Trigger Warning: Mom with Alz & Suicidal Ideation

Meg380S

This topic contains information regarding mental health issues that may be triggering to some people. Please think deeply about how reading this may make you feel, and back out of this screen if you deem the topic as emotionally or physically triggering. If you do read it and feel triggered, please seek help immediately by calling the National Suicide Prevention Hotline at 1-800-273-8255 or text HELLO to 741741.

 My mother was diagnosed with Alzheimer's in January 2021 after 10 years of MCI and dementia. She's on Aricept and Namenda, and 2 anti-depressants. I believe she's currently in stage 6a. She believes she's about 20 years old, believes we are sisters, and that her husband is our father or mother (she's in her 70's, her sisters live out of state, and her parents are both gone and have been for a long time).

This may be normal, and I haven't done a ton of research due to lack of time: she has begun bringing up suicide when she remembers or is told she has Alzheimer's and that it will never get better, is reminded that she's not allowed to drive anymore, or when she feels trapped in the house (she has trouble recalling that there is a pandemic; my stepfather, sister, and I all get her out of the house 4-6 days per week even just to run to the grocery store but she just wants freedom and independence back). Fortunately, my sister and I are both trained MH therapists, so the topic of suicide is something we feel comfortable handling and appreciate that our mom trusts us with her thoughts. While she once brought up using knives (and knives were promptly removed from access) she has never repeated that and does not have a plan in place. We have a great Mobile Crisis team that will step in should things get worse, and of course we know the options for hospitalization for MH crises. I'd like to set her up with a therapist, but with her memory, that isn't really an option for my mom.

The idea of suicide was brought up again this morning when she confided that she planned to make her escape from "Dad" today. We discussed how she was going to "escape" and where she would go (she wants to go "home" - to the house she grew up in). She asked if I wanted to come with her, so I gently reminded her that she isn't able to drive but if she would like to go somewhere else, I would take her. She became furious with me, and talked about ending her own life. We had a long talk about identifying emotions and being able to feel what we want (for example, it's OK to be angry - be angry with Alzheimer's, be angry with God - but it's not OK to be angry with oneself, her loved ones, etc). We talked about meditation and breathing. We went over a few coping skills. She feels better knowing she has my support (she has everyone's support but doesn't recognize that).

I'm curious if suicidal ideation is common among people with MCI, dementia, or Alzheimer's, and what the follow through rates are. Has anyone else dealt with this from their loved one? If so, how have you handled it? While we are trained in this area, my sister and I haven't dealt with ideation in Alzheimer's patients professionally, and do not want/are not allowed to practice on a family member. Do you have any recommendations? I'd appreciate any feedback. Even knowing my family isn't the only one experiencing these comments would be validating.

A little more background: we rarely correct her memory. When she brings up her parents, we go along with it ("oh you saw your Mom? how is she doing? I haven't seen her in ages!") and we rarely "correct" things such as when she mistakes her husband for her father, or me for her sister. Her neurologist recommended we blame things on "Al" (Alzheimer's) so Al has become a fixture in our routine and conversations. When she brings up plans to drive, we gently remind her that she isn't allowed to anymore. Sometimes she'll remember, and other times, she demands proof which we always provide. We try to be gentle, respectful, and unemotional with the reminders we have to make because we do want to preserve her dignity. As she progresses, it's becoming more and more difficult.

This topic contained difficult information regarding mental health issues. If you feel triggered by any of the information I provided, please call the National Suicide Prevention Hotline at 1-800-273-8255 or text HELLO to 741741.

piozam13

DH 76, used to say ' I want to die' when he got up in the morning.  The doctor increased the dosage of quietiapine/seroquel. [not sure of the spelling].   This went away.

terei

My mother during her lifetime, prior to AD attempted suicide at least once.  She did not threaten to do it, but made a plan + was nearly successful.    She was treated at that time with anti depressants at that time, in her 40s.

We discussed death openly in my family ie: she would say, “Cy really does not want to die but I have lived a very good life + am ready to go”. She had a DNR from her 60’s onward.

During her time with AD, she openly wanted to die + attempted it twice with pills. The first time, she was treated in a geriPsych ward + medicated again with antidepressants which seemed to help some, though she made at least one more attempt nearer the end of her life.  She regularly  would ask me + other relatives to get her pills to accomplish what she wanted.

