Assistance v. Autonomy: How can I edge Mom toward self-advocacy and initiative?

Executive function is one of the first things that go with cognitive decline.

It isn't necessarily that she doesn't want to do things, it's that she can't do do them. Knowing your glasses aren't working properly and scheduling an appointment to get that corrected are not in the same category of function.

Your dad was probably compensating for her loss of abilities and you didn't see them.

I would get her into her doctor, you will have to set it up and make sure it happens. Go with her and get her to sign a HIPAA release so you can truly advocate for her. Probably a referral to a neurologist would be in order.

Unfortunately there are steps required to intervene. Getting a diagnosis is the 1st one.

From what you have said, don't frustrate yourself by trying to get her to do things she is no longer capable of.

If she has cognitive decline, what makes you think you can nudge her in the opposite direction toward independence and autonomy? That makes absolutely no sense.

My husband is 61, retired two years ago, and has perfect cognition. He realized he hadn't been to a post office in at least 35 years. He didn't know how to use the automatic mailing machine, he didn't know anything about classes of mail, or even how much a stamp cost. I had always been the one to handle that stuff. I taught him all he needed to know, and now he goes to the post office himself.

THAT'S who you can nudge toward self-sufficiency, not someone who's 86 and cognitively declining. You're going to have to understand that at that age, tasks can be overwhelming, and just getting one thing accomplished per day is a victory.

Help her get her appointments made, and help her get to them. Griping that she's not on the upswing when she's at the downturn of her life isn't helpful. Remember, she's not you nor is she your age, so don't apply expectations of what you can do to someone 20+ years older.

I agree with what's been suggested: she's in decline and is far less able to keep up with any learning curves or moves toward "independence".

I think it would be very important to take her for a cognitive/memory test to see just where she's at. This enables you to know what reasonable expectations you can have of her. It would be awful for her to never meet people's expectations when she literally can't.

Bring up your concerns with the doctor (or his nurse) BEFORE the appointment. You may be entering into new territory here. Dad may have been covering for her and now you are starting to see that she is perhaps worse off than you had realized. That's very common so don't feel bad about it. At 86 it is pretty common to have dementia.

The ship has likely sailed on self-advocacy and initiative. First get her to the doctor and make sure that her cognitive abilities are on the agenda. They can do a little memory test which I think is a start but only a little bit useful. I did not think that it picked up on the severity of my mom's issues which was frustrating.

I don't think you can just let her be and certainly not follow her lead. This will be a hard adjustment for both of you.

Good luck.

You may need to use a "therapeutic fib" to get her into an appointment. Here's what I did with my MIL, who was having short-term memory and cognitive issues. Figure out what will incentivize her to go: maybe tell her Medicare requires her to have an annual checkup. Then help her make the appointment, and offer to drive her (and make it "fun" - maybe take her out for lunch before or after).

Before the appointment, write a note addressed to the doctor, outlining who you are and why you are concerned for her cognitive state. Then request a cognitive/memory exam and test for UTI. Hand it to the staff discretely at the check in. Make sure you take your PoA paperwork with you to this appointment and give it to the receptionist. You might want to try to be in the room during the appointment, sitting directly behind her so that if she gives inaccurate responses you can shake your head yes or no to so the doc gets facts straight.

Your PoA should allow you to know the results of this testing. Now you will be better able to understand her actual capabilities. She may need anxiety meds to help her through daily life going forward, and an accurate diagnosis is the gateway to treatment options.

So when she says "I need new glasses," you say "okay, that sounds like an idea. What would you like to do?"

[Tip: it's amazing how much better people's glasses work when you clean them :) I always keep spare lens wipes in my tunic pocket now.]

This is only an example of the principle of using open questions, thus:
- I need new glasses.
- Shall I make an appointment with Acme Eyes?
- No, don't bother me! You're always nagging me!

- I need new glasses.
- Okay, what would you like to do?
- I don't know, I'll think about it...

... is actually the reply you're likely to get; but a) at least you won't have set up an Aunt Sally for her to knock down, and b) this probably isn't about her glasses anyway, it's more likely to be about the decline in her sensory abilities all round which glasses will not solve.

What are the other areas you have concerns about her managing?

Total agreement with MJ--and 86 yo? They have probably peaked as far as learning new skills--just try to keep status quo.

I'm only 65 and I hate it when my kids try to teach me something that I truly do NOT care about. Like how to work the remote for TV. (Why should I start watching TV when my life has been fine w/o it for 40+ years?)

We're just trying to keep mom oriented to time and location. That's really all we can hope for in a 92 yo person. Some elders retain so much and are lively and very interesting people (my 2 grandmothers) some are stuck in the 50's or 60's and bemoan all the technology that's out there and make no effort to use it--which is FINE, but they can't complain when someone posts a FB picture of a GGkid and they can't remember how to log in to FB--despite written instructions.

You can't edge her anywhere but you can make the appointments and take her, as your dad did.

If she does not drive and you are the one who is going to take her to appointments, can you make those appts for her so you can make them at times more convenient for you? You may be worried about setting a precedent of taking over that task, but,if she is having some cognitive decline, she is likely to procrastinate or forget or just not understand how to go about it. Anxiety contributes to the inability to follow through.

Appointments and scheduling take at least some "executive decision making," and that is the cognitive skill that drops most quickly. Nagging will be counter-productive. You or a designated person could more easily take over this part of your mother's schedule.

Hello. I am about your moms age. Im saying that so you dont think im a younger person who doesnt understand.

but i do.

i have had multiple jobs and have found that in some cases the wife has done the managing and contacts. In some cases it’s been the husband. sometimes each has handled their own “business”.

it seems your mom needs your experience to handle appointments etc whether your dad did it or for whatever reason she is loathe to do it now.

so make appointments and whatever she needs and if she then says she wants to do it the leave it up to her.