Alzheimer's/Alcohol Dementia, Alcoholism, Hoarding and Medication Refusal - what to do?

MLV30642

Hello,
My mom has been a lifelong alcoholic who has refused most medical care in her life. She lost her home, was asked to leave her independent living situation due to hoarding, and she is in assisted living now for the last week but seems to have declined. She is physically weak, uses a walker, and is essentially blind from lack of proper eye care.

Short version - we had scheduled cataract surgery for her last year but she refused help for the pretreatment drops and could not administer them herself. In assisted living, she has medication assistance. We have rescheduled surgery, but we are not hopeful.

In general, she refuses to see doctors. She refuses to take medications and has bladder control issues. She is paranoid and believes people are stealing her things and are spying on her with cameras in her apartment. She has become extremly aggressive and even more argumentative with everyone she meets (especially me).

My family is at a loss for how to handle her multiple disease(s). In the past, she has tried to stop drinking (refused medical care) and ended up hospitalized with DTs and low sodium issues. She still drinks.

Does anyone have any suggestions on what to do next? We do have POA, advanced directives, and a will. I am her health care agent. But, as the assisted living nurses told me, they cannot force her to take medicine or be treated.

Does anyone have experience with a situation like this? Did you simply have to wait and see?

This is the second time I've had a parent with Alzheimer's, but her behavior and habits makes this far more difficult. Thanks for any advice you can share.

M1

Welcome to the forum. There are medications that can help the delusions and paranoia. Honestly, she probably needs two things: hospitalization for alcohol detox and medication stabilization, preferably on a geriatric psychiatry unit; then a more controlled living environment with no access to alcohol.

there are several posters who have dealt with dual diagnoses, hopefully they will chime in.

housefinch

@harshedbuzz

harshedbuzz

@MLV30642

Hi and welcome. I am sorry for your reason to be here, but please you found this place.

This is a very difficult situation. Are you her POA? Is it "durable" meaning it remains valid should she lose capacity? Is it "springing" meaning you need a physician's opinion that she is not competent? If it's valid now, you may be able to act on her behalf now making the safe choices for her including medical care and a transfer to a more secure facility.

My dad had mixed dementia with one being alcohol related. It is much more challenging than "just dementia".

You mention a lot of health issues. Does she have a dementia diagnosis? Specifically, has an alcohol-related dementia like Wernicke-Korsakoff's been ruled out. FWIW, vision and gait/mobility issues are common in WKS dementia. WKS causes unusual eye movements which impact vision as well as a kind of unsteady, almost rolling gait. Anecdotally, many with this form of dementia have challenging behaviors and earlier onset of incontinence than in other forms. The bladder control issues could be related to stress incontinence or a symptom of dementia progression. Medication to treat "overactive bladder" may be related to dementia, so I would avoid that. Other symptoms especially noted in WKS include confabulation (made up stories that have a grain of truth but are scrambled in terms of the who, what, where, how details) and poor temperature regulation that makes them cold all the time.

If you can act on the POA as written, you may need to get emergency guardianship through the courts to force detox and the geri-psych stay to trial medications to treat her agitation. From there I would recommend a secure facility. Dad was living with mom when diagnosed which made keeping him abstinent very difficult as he was abusive of her in the role of alcohol-police. We tried replacing with NA versions of wine/beer but he could always tell and, again, would get abusive as a result. Ideally, he should have gone to MCF immediately, but mom refused.

This is a pretty good article about WKS.

https://academic.oup.com/alcalc/article/44/2/148/185585

HB

MLV30642

So sorry for what you've had to go through as well. I believe we have durable power of attorney. We were trying to avoid the courts if possible, but it may lead to that soon. I'll read through that article. I appreciate you sending it. "Moderate dementia" was documented by her previous doctor, though no specifics were given.

I also appreciate the insight into confabulation - didn't know it had a specific name. She comes up with some doozies - all with a few elements of truth.

Thanks again.

M1

If you in fact already have durable power of attorney, you don't need the courts, you just move her to a more secure environment and/or hospitalize her for detox before the move. Dont' expect her to agree, and you don't try to reason with her. Read your paperwork and see. Durable POA does not require a declaration of incompetence, and in fact confers an obligation to act in her best interest in addition to the right to do so….

H1235

You can not wait until you are able to convince her, because that is not going to happen. I know how hard it is to act against her wishes. It has to be done. She is not able to think clearly enough to understand things need to change. Read through the DPOA and see what it will allow you to do. If it’s not clear see a lawyer. I’m surprised AL is not telling you she needs more care than they can provide if they can’t get her to take medication. I’m not sure if a hospital for detox or just a move to memory care is in order. It’s concerning that she is still drinking. How is she getting it? Is it being given to her to avoid detox? So sorry your family is going through this.