When do I let things go when my mom confabulates?

I suggest you get her evaluated by her primary care doctor for dementia and/or mental health illness. Don't be surprised if the doctor makes referrals for a neurologist for dementia and a psychiatrist for mental health.

If she is mentally incompetent, then she will need to have another person direct her care. It can be you or you can ask the local court to appoint a legal guardian to make those decisions.

It seems like you have dealt with a counsellor/therapist in the past to deal with your childhood. If not, it might be a good idea to address coping strategies with your mom's current issues - altered reality and grandiose expressions. I would also suggest reading any of the books by Townsend and Cloud about "boundaries." These counsellors have a successful method for dealing problem behaviors... and your mom definitely has problem behaviors

dearstraits: I am sorry that your mother shuns life saving tests, e.g mammography. Also since she does have cognitive decline, she should see a neurologist for HER own good.

My mother’s lies (confabulation is too nice a word!) and gaslighting pre-date her dementia and poor health too. I dealt with that by having very little contact as an adult. And I eventually became strong enough to call her out on the things she said and did. Her behavior was more than eccentricity- she had many other abusive qualities and likely undiagnosed mental health concerns.

When I stepped in to manage her care due to her advanced dementia, her personality never changed! If I ever need to have contact with her now that she is settled, I just say nothing. And I don’t use any agreement via facial expressions or body language. Okay - I do raise my eyebrows now and then! I usually excuse myself quickly. I still can hear her manipulation, nastiness, abusiveness, and lies through her dementia. And I still think she is calculating, even in advanced dementia. I become extremely anxious due to past trauma, so I keep any contact to a bare minimum, if at all. More recently I had to help move her to LTC. I went into a little depression following that week! So bottom line, I DON’T play along. And I stick to one calm but firm statement when she starts to yell and make accusations against me: “I have to go.” I don’t say anything else or try to reason with her, or explain anything away. I know she understands in there somewhere because after me saying this she has on occasion said, “oh I guess you are having trouble in your marriage and you blame me!” She is still trying to trigger me into a reaction! PS I have an incredible and supportive marriage that she always tried to criticize!

This hasn’t stopped me from making the best, researched decisions for her care. I try to be neutral. But if I didn’t take the distanced, no contact approach, I believe I wouldn’t be as objective as I am. Someone else in this thread said they are 64 and there is not enough time for the therapy they need to sort their feelings out. I agree. I am also 64 and need to insure my mental health stays intact!

It's tough but you'll have to adapt on the fly as she concocts new versions of events. Unless she's going to miss an appt because she's arging the date. Or something dangerous like missing meds. Get used to being "wrong" every day of your new life. Ridiculously over the top wrong. I'm finding it so difficult too.
My mother told me, when I was very young, that she was always right. About everything. She has clung to that. She doesn't forget - I erred in forgetting to tell her. Plus her expertise is increasing. She just knows she knows more than others, in spite of their education, training and experience. She just knows.
Try not to bite through your tongue.

Sorry you’ve been through that in life. I think the best self protection I would do is humor her without really listening to her. Let it go in one ear & out the other with a “uh huh yep” and be thinking of other things. Eventually it will become a habit to tune it out.

Go with today's story because tomorrow's story may be different. Relationship with mom got calmer when I just let her have today's story without having to remind her that yesterday's story was very different. I try to avoid anything that would indicate she is wrong. Why do that to her? Or me?
It's not the time to have a conversation. No more using the "R" word--remember. I feel that taking care of her means making the way for there to be peace. For both of us. And of course making sure she always has a dish of chocolate ice cream in the freezer for when she wants it at 2 am.

My mom is the same way.

She can't remember things in order, something that happened years ago, she talks about as if it were yesterday. She sees something on the news and freaks out if it happened anywhere near where we live (it never is, this is the national news). She flat out lies about a lot of stuff.

She said, a couple weeks ago "I had my eyes checked and Dr. said they were actually getting better!" Ok, that's not believable, but whatever. Then the next time I see her she is saying "My eyes are getting so much worse". I remind her she'd just told me she was doing BETTER. "Oh? That was from about 4 years ago. I probably need an eye exam." (She had an exam last year, right before COVID).

She's just who she is---she's always had her own reality, as we all do. Most of us realize that we candy coat a lot of stuff because the truth isn't fun. But we know, in our hearts, what is true. She's just becoming more intensely 'who she is'...kind of a spoiled, difficult woman.

I do very little for her, as I need the emotional space and she's done a number on me--I'm 64 and there's not enough time left to get the therapy I need to rearrange my own feelings and thoughts. The one half day a week I have to spend with her has me grinding my teeth that night.

Honestly? At age 91, she is not going to change for the better. I just kind of shut down around her and do what I need to do and don't start discussions. Not worth it.

It would be helpful to know how old your mother is and if she has an actual diagnosis of cognitive impairment and memory loss. There are other ailments that can mimic dementia symptoms, like uncontrolled diabetes, thyroid issues, undiagnosed Lyme's disease, substance abuse (like prescription meds), and bigger issues, like brain tumors and cancer (but much less likely).

You are under no moral obligation to be the hands-on primary caregiver for your mother as she ages and needs help. If money is an issue, you can contact social services and see if she qualifies for in-home services. If you are not her PoA then eventually you will not really be able to legally manage her affairs (like finances and medical decisions), so social services would need to be involved for certain when a crisis causes a need for a dramatic change in her care.

Many on this forum have been in your shoes and will offer advice on how to navigate things when a parent has had a dysfunctional relationship with their child. FOG = Fear Obligation Guilt is often at play. Just know that caring for YOU is the first priority. If you burn out or have a crisis then someone else will need to take care of your mom anyway, so a thoughtful plan needs to be in place. I wish you all the best and peace in your heart.