Mother with Alzheimer's/Dementia just started hitting her younger children. Any recommendations on what to do?

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Mother with Alzheimer's/Dementia just started hitting her younger children. Any recommendations on what to do?

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My Mother has dementia and we were just recently told she has Alzheimer's. There are 7 children that care for her at home for the last year and a half. She has to have 24 hour care and each of us spend at least one night with her. She is incontinent so we all have to change her and either wash her or give her a shower which both are a chore no matter who is doing it. The problem is with the younger two (a female and a male) just recently she started hitting them when they were trying to clean her up. My sister bent over to clean her legs and such and she started smacking her on the back of her head. My brother started cleaning her up and bending over to do the same and she started hitting him on his back with her fist. She has never been a violent person. Was told by Occupational Therapist they shouldn't be cleaning her. That would be great if we had someone to come over every time she made a mess in her pants or she needed to be cleaned up. Recommendations?

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Since my previous answer, I thought of another possible cause of her behavior, even though it is unlikely since she only hits these 2 specific people. When my dad was in the mild/moderate stage of dementia, when his blood sugar would get too high (he was a type 2 diabetic), he would become stubborn and would push his hand at me when I wanted to check his blood sugar with a fingerstick. He would hold his hands together so I couldn't get to his fingers. He never hit me, probably because I could still rationalize with him. I was also an only child and he would do just about anything to make me happy. Behaviors do change with alterations of blood sugar and other chemicals (i.e. sodium, potassium, chloride) in the body. Your mom needs to be regularly evaluated by a PCP to make sure everything is stable. If she can't be transported to the PCP, a lab and/or a home care company can draw the blood and have the results sent to the PCP. Then you can have a telemedicine appt. to discuss the results if anything is abnormal and talk about a change in the treatment plan (meds, etc.)

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I am so sorry to hear of the problems with your Mom's physical abuse towards her own children. I feel rather humbled, because I just deal with the verbal kind. However, I am a former nursing assistant and have taken care (hands-on, otherwise known as direct care) of Alzheimers/dementia patients in varying stages of Illness. Here are a few ideas:

1. Have you talked with her doctor about her aggressive behavior? You didn't mention her medication, so maybe a change in her meds might mellow her out. There's no shame in your mother needing to be medicated because she can't control her behavior. No one deserves to be put in a situation where there is the threat of physical violence.

2. You mentioned her toileting and bathing issues. Toileting (changing adult diapers, cleaning someone up after soiling themselves) can be difficult with any person. I feel for you . What you could do with the bathing issues is buy a shower chair and install a bar on the wall of the shower stall or tub. These things can give a patient a sense of security, which might calm her down. But I really think that you need to consult her doctor first and honestly explain her behaviors. There are medications that might help her aggressiveness. Good luck and God Bless.

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Medication. Understand her fears and anger from her perspective. Her brain is telling her to act out, perhaps that people are trying to 'hurt her.' As she is possibly protecting herself from the hallucinations (if that is what is happening), she will do what she feels is in her best interest. She needs to be medicated or perhaps needs to be in a locked facility. Certainly, it may be time where care providers cannot handle her behavior in the home.

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Mom is having paranoid delusions. I yelled at her today to try to get through and said im calling 911 if shes a danger to herself and others. Right now its covid pneumonia, unstable blood pressure, and a question of a UTI. She took 1 keflrx 500 mg yesterday afternoon and it's crazy. Its always crazy when she's back from hospital but it's been a week. I told her I'm not available today. I feel like she's killing me. I have covid too and am severe asthmatic. Cant get well.

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OT told you not to clean her up? There's no choice involved with that. No one can be left in a soiled diaper with piss and crap on them because they will get skin breakdown, UTI's and open sores if incontinence is not cleaned up immediately.
I find that in my years of elder care service that when it comes to diaper changing and personal hygiene it's best if the client (or in your case your mom) can be included in process. Sometimes speaking to them in plain language and very matter-of-factly like, "Come on, let's get cleaned up. It will only take a second" works. Or telling them that 'their doctor' said they have to wash up (X number of times a day) or they won't get better works too. Asking the person to hold on to the towel for example or the soap often worked as a distraction. There have been times when a dementia client refused a diaper change and a wash up because they didn't believe they had a mess. More than once have I had a client need to put their own hand in their diaper and see for themselves. Whatever it takes because the work must get done no matter what.
If she's at the point where she gets violent and aggressive about getting changed and washed then it's time to look for placement in a care facility. No one wants to see their LO have to be placed, but sometimes a person can't be cared for properly at home by family.

