Expert: Paula Damgaard - 8/4/2008

Question
My father has AD. He is being taken care of by my stepmother who does a wonderful job. He really doesn't speak, has no clue who he or anyone else is. He eats when you give it to him and still is able to say he has to go to the bathroom. I am concerned about his anger. He was a pretty physically violent person in the past and I am concerned about his behavior in the final stage? I am searching for homes for him and his wife is not really able to let him go.....yet. How much longer do you think he has before he ends up in a home and do you think his behavior will turn violent along the way. Right now he is verbally abusive at times. What should I be watching for?

Answer
Hi Diane, my question is does he have anger now?  Usually with the disease the anger comes in the beginning to middle stages of the disease.  If you are saying that he was pretty violent in the past meaning when he had disease, then I would hope that he has "outgrown" that stage.  One can never know for sure, but it is similar to child development in that as children grow they go through the terrible twos, etc.  As the disease progresses they are going back through stages in a sense.  

ON the other hand if he is still violent now I would hope that he is on medication to prevent this.  It is never safe to allow that to continue with these patients cause they can hurt people. Not intentionally, but the disease takes over and they can do serious damage.  If he is violent now, I would suggest talking to  his doctor and getting him on some happy drugs.  They may make him sleepy, but better that than violent.  Also, if you can find out what triggers the violence and be very conscious about it and not doing or saying or whatever it is that causes it that can decrease the violence as well.  These drugs can help with the verbal abuse as well.  If his doctor doesn't do anything about it find a new doctor one that specializes in geriatric medicine or memory disorders.  Don't let them tell you there is nothing to be done.

I cannot tell you how much longer he has before he needs to be placed.  That is always a hard question.  Basically, you need to be the judge.  Your stepmom cannot.  She is so far in trenched in caregiving that she cannot see the forest for the trees.  You need to explain to her that placing him in a home is not an admission of guilt or failure, but that it is the "treatment" for this disease.  If he broke his arm you would put a cast on it, his head is broken and he needs to be in a place where he can get 24 hour care, and stimulation that is appropriate for him.  

I hope you can get her to agree to this.  She needs to have relief from this disease.  Telling her it that way helps sometimes too.  It is not that she isn't doing a good job it is that the disease is bigger than her.  

I hope this helps.  Please know that I feel your dilemma!  Good luck and let me know how it goes.  Paula