Trips to town and time management

SarahL85

Hi - wondering if there’s any suggestions on how to minimize trips to town? MIL has Alzheimer and she wants to go into town sometimes multiple times a day. It’s been a lot for my FIL. She usually wants to go right away and will just go and wait in the car and will not take no for an answer. 

I suggested making a calendar with certain dates they go in, but sounds like that didn’t work. 

Just wanted to see if there’s any suggestions. 

Marta

What do you mean by ‘she won’t take no for an answer’?

SarahL85

She will just go and sit in the car or get angry, keep asking and getting agitated. It’s warm so we don’t want her to sit in a hot car, so he just ends up going. It’s an hour away so it’s a bit of a trip.

loveskitties

First, as far as waiting in the car...the solution is keeping the doors locked and not give her access to the keys.  At least that way she can't wait in the hot car.

As far as wanting to go to town, what does she want to do when they get there?  Does she have a destination in mind or is it just the ride there and back?  If the latter, it may be enough to just take her a short way from home and then turn around and go back.

It is so difficult to know what will appease a dementia patient when they get fixated on a need or want.  Does she ever forget that she wanted to go to town after making the request?  Does delaying the trip make any difference or does she just get more agitated?

Hopefully, others here on the board will have more advice.

SarahL85

That’s actually super helpful, didn’t even think of just keeping the doors locked.

I think it’s more about the trip there than the groceries. She usually forgets or she wants to go to get one thing but she usually already has it at home. When she’s there she just likes to look around I think. 

That’s a very good suggestion! Thank you! 

Iris L.

Some PWDs want to be on the go.  Unfortunately this may require a huge time commitment on the family member.  If they have to drive an hour to get to town, this does not sound sustainable.  Perhaps someone could be found to be a companion for appropriate activities in the home.  

Iris L.

SarahL85

Yeah, she likes to to go and it’s usually has to happen right away which can be very challenging. There’s not a lot of options around where they live, but maybe there’s a gas station that could work as a distraction. It’s closer than the grocery stores. Not that many people around where they live, they live in a remote area and at this point I think it would be too much to ask aa it’s a bit of a struggle inside the grocery store and the car ride.

Marta

Sarah:  it may be time for your in-laws to move closer to family. This situation with wanting to drive to town is not going to be the only one that will require more than your FIL can handle.

SarahL85

If it only was that easy. Neither of them will ever move. We try to visit frequently but we live hours away. There’s only so much we can do on weekends up here. More challenging things happen daily, but I was just wanted suggestions on the trips as it seem like one of the easier problems to handle... thanks for the input though.

Marta

Sarah:  the handwriting is on the wall. Read through threads on this forum pertaining to moving loved ones against their will. 

Best to you. 

harshedbuzz

Sarah-

I am sorry your family is struggling with this.

There are ways to address this, and I will get to that, but this is likely part of a bigger picture. If the family ignores the bigger picture, than they risk playing whack-a-mole. 

Was MIL always a woman who was busy and on-the-go? Or is this new? Is the dynamic in the relationship one in which her wants and whims have always come first? Or could this desire to get out be a function of anxiety that might respond well to medication?

The other piece is your FIL- is he up for caregiving long term? Is he a younger and healthier senior? Are the legal documents in place so that your DH can step if and when it becomes needed? He (or a sibling) need to step if dad can't advocate for himself or if he can not longer care for his wife because of illness or death. To this end, I would decide on next steps now and either find a suitable MCF for mom or prepare space in your own home for her so you are ready to make a change on the fly.

Moving them might make sense; moving mom into a MCF with activities and outings might make better sense if dad doesn't want to give up his home. I'm all for kidnapping a PWD who is single or whose spouse is on board: I even did the latter. I would not allow my dad's illness to dictate decisions against what my mom felt was right for her so when she said "no" to a CCRC, I did not push it even though it would have been easier all around. Assuming dad doesn't have a cognitive shift, he gets to decide where he lives. 