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Imho, the cleaner/caregiver should first explain what is going to transpire, e.g. similar to a patient being in the hospital - physician or nurse says "we're going to clean your ____." before proceeding. Prayers sent.

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My daddy started the hitting. The best thing to happen was admit him to a Geriatric Unit in a local hospital. The psychiatrist who treated and tended to daddy. He increased meds he was already on and added more to help with outburst. The multidisciplinary staff includes psychiatrists, a psychiatric nurse practitioner, licensed counselors, licensed clinical social workers, nurses, activity therapists and other support personnel, who deliver care to adults. Patients participate in a variety of individual and group-focused activities to learn more effective tools for living. As they make progress, the staff will prepare them for the transition from the hospital back to the community. They help older adults cope with changes they may be encountering, ranging from anxiety and/or depression to dementia and paranoia. They may be referred by their primary care physician, human service agencies and other mental health providers, or they may self-refer. Some may have 6 month programs for Medicare patients to help them safely return to their optimal style of living. The program can help seniors who are dealing with a range of difficulties, including depressed mood, unresolved grief, anxiety and nervousness, isolation or loneliness, sleep or appetite changes, among others. They teach coping skills through confidential treatment; group, individual and family therapy; and coordinating the patient’s care with their primary care physician.
Im slowly seeing a change for the better in daddy.

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Those are all good measures, however, the patient has alz/dementia so she most likely can’t understand enough to go thru any type of program like the ones you state. Not if she needs 24/7 care and doesnt know if she has soiled her self...

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Spend the time to watch TEEPA SNOW on untube . There is wonderful information there . It will enable you to understand moms point of view. Medication is not always needed. Some understanding helps .. talking calmly , going slow, don’t come at her from her side of from her back ( it will frighten her ) telling her what you plan to do , have her help by holding your hand while you are working on her , covering her privates and working under the protection . Her range of vision has shrunk and peripheral vision is basically gone . She might only see what is directly in front of her.
a little training by way of TEEPA might help ..

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Eventually she has to be cleaned. Sometimes it does work just to wait a while. Hitting and other behavior like this is not uncommon. My mother bit the nurses when she was in the hospital. I think it happened because she is non-verbal and can't communicate in words any more. Hitting expresses that she doesn't like what's happening to her. It could be embarrasment, or just that she feels annoyed by it. Cleaning with warm water and soft sponge or cloths might feel better. Try to find what works. But maybe it's just having the younger less familiar people doing something so intimate. Talk to her and tell her what you have to do. Good luck!

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So many wonderful answers. I would again suggest explaining to Mom what is happening. If she objects, tell her okay later. Try again...it's later so I need to do.....
I want to make sure that you are clean, so that you don't get any sores. I want to make sure your comfortable. Talk calmly as you're working.
Change the subject...I remember when I was small we used to go to...that was so much fun.
Best wishes to you.
From what I understand, this is normal behavior for Alzheimers patients.

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I would ask for help training them to deal with the need. Whether her PCP can request this or the OT can provide it will take some investigating for you guys.

Sometimes we are doing things unknowingly that create confusion or fear and then our loved ones lash out the only way they know how to. So having a professional observe the technique and add their 2 cents can be priceless.

I would also buy a long handle, soft bristle brush to clean her legs with, it is something that keeps heads from being down and not seeing what is happening. Have mom hold it and help her clean, this creates distraction as well.

Best of luck getting through this stage. You all are a testament to what a wonderful mom you have, God bless all of you and give you wisdom for this journey.

Great big warm hug for all of you!

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The long handle brush idea is great.

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Your mother may be having anxiety with "younger people" caring for her. If she is hitting the youngest caregivers, she may soon be hitting everybody. Take some time with both "younger caregivers" to see if there is something that they do differently. If not, this behavior should be brought to attention of your mother's doctor. He/She may be able to prescribe some mild anti-anxiety medication so mom can relax more when she is cared for.

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When OT said they shouldn't be cleaning her, what was the reason? I mean, she has to be cleaned up and whoever is on duty at the time has to do it. Do they really know how to do it? Could they have hurt her? Or, has she just moved into another phase of the disease where she may lash out at them and eventually others? I would definitely ask OT why they shouldn't have attempted the clean up.

