Expert: Mary Gordon - 8/24/2009

Question
My dad of 70 is on stage 6 alzheimers.  My mum looks after him, this week the doctors have said he needs to be taken in to care as he is now aggressive with people.  I live 164 miles from him but last week i was home, he was very aggressive with me mum and my son.  With in one week he has now become incontinent he has progresive alzheimers, the doctors have sectioned him but my mum wont let him go, can they just take him?  I know iv lost my dad to this alzheimers but i feel in the last 6 month he has gone down hill very fast, he is a fit man and very strong. He cant speak to good anymore. What is the next stage after this.

Answer
Hi Hazel
As far as I know, they can't forcibly take your father unless it can be determined both of them are in danger in the current arrangement (i.e. he is a danger to her, or he is being neglected because his care is too heavy for her to cope with).

However, your mother should seriously consider how much she can handle. If she is petite and your father is large and strong, she may have a real challenge handling him, even if he is as gentle as a lamb. He will be increasingly helpless, and need complete supervision and assistance with every aspect of his care. Now that he is incontinent, the care will get heavier and heavier - bathing, dressing, diapering etc.

If he is aggressive on top of everything else, realistically, she may not be able to manage this on her own. Moreover, she may be in physical peril if he could strike out and attack her in any way. He will be like a large toddler. When things are too much for him, he may hit, kick, push and hurt her, and he will not realize that he could harm her. He will have no self control or understanding of his own strength. He may not even be sure who she is all the time.

Has she spoken to the doctor about medications that may decrease his agitation and aggressiveness? There are several that may help, and she can work with the doctor to come up with the right one. The right one will settle him down, but not make him drowsy or floppy so he is danger of a fall.

There may be things she can do to head off the aggressiveness. She should closely watch and see if she can see patterns to what sets him off. Does he give off signs that he is getting overwhelmed and frustrated? If she, it's time to stop whatever activity she is trying to accomplish. Sometimes particular activities are very challenging, such as bathing. Sometimes it helps to schedule these things for times of the day when the person is at their best- rested, fed, relaxed - often this is early in the day. Later in the day, tensions may have built up and the person may be more volatile. My mother in law was actually meeker and easire to manage when strangers did the bathing than if a loved one attempted it. I'm not sure if that had to do with her sense of privacy.

Are there other options to assist your mother? Can she hire help? are there local services she could qualify for, like visiting homemakers? Are there other family members who can assist? Can she move closer to family assistance? Even if she got help at home, she really does need to contemplate future options. Her health, safety and sanity will be at risk with an uncooperative person who is larger than she, aggressive and needs so much assistance. She will not be able to leave him alone for one minute, and this will take a toll on her - she won't be able to run to the shops for a loaf of bread. If she should become ill for any reason, there will be a crisis for all of you to cope with. Homework needs to be done right now to figure out next steps and what facilities might suit if he needs care beyond what can be provided at home.

With time, as the disease progresses, the aggressiveness will start to diminish - but so will everything else. He will be less and less able physically, lose more and more of his speech and eventually, need to be fed. He will be more and more like a 12 stone infant. He will not be able to walk or do anthing for himself. Your poor mum has to be realistic about what she can supply in a home environment. Her real job is to love him - no one can do that like she can. However, that does not mean she has to do everything physical for him herself. Even now, he may be very hazy about where he is and who he is with. By this stage, when my mother in law said she wanted to go home, it was to her parents home where she hadn't lived for 60 years. I don't think she really knew where she was. His moving to assisted living is probably going to much more upsetting for your mother than for him. I think everything is a confusing jumble for him. She needs to consider that he needs her to be able to look out for his comfort and care, and if she gets ill and worn out from trying to do too much, or worse, if he hurts her by accident, no one will be helped. She won't be any good to him if she is not well, so she has to look after herself, and consider that when she is thinking about his future care.

If your mother has a health visitor, you might want to try and talk to them about how they think your mum is coping, and what the local options are. Could your mother try a placement as a little holiday for her? Many places offer "respite care". Perhaps she could give it a shot as a trial to see how it goes, perhaps while she comes away for a visit to you to get some rest.

I wish I had firm answers for her, but I know you know that he will get worse and worse. He may not become more aggressive, but he is large and fit, and that makes it that much worse for your mum to try and do this on her own. She does need to talk to the doctor immediately about his aggressiveness to see what the doctor can offer in way of a short term fix with medicaitons.

Hope this helps.

Mary G
Toronto