'How I Treat:' Overcoming Treatment-Resistant Agitation Through Innovative Strategies Case Presentation
The Case:
Victor is a 92-year-old married man with a several-year history of Alzheimer disease, currently in an advanced stage. He is able to ambulate and interact with others, but his speech is garbled, and he cannot make his needs known. His wife managed him at home for several years, but it got to the point where he was getting aggressive and leaving the home so often that she could not manage him, especially since she had several medical issues and was getting increasingly frail herself at age 90.
She tried having aides at home, but Victor often fought them whenever they tried to help. After he punched one of the aides and injured her, his wife had him admitted to a nursing home.
In the past 3 months since admission, Victor has been a challenge to manage in the memory care unit. He paces the floors during the day and tries to push on the locked doors to leave. He is up much of the night and then will take cat naps during the day. He refuses to participate in activities but will wander into other residents’ rooms intrusively, requiring staff to keep a constant eye on him. He has gotten stiffer and more unsteady over time.
He has failed multiple psychotropic medications, including benzodiazepines, which caused unsteadiness and several falls, antipsychotics which caused him to be overly sedated, trazodone, which also caused excessive sedation, and several antidepressants, which caused him to be more aggressive and appearing to be seeing things in the air that he would swat at. The chief medical officer of the center is contemplating an inpatient psychiatric hospitalization.
