Expert: Michalene Peticca - 12/2/2008

Question
QUESTION: My dad has Alzheimers for about 8 years now and we admitted him to a nursing home last July. He has become very hostile and combative, hitting and kicking the staff when they try to dress or care for him. The Psychiatrist started him on a very low dose of risperidal and valproate about 3 weeks ago. Since then his muscles/joints have become very stiff, he can longer walk by himself, does not want to eat. The staff is working with him as far as eating and physical therapy, and seem to think this will work its way out. Will it?

ANSWER: Hello Joan,
Thank you for writing.  You bring up some good points within your question about combativeness and medications.

First, let me say that Risperidal has been phasing out for treatment with Alzheimer's & Dementia individuals due to it's side effects.  I would question whether a medication like Ativan might be given.  It is a short lived med. and it's usage is much more effective.

Is the combativeness only at care time?  If so, i would strongly suggest that staff review their approach to your father.  Do they calmly approach him or do they approach him as matter of fact and as if "doing a job"?   Sometimes slowing down actually is the "fastest" way of getting something done.   Care times are the #1 time we see challenging behaviors.

Also, can staff approach him at different times of the day?

A very good video about Alzheimer's and care is "Bathing Without a Battle".  Check out your local Alzheimer's chapter and see if you can borrow it from them.

Thanks for writing!
Best Regards,

Michalene Peticca, MA

---------- FOLLOW-UP ----------

QUESTION: Thank you for your reply. I know the staff does try to reapproach him later in the day, or at other times to accomplish some of his ADL's. I do not think they have tried Ativan, I do know they have given Haldol injections at times, so I am unsure if this sudden stiffness in his limbs is a side effect from that, or if he is just declining into the next phase of Alzheimer's. How long would it take to clear these medications from his system?

Thanks,
Joan

Answer
Hello Joan,

Haldol is to be used ONLY as a last resort...and in the state of Pennsylvania (i'm not sure what state your writing from) it is not even really allowed in long term care settings.  

Haldol is not a lasting medication, so it will deplete your father's system usually within 8-12 hrs.  Risperadol usually takes 2-3 weeks to leave the body's system.

Yes, Haldol can certainly cause stiffness as a side effect.

Please talk to your father's physician promptly and see if he can be reduced to Ativan.

Best Regards,

Michalene Peticca, MA