Alzheimer`s Disease/medications - Lorazapam

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Question
I just helped a family move their mother to an assisted living facility (brand new!) - Generations - memory unit. Mom has alzheimers and can no longer live alone in her home. Upon moving her it was recommended Lorazapam to take the edge off. She is a fiesty woman who DOES NOT want to be there - wants to be home.  So this is a day to day progression. I agree she needs some anxiety meds (she refused medications all her life - so at 90 takes nothing. However, for this move it is essential. My concern is too medicated. The facility medical services director has recommend 3 doses .5mg each 10/3/7pm to assist in relaxing her. Is there other suggestions for meds or not meds? This is very tricky.. We are 3 days into this living... as of last night she "kicked me out of her house" - good step... Just need another persons opinion as to helping a senior become comfortable in her new living conditions. She is 1 of 6 in the unit - which is great - she is also the only one fighting this move.  Thank you.

Answer
Hello Cindy:
First of all, let me remind you that I am not a physician, so my answer here would be based on my experiences as a nurse and a dementia consultant.  
I just love these elderly ladies who make it that far in life and are still so feisty!  My preference for a med to try to soften the edges would be Namenda.  It may help maintain her current cognitive and functional levels, and it has been shown in studies to reduce agitation/aggression.  It has to be titrated up, and it has a very low side effect profile.  Ativan, on the other hand, can have a rebound effect and has a lot of side effects including falls.  If she's balking at taking meds, then the facility should get permission from the POA to put it in her food/drink.  Also, telling her what she wants to hear will go a LONG way to calming her.  If she has little short term memory, then telling her therapeutic fibs such as "Once the doctor releases you to go home--and we're hoping that will be tomorrow, then we're really going to miss you!"  Possibly, "Yes, your daughter will be here to pick you up in just a few hours, but she told us to have you go ahead and eat lunch here first."  As long as you know she will forget the conversation, when you've told her what she wants to hear (she's going home soon), she may just calm down.  But, everyone needs to be on the same page with what is being said.  Good luck to you Cindy.  Cindy

Alzheimer`s Disease

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Cindy Keith, RN, BS, Certified Dementia Practitioner

Expertise

As a nurse and dementia consultant, I can answer most questions on all types of dementia. If I cannot answer your question, I will attempt to find someone who can. My passion is to help caregivers of people with dementia, which in turn helps all those wonderful elders with dementia live better lives. When caregivers are better educated, they are able to better care for themselves and their loved ones, so education is key to decreased stress levels and healthier, happier families.

Experience

I have worked as a nurse in various disciplines of nursing for over 20 years, most of which was with the elderly. I was a health care coordinator in a dementia dedicated assisted living facility for 4 years before I started my own business (M.I.N.D. in Memory Care) as a dementia consultant six years ago. As a dementia consultant, I help families nationwide through phone conference calls as they struggle to care for their loved ones with dementia.

Organizations
Alzheimer's Foundation of America Geriatric Interest Network Sigma Theta Tau International

Publications
Published "Love, Laughter, & Mayhem - Caregiver Survival Manual For Living With A Person With Dementia" which is a collection of stories about people with dementia I have known, loved and worked with. Every story has a lesson to teach and this book gently teaches family caregivers lessons about how to better care for their loved one, as well as themselves during their caregiving journey. Published "Love, Laughter, & Mayhem In Eldercare Facilities: The Master Key For Dementia Training" Created "Bringing Nurturing To Memory Care" staff dementia training video Created Ebook: "Hair Stylist's Helpful Tips For Working With People With Alzheimer's & Other Dementias"

Education/Credentials
Registered Nurse with Bachelor's degree in Nursing; Certified Dementia Practitioner; Author of 2 books and an ebook

Awards and Honors
Sigma Theta Tau National Honor Society of Nursing

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