Alzheimer`s Disease/dementia & OCD (self-mutilation)
My 84 yo father sustained a catastrophic fall May 2014, (parking lot bumper) FX x 2 to his dominant shoulder, (non-surgical), a multitude of abrasions, 20 days hospital, rehab,(me at his bedside every night, Mom and sister all day) - We have not left him alone, since, ever, except for daily AM walks until recently as his fall risk is increasing. So, one could say we have taken away all personal control of his life, 24/7 supervision. Prior to fall, mild dementia - still drove, independent gait, ADLS, etc but gambling a bit out of control. Since the fall & hospitalization, he began picking every scab, bumps, scratches, etc, waking up next to him in the hospital with the pillow case and his finger nails all bloody. I gloved him at night, he took them off. He's been at home (Mom, sister and part-time help. Currently, he easily has 75 or more open wounds, each surrounded with S & SXs of infection, (on ABX), he removes all bandages, dressings as fast as we can apply. Wound care centers and HH RNS have no answers. Nails are cut short. We cannot glove him because he reads, plays cards, internet games. It is non-stop to the point of self-mutilation. Shorts vs pants don't matter, arms, legs, face, chest - it's now embarrassing to take him out - looks like he fell into a cactus pile. He's OFF Namenda, Seroquel and Haldol. Currently on ABX, Aricept, Celexa (new) and sleeping more and more so we don't really want to give him Ativan or Xanax. He's also gained about 50 pounds, says he eats out of boredom, I ask him why he's picking, he's says cuz it's fun, he's bored, something to do other than eat. I realize we have taken away 99% of his ability to control his life, daily choices and this may be a control issue, but..... I fear we will end up back in the hospital on IV ABX soon, which means me at the bedside, nightly again, exhausted as I work full-time (Home Health). ANY MED COMBOs that you think would minimize this OCD?
Thank you in advance.
Hello Sherri: I apologize for the delay in answering your question--I was out of town. I'm very sorry to hear of your father's current issues and of you and your family's exhaustion in trying to care for him. Please remember that I am not a doctor, so could only give an opinion on what I believe some meds might or might not do. Several things come to my mind as I read your question. First, he needs a lot more stimulation to take his mind off his injuries. If he is able to walk, then LONG walks holding hands with the caregiver and engaging in reminiscing at the same time. What about animals being a diversion for him? Cats, dogs, horses, etc. Whatever would hold his interest and if it's feasible to have that animal around him as much as possible--including his helping to care for it would be a great diversion as well as calming for him. Check out Pete the Parrot which is a talking stuffed toy parrot that many, many elders with dementia find fascinating and will spend hours talking to.
Secondly, be sure he's getting plenty of protein in his food because he needs it for skin healing. Keep all the lesions covered as much as possible so he doesn't see them. Keep him well hydrated.
It's probably good that he's sleeping more until his lesions heal, but I agree on holding the Ativan or Xanax. I do like Namenda, but some people just don't respond positively to it. I also think Lexapro is a better choice than Celexa (same drug company, but Celexa is the older version--and less expensive, but not as effective as Lexapro). Many docs will say they're the same, but they're not. If you're not seeing much change within 2 weeks, I would push for a change to Lexapro. Realize Sherri that the behaviors that are exhausting you now will go away eventually. Also check out HipSavers arm/leg covers that you may be able to use to keep his hands off his lesions awhile longer and they will provide some padding as well.
Please take care of yourself and urge your family to do the same--work it out so you can get away from him regularly so you can re-charge. I wish you and your family much luck as you continue to walk with your father on his journey through dementia. Cindy