Sib is main caregiver

mjd42970

My mother is in an assisted living facility and lives in the same town as my brother. He is the main care taker for my mom. He makes the dr appointments, he takes her groceries and brings her home to his house for weekend getaways. His wife is the main care giver, takes her to hair appointments managed her meds when she’s home with them, deals with the women related issues. My sister in-law is unfortunately the person who takes the brunt of her aggravation. My brother is of the opinion that there is nothing that can be done to improve her quality of life, mainly related to any meds that are available for Alzheimer’s. My wife myself and my sister in-law would like to get her to a different neurologist for a different opinion. My brother becomes defensive when anyone suggests to try. I live 6 hours away, they provide all the care outside the assisted living facility. Looking for suggestions on how to approach the conversation between my brother and myself to try a different neurologist.

Thank you.

towhee

Hello mjd42970, welcome to the forum. This particular section of the forum (Caring Long Distance) does not get much traffic. You can also post on the Caring for a Parent or I am a Caregiver sections for more responses, it is perfectly ok.

It is somewhat difficult to give advice from a distance to the person on the ground, and that person can be so overwhelmed, and often depressed, that they do not feel they can handle anything else even if it might make the situation better. However, I believe you said your sister in law who was helping also wanted some changes? It might be helpful to gather information and further define what you wish to accomplish so that you can present your brother with a simple and defined goal. As a goal, "quality of life" is pretty broad. Do you wish (1) for your mom to have a better memory and be able to do more things for herself or (2) for her to be less upset and angry and easier for your sister in law to care for?

If it is the first there are really only two classes of dementia medication, generically usually represented by donepezil and memantine. While they can be marginally helpful (maybe) neither one offers a huge benefit, and there are some doctors who do not think they are worth prescribing, or the doctor might have another reason for not proscribing such as fall risk, other side effects, or does not think the patient is at the dementia stage to benefit. Do you know what medications your mom is taking and the doctors' reasons for not prescribing any that she is not on?

If it is the second, the dementia medications are not usually the answer. Often the medications you start with here are anti-depressants, and either your moms PCP or the neurologist can prescribe these, you just have to communicate the problem to the doctor (by a letter or message to the doctor, not in front of your mom). In this case you really should not need another neurologist. In case your moms problems are more severe and she needs an anti anxiety or anti psychotic medication another doctor that might be helpful is a geriatric psychiatrist.

Sometimes as you learn to understand dementia, you can make non medicine changes that will be beneficial. For example, for persons in the middle stages of dementia (Alzheimers) being out of their normal environment and out of their routine can be very tiring and can lead to emotional upset. Many family members with relatives in assisted living limit outside visits. Changing the way you approach your loved one may also be helpful. It is often recommended here to read "Understanding the Dementia Experience" free on smashwords.com or checking in to the youtube videos of "Dementiacareblazer". You can also spend a little time here reading other posts.

As to how to approach your brother the only thing I can advise is that you make it clear to him that he is doing a good job under very difficult circumstances, that you feel badly that you have not been able to help more, and that the only thing to blame here is dementia.

I hope you find something helpful here.

H1235

You said something about her aggravation. If that is what you feel needs to be addressed could you maybe convince your brother to allow you or your sil to send a detailed note through a healthcare portal, to the current neurologist. Maybe the problem has not been made clear to the current neurologist. It’s almost impossible to tell a doctor about a lo anger issues with them sitting next to you. This works well for us. We were prescribed something to even out her moods. Not sure if it will work yet. I also agree with towhee that a change of routine and a different environment can be confusing and disorienting ( even if she has been to their home many times). Sometimes a PWD will take help from a stranger better than a family member. If sil is helping with personal things, that could be the problem. Not sure how you approach that. There are many great videos out there, but unfortunately you are not the one that needs to see them as much as your brother. My mom lives with my brother ( I handle doctors) and it frustrating when we don’t agree on how things should be handled. I appreciate all he does for her and don’t want to be critical, but I want what is best for mom. It’s a difficult place to be.