Hello @leeandpat I'm sorry to read to your husband's journey with dementia. My name is Scott and among other things would like to welcome you to Mayo Connect! We have a robust community here with lots of folks who can offer suggestions, share advice based on their experiences, and lend a willing ear to listen, especially when the times get tougher than usual.

I am not any kind of medical professional so I speak only from my experiences. My MIL had dementia, I worked for the Alzheimer's Association for some years, and cared for my wife, who had many dementia-like symptoms as she fought brain cancer for over 14 years.

Every caregiver's patience gets tested often during our work! Don't be too hard on yourself for that. One thing I did learn is that as mental capacity declines so does our loved one's abiltiy to be logical and cope as their confusion gains on them. Corrections, etc. become more and more difficult since as they are confused to begin with, a correction often times makes their confusion grow worse.

The only thing I can say about some of the Alzheimer's drugs I know is that they aren't intended to make a patient better, rather they delay the onset of future symptoms. In my MILs case, her doctor told us her meds could help her stay on her current plateau for longer than without them and hopefully delay, but not prevent, future declines. You may want to check that with your husband's doctor.

While my mother-in-law never had bouts of combativeness during her years of illness, our daughter-in-law's father had those fits of anger. They quickly escalated and resulted in him needing a safer environment so he entered a facility. It was a hard decision, but it was the only right decision for both him and his wife, who was increasingly concerned for her safety and ability to manage him.

Often times, while careing for my wife, I failed to see the forest for the trees and it took our daughter or son to tell me some of the changes, etc. they were seeing in their Mom that I was missing. I would suggest you listen to your family's and friends' concerns for your safety. If tney are telling it to you, they must be sincerely believing it to be true. I remember when my MIL could no longer recall which room in the house was her bedroom. That was the tipping point for my wife to go home to work with her dad to get a caregiver in the house to protect her Mom from accidents and prevent any undo anxiety from her being alone and confused in her own home.

As to planning, all I can say is that disease follows its own plan, not ours. It progresses on its own path and timeline no matter what we may wish. We can only react as best we can as things change, often right before our eyes. I know I was nowhere near ready when my wife's doctor prescribed hospice care for my wife when he did. Luckily, well before that we had done all our advance planning we needed to do such as our wills, estate planning, power of attorney, medical directives, HIPPA, final arrangement decisions, etc. That was not only very helpful to me, but really helpful to our children.

Again, I am glad you are here! What questions do you have that most often creep into your caregiving thoughts?

Have you considered an anti-depressant for your husband? During one of our visits to Mayo, we met w/a psychiatrist, & he suggested we try one. First one (can't remember the name) was not good; gave him nightmares. But he's been on Sertraline, generic for Zoloft, for almost five yrs & has never had any outbursts or aggressive behavior. He has always been a Type B-mellow guy in the 50 yrs that I've known him. He's 78 now; diagnosed w/ALZ nine yrs ago. 'Also on Donepezil, Memantine, D3, fish oil, turmeric-curcumin, PreserVision-ARENDS 2 (for macular degeneration). Blood work, excellent; probably in moderate stage. I, too, have a-fib. I hope to care for him at home as long as possible. God bless.

@leeandpat, I also like to bring in @debbraw into this discussion. Her husband has early stage dementia and recently she also had a knee replacement. I bet she will have some insights to share.

You may also be interested in this discussion:
– Dementia Anger Issues – bathing https://connect.mayoclinic.org/discussion/dementia-anger-issues-bathing/

Even though you know the anger is the disease, not the person, you have to know that you are safe. Have you talked with someone about how to stay safe?

Hi @leeandpat - I can really relate to the issues you are having. As @colleenyoung mentioned - I'm facing several of the same ones myself. I will share some of the things that have been helpful to me.

This year I joined a Caregivers Support Group at our local Council on Aging. I learned that one of the services our local hospice offers is grief counseling for caregivers. The patient does not have to be end-stage. At least here in North FL, hospice provides support for any dementia cases that are referred to them. I learned that you CANNOT do this alone. My advice would be to seek out a therapist/counselor, start looking at the care facilities in your area – even if you won't need them for awhile, and find out what hospice can do for you. All of these things brought me tremendous peace of mind.

In regard to your husband's anger issues, I know every case is different. For me, its important to remember that anger and fear are very close cousins. I find that when my husband is anxious or afraid about anything going on in our lives, he either tends to get very weepy or else have an angry outburst - but the anger is more like a child's tantrum. It's not something that causes me - or family members - to fear for my safety. Anyway, I have learned that when I have medical issues, it is VERY scary for him so it's better if I downplay them and have a friend or relative take me. If I were you, I would consider letting your husband stay with a relative while you have your knee surgery. Also, you might ask your surgeon about the possibility of going into rehab yourself for the first week or two after knee replacement so you can really concentrate on your own recovery. I had a friend who did that and she said it was the best decision she ever made!

Is there someone you could talk to -I would say outside the family - to get some constructive suggestions on your husband's anger issues as well as how you might plan and schedule your knee surgery in a way that keeps both you and your husband safe and in a good frame of mind? Maybe a counselor or therapist?