Frankly, to me, her wish to die was reasonable.   She was suffering mentally from the scourge of AD, her husband was dead + as much as she loved her 3 children, it was not enough to outweigh her anguish about what she was experiencing.

I would not, under any circumstances remind your mother of her illness.  If she wants to drive, I would use excuses like the car is not working or that the doctor says she cant drive until she is feeling better.  She is going to forget what the excuse was in short order. The only thing we ever said to my mom when she asked what was wrong with her was that she was just having a bit of memory problems...nothing to worry about...+ change the subject.  We never used the terms. Alzheimer’s, dementia, etc.  When she told me she wanted to die, I told her I was sorry she felt that way, that we loved her + hoped she would stay with us as long as possible.

The wish to die or to commit suicide when you have a progressive, fatal disease that is going to destroy your brain, be incontinent + leave you unable to lead anything close to a normal life is remarkably lucid.    Because I watched what my mother went through, I already have plan to ‘check out’ if I am ever diagnosed myself.  Hopefully I will have the strength to do this while I still have the mental + physical capability.

jfkoc

Not to worry, all of the thing you have shared are common to many.

The only thing that triggers me is the fact that you have not had time to do much research on taking care of a person with dementia due to lack of time. You are approaching the care of your mother from a mental health position. Not a bad start but it  is only going to go so far. Dementia care requires a lot of specialized learning.

I suggest you read any book by Naomi Feil on validation. Then read I'm still Here by Zeisel.  You will understand that you now must live with your mother in her reality. Reasoning is out the window along with arguing. I would also forget analyzing/identifying and bringing up the fact that she has a fatal disease.

Additionally please continue to come here where you will find cutting edge as well as day to day information as well as support.

I look forward to getting to know  you and learning from you as well.

zauberflote

Meg, welcome. Have a read around here: LO talking of not living any more is common. My mom told me, a few days after we moved her 600 miles to MC, that if it was going to be like this for the rest of her life, she didn't want to live any more. In fact, she was going to sit there and hold her breath until she died! (Shows how old she thought herself at that moment lol). And she held her breath while I looked on sympathetically. She was 91 and pretty much incapable of anything except possibly doing a nosedive off her bed to intentionally harm herself, so use this only as an illustration.

You point out that you rarely correct her memory. To me it sounds like all this talk of suicide comes up when you do correct her memory. "Mom, you can't drive because blahblah and you can't go home because you have Alzheimer's  blahblah..."  Have a look around the forum for mentions of "therapeutic fibbing". This is when we tell fibs to keep our LO comfortable, to help them deal with their feelings by continuing to help them feel validated. So you may say, for example, "yes! I really want to come with you, can we do that tomorrow, I have to finish this little project right now . Remind me tomorrow! What's it like at home right now? Are the azaleas out yet? What do people do to keep the pine pollen from getting inside? Where should we go when we get there? Speaking of where, lets's have lunch now! Want me to order Arby's or Chik-Fil-A? They will deliver right to our door!!!!" You won't have told her she can't do this or that, and if delivered right, that breathless, chirpy conversation ought to distract her nicely. Until the next time, when all you have to do is the exact same thing.

I hate to say this as a TOTAL non-therapist, but-- having long talks about anger and other negative emotions is going to be counter-productive at this point in mom's dementia. She will possibly remember "I'm angry and she was humoring me", but if she is in Stage 6, the rest of it stuck for about 90 seconds, if that. Focusing on avoiding the anger in the first place can be extremely helpful.

This may sound simplistic to a trained therapist, but you know what they say--"to a carpenter, everything  looks like a nail" . Your actual goal is to keep mom from ever having to start with the upset, thus avoiding any talk of self harm at all. She isn't like non-dementia people; her reasoner is broken, and keeping her calm by whatever "devious" means necessary can make life so much easier for all involved! And boy do we love the emotional stability, even if it lasts only one hour.  

Ed1937

Meg380S wrote:

she has begun bringing up suicide when she remembers or is told she has Alzheimer's and that it will never get better

Please don't tell her she has dementia of any kind. You seem to be doing a lot of things right, but even mentioning Alz or dementia should be something you do not do. 

Welcome to the forum. We have a lot of good people here, and they will try to help whenever possible. Sorry you are dealing with this.