To the immediate problem, the car might be a trigger. Perhaps it could be parked in a place outside of her sightline. Often "out of sight is out of mind". Keeping the doors locked spares her the risk of being overheated, locking the exterior doors to the house is good protection against elopement. If she's someone who needs stimulation and entertainment, I wonder if it would be worth seeking out a day program a few days a week to engage her and give her days purpose without wearing FIL. 

Good luck.

HB

Emily 123

Hello,

I agree with the posters here.  Harshedbuzz's suggestion of 'out of sight, out of mind' and hiding the car, or even adding a fiblet of the car being out for repairs might help, but might not be doable.  

It also might be time for a fiblet re: 'when we were at the store the other day said they didn't have that, and will call us when it's in''.  

It is really hard to start telling fiblets at first--see multiple threads here.

Your MIL has reached the point where she isn't retaining any short term memory, and her reasoning, judgement, and empathy is affected.  Calendars, written reminders, etc, won't make sense since she can't do the steps to identify the date on a calendar and correlate it to the current day/time, then see that a checkmark means that a visit to the store has occurred.

Her behaviors have likely become exhaustively repetitive for the caregiver.  Has anyone spent a few days with your in-laws, maybe just to give your dad a break, and see if new needs are cropping up?  One of the things that drives the partners of the person with dementia to make poor decisions is the desire to remain as independent for as long as possible, refusing assistance.  When that becomes the driving focus, the decision making process can tend to unsafe choices, with an inevitable catastrophic event leading to hard choices needing to be made quickly by the children.

Would your FIL be interested in looking at the spouse support forum here?  It might help him.  Have your family had a chance to read this? Very helpful in understanding the behaviours...

http://www.dementiacarestrategies.com/12_pt_Understanding_the_Dementia_Experience.pdf

ButterflyWings

Hi SarahL - I'm sorry this is happening to your family, and wondering what the other (you say more troubling or complex?) issues are. I agree with the posters here, FIL needs help and since dementia is progressive, it is prolonging the inevitable to wait for things to decline so much that a move closer to family/support system is urgent and last minute.

But I wanted to share as the wife of a "go and do", constant motion DH. Are you saying they actually make the hour long trip multiple times a day sometimes? Also, I agree the keys need to disappear and the car should be locked if not parked out of sight as much as possible.

If this happens more during the afternoon, sundowning time, that sounds like my DH. We have had lots of success with Seroquel for his agitation and restlessness as well as delusions that he HAD to be somewhere to meet so-and-so, (including deceased persons), and HAD to be at work etc. (which he had to stop upon diagnosis 3 years ago). Things are much better but he still ramps up almost daily, with getting dressed, sometimes packing a briefcase of random things, and then he's ready to go...whether I am or not. (Lately, that had flipped to a refusal to go, and I was relieved for a while, then that got challenging as I missed appointments etc.) We are back to him waking up talking about how he has no time to change his depends, he's late and has to get going. And I understand what your FIL is going through. It can be hard to stop him from heading out the door.

If I absolutely cannot redirect or stall or divert him, I have found a few drops of Melatonin helpful to slow him down. Sometimes he takes a short nap but usually he just chills without realizing I intervened to stop an escape. BTW, Melatonin is a safe (in our experience) liquid sleep aid, natural and approved by his Dr.) This seemed extreme until I got tired of trying to stay awake/get up multiple times at night to be sure he wasn't wandering while he rummaged or barricaded doors against the (imaginary) intruders. I don't care if he does nap at 4p, if it keeps us from running around randomly. I have to work (from home) to feed us, and that comes first.

It sounds like MIL's behavior "seems" more reasonable than the clearly AD behaviors my DH was exhibiting, so FIL may just be trying to keep the peace as the frog in the slowly heating water. But, he is following a broken brain and letting her disease dictate some things that don't make sense anymore. Even if this was a prior dynamic in their relationship as HB asked about. I agree 100% with Marta's comments. She, and he, need help and it is hard, but necessary to stop letting dementia call the shots for you all. On diagnosis, my DH's neuro team said point blank: you're in charge now. 

jfkoc

Is she bored? Can she be distracted?