How to respond to despair, depression, threats of suicide?

ReallyScaredSon

     Hi all.  First, a huge-thank you to this wonderful and supportive forum.  I've posted several times now, the two most recent being "Crisis management: Emergency Response Services, Emergency Rooms, Respite Care" (https://www.alzconnected.org/discussion.aspx?g=posts&t=2147559584) and "In crisis mode with Mom; nothing has been done; how to make the necessary happen?" (https://www.alzconnected.org/discussion.aspx?g=posts&t=2147559405).

The short version is, my mom went a very long time (likely 6+ years) without discussing her increasingly obvious cognitive decline with any medical professional.  In the last month, she had a significant increase in "episodes" (nearing about every 36 hours) where she was completely not herself, very aggressive towards my dad, delusional, and increasingly hard to calm down.  Last Tuesday (Jan 25), the ambulance was called for her, and she ended up at a hospital (Methodist, in Peoria, Illinois), that does have psychiatric support.  She was admitted there.

On Sunday (Jan 27), she tested positive for Covid and was moved to a partner hospital, Proctor (she's fully vaccinated and boosted, so hopefully the Covid won't be an issue).  They claimed the move was due to her Covid diagnosis.  But I look at it as somewhat of a blessing in disguise, because all the research I've done pointed to this hospital as having a well-reputed geriatric behavioral health center.  Prior to her admittance, I was told that the whole inpatient ward for geriatric psychiatry was converted to covid use... but her current attending physician is a specialist in geriatric psychiatry.  Long story short, I do believe she's in about the best place she can be at the moment.

In my previous posts, I talked about her extreme reluctance (i.e. refusal) to take meds.  Immediately prior to the hospital admittance, I stayed with her and my dad for a few days.  I didn't witness any episodes, but I do believe she somehow managed to "keep it together" while I was there.  But I saw firsthand the struggle for taking prescription meds: on a good day (which is what I witnessed), it's a 10-15 minute process of walking the line between gentle encouragement and reminders, versus "hovering" and treating her like a child.  My dad has said, when I'm not there, if he crosses the line, it will trigger an episode.

From what I've gathered, even the hospital staff is struggling to get her to take her meds.  I called her today.  It was literally the saddest conversation I've ever had with anyone.  All she talked about was how my dad made up all these lies about her, to force her into where she's at.  She said they are doing terrible things to her.  She wants to kill herself, as she has nothing to live for.  She just wants someone to come get her so she can go home.  She wants to be with her parents (her mom died about 34 years ago, she's been estranged from her dad for at least a decade)... I was so taken aback by what she was saying, I did not know what to say.  I tried to suggest that taking the meds might make her feel better.  At this point she started to get angry, telling me she doesn't want to take the meds, they don't do anything.  I said, sometimes it takes a while to work.  She yelled at me, saying she knows that, then hung up on me.

My question is: how do you talk to someone who seems to be wholly and completely trapped in a state of utter despair?  If she truly feels the way the says she does, then it's just heartbreaking.  I wouldn't want anyone to ever feel that way.  But I don't know what to say.  Trying to reason with her just upsets her.  It seems a common theme to talking to a PWD is to go along with whatever they are saying - but I can't go along with her desire to hurt herself, or encourage such painfully depressive thoughts.  I kept trying to redirect, but that didn't work.  No matter what I said, she managed to bring it back to her own woes.

On top of all this, the covid situation has made a bad situation worse: the hospital is on complete lockdown.  She can't have any visitors.

A related question I have: is it possible that some PWD have to go into some kind of permanent residence at a MC/AL facility earlier than others, because their demeanor can't be controlled?  In other words, when I was staying with them: yes, her memory was abysmal, but she seemed reasonably happy, and it was a manageable situation for my dad.  But these episodes, or her current mindset: this is simply not something I can imagine my dad (or any single person) being able to manage for any length of time.  She's only 67, and in great physical health.  But if we can't get these episodes and general behavior under control... I don't know, I don't see how she can stay at home.  I am 100% certain she will not take to having any kind of people helping her.

Thank you all, again, for your continued helpful thoughts and suggestions.

Tfreedz

It is so very hard to hear a loved one speak with such despair. I think she has known something has been “wrong” for quite awhile and now she is being forced to face it and out of her comfort zone. That would be scary for anyone especially someone who has put up walls and anger as a defense mechanism. 

This happened with my mom. When finally faced with her diagnosis of cognitive impairment at the hospital she said I might as well go jump in a lake! My job was comfort and soothe her. Mom, I’m so sorry you are feeling so down, yes this sucks, I’m right here with you and nothing will change that. I held her hand when she said she wanted to go home and said I wanted to help her anyway I can even though I knew that wasn’t an option. I realize you can’t be with her because of Covid but when you talk to her, reassure her that her feelings are valid, then redirect like you’ve been trying to do. 

I don’t think your mom will be able to go home and be reasonable for your Dad unless she agrees to take the meds. My mom took them at the hospital then at home said she didn’t need them and would pretend to take them. It wasn’t until several weeks of me trying and saying I was just trying to do the best I could for her that she agreed to take them. Now she is in AL and loving it even after refusing to go! My mom is young and physically fit and loves the socialization of the facility even though most are older and less mobile than her.

Sending positive vibes your way!

Iris L.

Appropriate dosage of psychoactive medication may decrease the agitaton.  The psychiatric team at the hospital should be very familiar with this resistance.  Ir can take two weeks or more to see the effects of the meds.

Iris

jfkoc

One thing you can try is validating...listening....expressing your love for her.

JenEJ

So very sorry.  I sympathize with your situation.  I have had very similar issues with my mom.  When she had to be hospitalized, she would sundown and try to escape literally from the hospital floor.  She broke her hip during covid and would call me screaming to come get her and I tried to explain that I was not allowed into the hospital or the rehab facility. It was torture.  Once she took all her nerve medicine and tried to overdose because she was sure my 86 year old invalid dad who was in rehab was having an affair with his caregiver.  That got her sent to a psych hospital for a week which was another living hell for all involved.  It is hard to reason with them.  They get angry and argumentative.  After my dad died, I tried to take her to my house to stay because she didn't want to live in a facility. She would lay her head on the dining table and just be so depressed and negative that I would be in tears.  Nothing makes her happy.  We've tried everything.  She says she wants my dad alive again and them living in their own house again.  Anything short of that, including any joy from being surrounded with her children and grandchildren is not enough.  Your description of hutter despair is so accurate and the feeling of helplessness that our family endures daily is horrible.  We spent 7 years caring for my dad who had cancer and other issues and we watched him be miserable in a prison of his physical body and then now our mom is in a prison of her mind.  It has been a lot to deal with.  We also have difficulty just agreeing with her as she thinks my dad is still living and would want to go find him if we don't remind her he died.  She tells us daily she wants to go back to her own home or have her own place and we know it isn't possible.  It is heartbreaking!! There are days when she actually seems like she could do it and then the next it is obvious that she can't.  Sometimes we wonder how it is possible for this to be the same person one day to the next.