If she allows others to do it, perhaps these two could assume other chores that don't involve personal hygiene.

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Is it possible the younger ones have hurt her (physically) at some time?
Perhaps she does not like having a male caregiver? She might have been abused/injured by a male person at some time in her past (not necessarily her own child)
Have the primary care provider (MD, NP, or PA) check her for a urinary tract infection. Many times changes in behavior are related to a UTI.
The PCP might also recommend medication for the behvior.

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I would refrain from the younger ones cleaning her and take the advice of OT. Does she get combative only with the younger ones? My 98 year old mother kicks her granddaughter on occasion and does not kick me usually. I explain what I am going to do every time. In the middle of the night I identify myself and explain what and why I am going to change her. She is usually very cooperative. Does this happen during the day and night? I woke my mom up in the middle of the night and I found something nibbling on my back I looked and it was my mom, she was half asleep. She does not hurt us and her actions are usually very gentle but I think she is scared a stranger is attempting to clean her in the middle of the night. Bath time niece and I both work together, if she gives my niece a difficult time I take over the task. This works for us. It is obvious you all are a loving family and all working together for the benefit of your mother. Your mom is fortunate that all 7 family members are helpful and cooperative. Wishing you all the best and hope things get better all around.

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Unless she’s truly filthy, don’t bathe her when she objects. Clean up her behind on the toilet as necessary with a bidet wand (they sell them as attachments for a regular toilet).

It’s not worth the fight to give her a shower when she’s not in the mood for it.

I know elderly people with dementia who have gone years without bathing.

If she has the resources, consider a memory care community. They’ll take care of the ‘maintenance’ stuff and you can go back to having a more pleasant, non-confrontational relationship with your mom.

If she doesn’t have the resources, talk with an elder law attorney about spending her assets down so she can qualify for a Medicaid nursing home when her care becomes too much to handle at home.

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Let the OT come and clean her each time ?
Real answers from the OT would be good... or an OT with a bit more experience ?
Are the younger siblings being overzealous? Is there skin breakdown or diarrhea? Or rash, etc?
Or does the mother see them as children? Perhaps an older sibling to oversee and address cause (probably already done)?

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Even though it is nice to have your loved one at home, NH are better fit to clean people. I have seem them put them in a special chair and then they can take a shower hose type thing to get them clean, as far as the private areas not sure how they handle that but it would seem that they can do it better than the average person at home. It would seem that she needs to be placed or hire a person to stay 24/7 in the home which they would do in shifts......so it would either be that or placement. Speak with someone at a place to see how they deal with those type of issues, maybe they can offer some guidance. wishing you luck.

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I don't know if this would be possible for a family working on a relay basis as you all are - and such credit to you! - but what we'd do is make your mother a 2:1 call, which means have two people at a time supporting her. One person distracts her, engages her in talking, perhaps washes her hands (which would also keep them busy!), while the other person tackles the other end.

This assumes that you've already explored what might be upsetting her? Plus, it is important to give her a running commentary on what's happening so that she isn't startled or frightened by any part of the washing routine. "I'm going to take this pad away, is that all right?" "Let's get this soiling off your skin, okay?" "I just need to make sure your skin is dry and comfy." etc etc etc.

I also have to assume that what the OT meant is to come back to the task if she's upset, and meanwhile just do what can be done. So, for example, take any wet/soiled pad away and put a clean one under her, then come back to proper cleaning and drying after a bit of a break; that kind of thing. The principle that if the client says stop, you stop is correct; but of course it doesn't mean that you give up altogether!

