Nursing Home Patient Can’t Sit Still and Repeats Herself

Reader’s Question

I work at a nursing home. We have a resident that cannot be easily be redirected. She walks non-stop, back and forth even when she is exhausted, and she repeats the same thing over and over again. She has a few behavior meds that apparently are not doing a whole lot of good and the Ativan we give her takes a long time to work and then works only temporarily. She cannot be in activity because she cannot sit still and disrupts the activities by her constant repetitions. We may be able to have her sit for a couple of minutes to eat ice cream. I feel we are not meeting her needs.

Our Consulting Clinical Psychologist’s Reply

Your patient is exhibiting what we call “akesthesia” or uncontrollable restlessness. There are several neurological conditions that have akesthesia as a symptom, including Alzhemier’s. You’ll notice that her wandering increases after the sun goes down, producing what is known in nursing homes and hospitals as “sundown syndrome”. Patients who are disoriented become more agitated and disoriented at night. Her frequent repeating is called perseveration which is also a common neurological symptom.

There’s another possibility here. You mention that she is receiving behavior medications. It is not uncommon to use antipsychotic medications for behavioral control — medications such as Haldol, Zyprexa, Seroquel, Risperdal, Thorazine, Abilify, etc. This movement disorder — Akesthesia — can be a side effect of antipsychotic medication. The connection between her akesthesia and her medications may go unnoticed as nursing homes frequently have “wandering” patients.

I would bring this possible connection to the attention of the staff physician or nursing director. If her akesthesia is related to the use of behavioral or antipsychotic medications, there are treatment options that may improve her functioning in the nursing home.

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