a client who was obviously in a delusional state, I called the client's power of attorney, her primary care physician, psychiatrist, therapist who all advocated that she voluntarily sign herself into a local psych hospital.  One thing I have observed throughout the years is that the person afflicted by Alzheimer's who has an emotionally negative experience, will remember it forever.  This was the case with this client.  I drove her to the psychiatric hospital and as I said earlier it was a  voluntary admission, but as soon as my back was turned she was brought before a judge who changed it into an involuntary admission, keeping her there for two weeks against her will as my daily visits bore out.  It was an awful experience for her.....multiple doctors who changed her medications so many times that even after discharge nothing seemed to work, keeping her with the general psych population which consisted of males, females, young, and older persons who needed psychiatric intervention, and managed by staff who weren't experienced with the word-finding problems that a person afflicted with Alzheimer's sometimes has and the exasperation that  it brings.  On her return home, she was far more agitated than she was on admission.  She never forgave me because I was the one who drove her "to the crazy house".  I went from being her loving advocate to "the enemy".  Her disdain for me made my life a living hell (again, because of the emotional connection she made to that memory).  I vowed never to recommend a psych admission to another client (unless they are a threat to themselves or others) as it served no purpose.  My client eventually went through a series of psychiatrists before finding a geropsychiatrist who put her on gradual increased doses of Seroquel which finally seemed to work.   She is now at home with live-in caregivers and the love of her small puppy, is peacefully managed, and will remain in her home until the end.

Even with the most highly credentialled psychiatrist, medications are not always a one-size-fits-all solution.  After many years of working with dementia behaviors, I have observed that not all agitation is resolved with a change of medication.  Sometimes an inexperienced caregiver can accidentally trigger behaviors and it takes gentle patience and training to get to the heart of the problematic behavior.  When you have caregivers working different shifts and one caregiver gets easily agitated while the other more mature and experienced caregiver elicits cooperation from her patient without reported incidents, you can surmise that more training may be needed.  Persons suffering from Alzheimer's disorders can also be affected by changes during a particular time of day (i.e,. sundowning), so careful monitoring of progress notes in the home can give the information necessary to determine if that is the case.

So, I close with the following advice: If sudden confusion or sudden changes in behavior are apparent with a parent, check with the primary care physician to rule out a urinary tract infection or push fluids if you suspect dehydration; follow trends with caregivers to see who may need more training; have them keep progress notes documenting their observations, finally report new behavior changes to the psychiatrist to see if medication adjustments are warranted.  Alzheimer's disease presents extreme challenges not only to the affected individuals and their families, but also to care providers.  The nature of the disease is such that our healthcare system sometimes fails to function in an appropriate manner.  As the baby boomers age and more persons are afflicted with dementia, our health system will not be in a position to handle the anticipated influx of Alzheimer's patients over the next decades.  I hope this post helps examine some of the challenges presented by this disease and has suggested several possible methods to improve our response to observed behaviors.  A Good Daughter Elder Care Management helps provide high quality resources for family members who have parents afflicted by Alzheimer's disease.  We provide advocacy, caregiver supervision and training, medications management, medical coordination, mediation, and host a free monthly dementia support group for families and caregivers.  We are available to our clients and their families for emergencies 24 hours a day 7 days a week, 365 days a year.  Please feel free to leave a comment below or contact: olga@agooddaughter.com  for more information.