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I have lots to say but I’ll try to make it brief. I’ve been caring for my mom with dementia for 10 yrs. She has gone through hitting phases. Phases because it happens to people who add to the confusion & are forceful making her do things that scare or humiliate her. The way to stop the hitting is to back off before it starts. If they don’t want something try later or just don’t do it. Don’t raise your voice & don’t over talk. Too many words add to confusion. Keep words brief, to the point, matter of fact & with a happy tone. Elderly can also be extremely modest. Don’t wipe them down unless you absolutely have to. You can add a bidet attachment that washes them if they have diarrhea. Watch their food intake & fiber so that rarely happens. The bidet helps a lot & is just for a minute, leaving their privacy intact. My mother has been fine for 2 yrs of incontinence this way. I put a little powder in the pull ups to prevent a rash. When they start to hit, tell them “no, that’s not nice” but learn from it. They need to be treated with dignity otherwise the control placed over them leaves them defensive in fear. If they’re not put in that position everything is much more peaceful. They also don’t have to stand partially or entirely unclothed ever. You can dress them with them having complete privacy on the toilet. Taking the socks, pants, pull ups off while they’re sitting & dressing the bottom half. Then pull up the shirt to replace it with a fresh one. I let my mom wear her bras longterm. After all, their peace is what matters most. They don’t sweat much creating bacteria, you can use body wipes on their arms & legs instead of showers/tubs. You can use a no rinse shampoo. It’s enough for them. I’ve never had to see her naked & our system is working. Hospice comes out once every 2 wks to check & sit with her while I run errands. Her physical hygeine is in great shape without any wipe downs or showers/baths. People with Alzheimer’s/dementia are in a terminal state so just be gentle, never pushy & do the least evasive things to just make sure they stay clean enough to not have skin issues. Follow their lead & only do what they’re ok with at that moment & they won’t have a reason to hit anyone. They’ll smile more & so will you!

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Fantastic answer!

Thankyou so much for your brilliant insight - I am going to print it out and give a copy to our local Alzheimers Society office!

Emmdee from Bristol, UK

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Anyone else think it is amazing that all 7 children are caring for their mother? I’m assuming everyone is an adult by now. That’s incredible! It attests to the closeness of your family (and the organizational skills to keep everyone updated on your Mom’s status)! Kudos to you! (But also don’t be afraid to seek out a good care facility if that’s what’s needed.)

Im not sure about the hitting issue. Alzheimer’s is very difficult. I like the idea of trying to distract her. But, definitely talk with her doctor about it. Maybe it’s caused by anxiety, but maybe not.

Good luck 💕

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I was thinking the same! Not just 2 or 3 but SEVEN! If it had come down to no choice but to take my mother in, I KNOW I would not have had help from my brothers. One refused to even go visit her after the last 20-30 minute (if that) visit over 2.5 years ago. The other, can't even get a simple response to text or email and I'm fairly certain he hasn't visited either. It's been hard enough to do everything else that needs to be done by myself, caring for her as well would have been the end of me.

But, kudos to the Band of Seven!! May you always be together and get along so well!

Like JuliaRose, I don't have suggestions for the hitting issue - there are many good ideas posted, so try those or a variation of them and see if any might work.

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There are many good facilities for her care. Have you looked into any? There are financial aid opportunities for her to qualify if you need to use that option to pay.
You might also create a care schedule. Get together with your siblings and ask who can help on which days.
Talk to social services in your town about best care. Also, speak to her doctor about best care and best meds. If there is a senior center in your town, call them for advice.

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Many people with dementia go through a combative phase - even if they were never violent previously. I saw this occur with my own father.

It seems that your only choices are to have her MD prescribe some type of low-dose anti-anxiety medication for her, such as Ativan or Xanax, or have her placed in a facility that specializes in this disease.

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We originally tried anti-anxiety medication but it had the reverse effect. My mother felt odd on it, causing even more anxiety. The best thing I found to do was to remove the source. Such as adult daycare full of strangers in an unfamiliar place & remove health aids that didn’t know her like family does so they were unknowingly instigating her. Just keeping her at home, in her favorite chair with a routine, familiar tv programs & favorite foods has subdued a lot of the anxiety. She does get up & push all the furniture around on the hardwood floor but I think she’s getting out pent up energy & it’s a healthy work out for her. The items she moves are lightweight so I just let her do it. When she’s done rearranging, she takes a nap & I put everything back in place lol

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Are they under the age of 12? Where they might not understand what is going on. If they are adults, they should just make sure their mother doesn't have anything in her hands that could cause real damage. Some never violent people do become violent. I am not sure there is anything you can do about it. You all just need to recognize this as a manifestation of her illness.

BUT don't stop taking care of her and don't push the care off on one person -- endure.

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I would have serious issues if these "children" were even close to 12, much less under 12, and were being asked to bathe their mother!

I think the missing word is adult in the title:
"Mother with Alzheimer's/Dementia just started hitting her younger <<adult>> children."

Since OP says:
"There are 7 children that care for her at home for the last year and a half. She has to have 24 hour care and each of us spend at least one night with her." I would doubt these are really "children" in the sense of young age. If they are, they shouldn't be overnight care-givers either!