Ed1937

Also, you have received excellent posts from others here. Please do not dismiss any of it. It is all good information, coming from people who have been in the trenches.

Cynbar

I am also a trained counselor, now coping with a husband who is late stage 6 on the dementia spectrum. It has been a big hurdle for me to get over, understanding that his brain is no longer working right and the old rules of reasoning, rationally explaining, problem solving and so on no longer apply. I agree that it is natural to be devastated by an Alzheimers diagnosis and wish for death before the worst sets in. You have the background to handle any suicidal concerns, and that will be very helpful going forward. But I think you may want to focus more on the Alzheimers component here. It sounds like you may be talking a little too much, hoping she will be reasonable and accept her deficits, examine her feelings, develop other coping skills. This sounds like too much for a 6a PWD to process --- and what happens is, this increases her anxiety and upset because she realizes she can't follow it, almost like you suddenly start talking in a different language. This is not maintaining her dignity, it's damaging it because it shows her on some level what has been lost.  Your relationship with her is unfortunately very different now. I would try less talking, less discussion of Alzheimers, more deflecting and differing. I came to these boards over a year ago and I originally thought advice like this was rubbish. But I was wrong --- once I accepted that the explanations had to go, I was a lot calmer and my DH was less anxious and agitated. I think all of us here have had to make that jump. It is difficult, absolutely, but it can be done. Good luck.

Meg380S

Thank you so much for reading my long post and for taking the time to reply. I truly appreciate it!

I'm so sorry to hear of your mother's struggles...though everything you said sounds completely logical and is going to cause me to think a lot harder about the entire death topic.

I generally don't remind her of her disease unless she asks, and unfortunately, I did leave that out in my post. However, I think it's a great idea moving forward to deflect and redirect the conversation.

Again, many thanks!

Meg380S

Thank you so much for taking the time to read and reply to my post. I appreciate your time and insight!

My stepfather and I are care partners, and we took an 8-week long course offered by the Alzheumer's Association. It taught me a lot at the time (it was almost 3 years ago, and my mom wasn't too bad back then) but certainly since, I should have kept up with the literature. Selfishly, I thought my stepdad would stay on top of things. I recognize this and lack of time as excuses: I'm actually terrified to learn more. It's time for me to "adult".

Thank you for your support and feedback. I truly appreciate it!

abc123

Why are you reminding her she has dementia and will not get better?

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jfkoc

Just checking in to say hi...hope you found something that has helped.

LadyTexan

I can only speak regarding our experience with Alzheimer's. I think suicidal ideation is likely a common consideration when dealing with a terminal, devastating, and expensive illness. Alzheimer's is all this and more because it impacts not only the person with the illness but their family and friends as well. And it is exhausting. 

As others have suggested, I would like to emphasize the importance of meeting your loved one where they are. Don't expect reasoning and coping skills from your loved one.

Early on in our journey, DH's happiness was a high priority for me. I have adjusted my expectations because his happiness is out of my control. Sometimes content is good enough and I feel fortunate to even see him content. Counselling was considered for my DH at one time. The neurologist was quick to inform me that counselling would likely not be beneficial because 1) DH may not remember from one session to the next what was discussed and 2) DH's reasoning skills are impaired. As a result problem solving is no longer possible.

My care giving responsibilities are many but I focus on keeping my husband safe and calm and fed and clean and to ensure he knows he is loved.  

riajean

We had a tease of warm weather, sunshine, sunburns even and then the temperature dropped into the 30s, cold/rain/snow, my husband can't go outside and for the past two days he's told me he wanted to die.  Last night, I was able to get him out of his funk.  Tonight, not at all, even though we had thai food and enjoyed that.  He got really low and couldn't really tell me what he was feeling, kept saying forget it and I reassured him I wanted to understand his feelings and help if I could.

Later he continued, breathing hard, very bad look on his face, dropping his head and more.  Then he told me he wanted to live with his sister because he was very disappointed in ME.  Why, I asked, because i have to work?  I've made sure someone is here with you every day even for a few short hours and i work hard and fast to get as much done as I can in that time.  I'm here everyday and I take care of you and on and on.

I'm tired now and angry with him.  He doesn't understand his illness, but to be blamed is hard, especially when there's no rhyme or reason.  He's set up to go to memory care.   I wanted to place him a year ago because i was spent.  Maybe this is just the writing on the wall.