Need Advice/Direction on How to Proceed with My Mother

michellc

My mom has been diagnosed w/dementia, probably ALZ as her mother & all her aunts have had it. She's 91. During the last year she's given my sister her health POA. My sister lives with my parents & suffers from mental illness. My sister is in denial of my mom's diagnosis & has encouraged my mom to stop seeing her neurologist. At this time my mom's ALZ is leading her to accuse phantom people of stealing from her & then making the items suddenly reappear. My sister has a codependent relationship w/my mom & backs my mother up on these distorted ideas. My mom thinks it's paranormal activity & my sister applauds her in that thought. In addition, after 69 yrs of marriage, my mom wants to divorce my 93 yr old dad who doesn't have dementia yet. They've had a very happy marriage. My mom wants me to take her to lunch this Friday alone. When she talks to me about all these delusions then, what do I say? When I've told her before that i think she should be checked out by her doctor, she becomes furious. Do I join her in believing what I know to be lies? I'm scared to death about Friday. She's become explosive & distrustful of everyone. Any thoughts? I'm their only other adult child. I'm quite worried about her. I have both POAs on my father & the durable POA on my mom. It's become extra difficult for me to have my sister taking care of my mom, yet be in denial of this situation. Thanks for any advice. I'm totally open to all possible ideas.

SusanB-dil

Hi michellec - You can still let the doctor know what is happening, just that without HIPPA accesses, they cannot comment back. I'm sorry you are dealing with all that denial. Where does dad stand in this? Is sis actually backing the thoughts of divorce as well as aligning with everything else? You could ask your mom why she is so against being checked out by the doc, without being confrontational. I would say to keep lunch light and short.

towhee

Hi Michellc, this is hard I know. When you first start dealing with dementia there is so much to learn. You want to know how to respond if your mom brings up things being stolen or believing your dad is doing something he is not. Short answer is you validate the emotion and distract. You do not necessarily have to agree with her belief, but you do not let her know that you think she is wrong or that there is something wrong with her. She says her things are being stolen, you say I am sorry, you must be upset about that, I will ask my friend for advice. And pivot, to news about another family member, a pretty coat, whatever. Repeat as necessary. This takes practice and you might not get it perfect but it is much better than telling her she is wrong. My mom used to believe someone had stolen her checkbook (at least once a day) I would say, Uh oh, I must have moved it when I cleaned earlier, I am so sorry you must have been so worried. Whereupon she told me I would lose my head if it wasn't fixed on and that was the end of it. No anxiety, anger or mistrust. I was of course lying, or using a fiblet, as we say in dementia land. She however was not lying. Her brain was failing, she was incapable of understanding that her brain was failing, and that "stealing" belief was the only way her brain could make sense of the fact that she, the one who always knew where everything was, could not find her checkbook. If she temporarily understood that she had problems with her memory, she could not hold on to that understanding. The medical term for this is anosognosia. People with dementia remember strong emotions much better than they remember facts. Sometimes validating and distracting can be hard to do, and we end up temporarily agreeing with the persons belief or something that is close to the persons belief just to stop the frustration and anxiety loop. You might think that person would be less anxious by being told there was no one stealing, but the anxiety is coming from not being able to make sense of their environment, and being told that they are wrong makes it worse.

About wanting a divorce from her husband, same general idea, but this one is harder. You might ask for advice on the spouse forum, or read some of those posts.

Regarding going to the neurologist, the medical POA should keep the financial POA informed of diagnosis and medications and general condition and financial POA should keep medical POA generally informed of resources available to pay for care. If you have trouble working with each other, you might involve a neutral and objective third party. What a neurologist can do is pretty limited. They diagnosis, proscribe the two classes of dementia medications, and if the caregiver mentions problems with anxiety, hallucinations, etc. they can proscribe anti-depressants, anti-anxiety, or anti-psychotics. But your primary care physician or psychiatrist can also proscribe these medications. My mom stopped seeing her neurologist after about 3 years and just saw a geriatrician. Ask your sister what medications your mother is on, and if there are any problems getting your mother to take them, look at the care your mother is getting, eating, drinking, going to her PCP regularly, having someone with her and not being left alone etc. I don't know your sisters problems, but living with someone with dementia is nowhere near a normal situation. To be able to judge what is going on you need to learn about dementia or consult someone with more knowledge. It might be helpful for you to read "Understanding the dementia experience" by Jennifer Ghent Fuller, just google it or someone can give you a link, It is free.