It's probably just a reference to the youngest of the offspring. My "younger" brother is 10 years younger, however he isn't a child (age-wise anyway...) Same for referring to my other brother as older - he's only a year older, not 20 years older! We are, by some definitions, still our parents' children...

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I find it difficult to believe that a Occupational Therapist has said not to clean her. I find that mind boggling.
Does she hit anyone else? Just the 2 younger ones? Seems odd. But then again so is the mind of someone with dementia. Go figure.
Is she taking any medication for anxiety? If so can the dose be given prior to the 2 youngest starting their shift of caregiving?
And would it be possible that mom be changed in bed where it would be m ore difficult for her to hit someone? You could give her a soft cloth to hold while you change her. Once you get the hang of it changing someone in bed is pretty easy and somewhat safer as there is less of a chance for her to fall.
Or using a commode where she can sit and she can be cleaned while she is sitting.
With 7 it might seem easy(ier) but this may only get worse as far as her violence and you might want to have a discussion about placing her in Memory Care if it is not going to be safe to care for her at home.

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Seven people who will remember their mother at her absolute worst..... Time for placement, I think.

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Truthfully, if she actually inflicts physical pain on others, the only two alternatives available for her care are a trial of calming medication or residential placement.

No matter how much you offer to pay, it would be VERY DIFFICULT to find someone who would do toileting and monitoring while having to deal with being assaulted physically.

Are her present targets afraid of her outbursts?

Keep in mind that her personality prior to her illness has NOTHING to do with what she is doing now. At this point, she is operating with a brain that is becoming progressively more and more dysfunctional.

As painful as it is, you cannot expect her to control herself or her reactions.

You have clearly tried everything possible to honor your mother, but perhaps it’s time to consider whether she’d prefer you to continue your present care plan or to consider another level of care.

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Your Mom is showing violent tendencies. You need to contact her neurologist and see if she can be given something. If it doesn't help, it maybe time to place her.

Why does she need an OT therapist. They help with ADLs. You Mom probably doesn't remember from day to day what the therapist has told her. You dress her? You bathe her? You cook for her? Laundry? So where does she need someone to show her how to do her ADLs? You probably do it all. I let Moms go. The Physical Therapist showed her how to use her walker. I did everything else for her. It wasn't like she had a stroke and had to be taught how do do things all over again. PT I can see but even then with Dementia they forget the exercises or are hard to teach.

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I have found OT intervention very helpful with my Mom. They provide strategies and solutions to thoroughly clean that I never thought of.
I do agree your loved one will not retain the skills to be independent but handling the hitting and preparing your Mom with calming strategies may be helpful and prevent the hitting. Every situation is different but very helpful for us

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Will add to previous advice that if this is a sudden change in mental status, she should be checked for a UTI.

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Yup - if this is a sudden change in behavior, do check for UTI or other infection (if UTI test, preferably a culture, is negative, have bloodwork done. High WBC can indicate another infection. Recent discussion with someone experiencing odd behavior/regression wasn't a UTI, but it was an infection in the mother's mouth. Once treated, she resumed her old "self".)

If no signs of infection, she may need some kind of medication to calm her down. During a serious sun-downing episode due to UTI, mom was also given the lowest dose of anti-anxiety meds. It was just enough to take the edge off, and worked first time, every time, within 15-20 minutes. No need to wean off the medication when it wasn't needed anymore.

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Please know it’s never okay to accept abuse no matter what the cause is, and while it’s true that your mother can’t control her behavior, it doesn’t mean anyone needs to put themselves in the path of it. Your first step is her doctor to see if there are meds to calm her behavior. And then to get professional help, either in home or in memory care, to help care for her. In an entirely different set of circumstances, we had professional care for both my parents and I was amazed by the tricks of the trade the caregivers had, things they knew to do that we’d never have known. Their skills and knowledge was invaluable. I’m sorry you’re in this place with your mom and hope you’ll find a new plan soon

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Mom needs placement, ASAP. At the very least she needs calming meds.

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Sometime placement will give her less care then what they are provided at home...
Fact is this is not a site to tell people what to do but share your experiences. They can decide what works from there.. Choose your words carefully.

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Mother with Alzheimer's/Dementia just started hitting her younger children. Any recommendations on what to do?

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