There are two things my mother does: 1) She starts harassing me about food starting at about 5pm, in a very passive-aggressive way. 2) She occasionally has complete melt-downs -- eyes bulging, teeth bared, where she calls me names like "stupid bitch," etc. when I stop her from doing something. Most recent episode was last night, where she began inexplicably cleaning the gunk from under her finger nails in the kitchen sink where I had a pot of pasta that I had just cooked draining. My husband feels like she should be punished, or made to suffer consequences, for her behavior. This would include ostracism for some period of time, a talking to, not being allowed to join us for our next meal, etc. I'm kind of OK with it for a certain period of time (I need a break from her being around for a few hours after being called a stupid bitch), but truthfully, not sure there's much efficacy in it. She claims not to remember her behavior (not always totally sure of that) and she isn't really capable of learning anything new--again, not 100% certain of this, as she has occasionally surprised me here). And I don't really want her to be unhappy in the presumably short period of time she has left with some level of self-awareness. What do you guys think? What is the best for all concerned?
BY DR. HELEN KALES
I am a geriatric psychiatrist. Um, what is that? An older psychiatrist who is ready to be put out to pasture? Nope. A psychiatrist that has an extra comfy couch so that older patients can lie down and tell me about their mother? Also, nope (although I do enjoy comfortable furniture).
A geriatric psychiatrist is a medical doctor (four years of medical school after college) with four years of general psychiatry training (an internship/residency following med school) and an extra one to two years of sub-specialty training (a geriatric psychiatry fellowship).
In psychiatry, the M.D. furthers the degrees and area of study into specialties.
In neurology, an M. D. can then specialize in psychiatry, adding geriatrics.
A geriatric psychiatrist specializes in elderly, and has accreditations.
Any psychiatrist can then specialize in elderly patients, but it is a matter of furthering their studies, obtaining specialty degrees, associations, and certificates to become accredited in the field of geriatrics, or gerontology.
Neuropsychiatrists specializes in study and treatment of the brain biochemistry.
Clinical neuropsychology is a sub-specialty of clinical psychology that specializes in the assessment and treatment of patients with brain injury or disease. A clinical neuropsychologist usually holds an advanced degree in clinical psychology (Ph.D., Psy.D.), and has completed a clinical internship and specialized post-doctoral training in clinical neuropsychology. What distinguishes a clinical neuropsychologist from other clinical psychologists is knowledge of the brain, including an understanding of areas such as neuroanatomy and neurological disease. The discipline involves the application of standardized measures in the study of brain behavior relationships. They use neuropsychological tests to assess cognitive deficits, and they are involved in the management, treatment and rehabilitation of cognitively impaired patients. Neuropsychology also entails the development of models and methods for understanding normal and abnormal brain function.
As Rainmom points out, meds helped her mom become calmer. I saw this with my mom as well.
I think many caregivers struggle with this. It's so tempting to assign some kind of blame. When the stress is too much and it's just very overwhelming, I would look for assistance. Trying to punish or blame is not really appropriate with a dementia patient. It won't get you anywhere and the person will not benefit from it, either. It is likely to just make them feel more confused, agitated and frightened.
Have you explored what options are available for her care? I might read A LOT about dementia and what you can expect down the road, because the behavior and challenges are likely to increase substantially. Having a plan is one thing the article recommends.
https://www.agingcare.com/articles/dementia-behavior-manipulation-154554.htm
However. It sounds as if he is still thinking, or maybe just hoping, that normal thinking processes - such as a grasp of logical consequences - apply. You both need to abandon that idea for good. They don't. If they haven't already completely gone, they soon will; and it is certainly futile and potentially cruel to continue to hold your mother to standards of behaviour that she cannot possibly keep in mind.
The rages that first led you to post... Those must be incredibly hard on you, and painful. I'm really sorry you're having to witness them, let alone be the target. Teepa Snow's videos might be helpful and comforting, and offer some guidance about detaching from the emotional hurt. The better behaviour you see at your sister's house, or during activities, I would guess is actually more to do with the pleasant stimulation of those environments rather than a control issue as such - again, I think it's probably attributing too much to your mother's remaining reasoning ability to suppose that her frustration and irrational anger comes from trying to be in control. Although, yes, I'd agree that it would be frustrating to her if domestic routines that should be second nature have become bafflingly difficult. For guidance on helping her to do things without triggering her frustration, there's another thread started by a lady whose husband is beginning to struggle and getting angry about it - can anyone remember the headline, please?
Please don't stop her enjoying anything she is still able to enjoy. Depriving her of these pleasures will not restore her reasoning faculties. It'll just deprive her of her dwindling opportunities to have fun.
I'm sorry to say this, but the real trouble is that it is only going to get worse and whatever you do is not going to arrest your mother's decline or mitigate the challenges of it in anything more than the very short term. So, it is time to consider options, collate information about costs, resources and her likely future care needs, and draw up a plan. Do you have POA? If not, it sounds as if you might have missed the boat there and could need to apply for guardianship, especially if your mother is unlikely to be co-operative. Ask around friends and your mother's GP, and if anyone can reliably recommend an elder care specialist it would be a good idea to take legal advice.
My mother gets most disoriented when she is around people who make her nervous. She pulls inside herself and gets absolutely confused.
Your mother may be doing something we call showtiming for your sister. When someone is around someone they don't see every day, they can act like everything is normal for a while. It is why someone with dementia can fool their neighbors and doctors. It does seem to take some energy to showtime, though. When they get home, they are tired and seem even worse than before for a short time.
About doing the nail cleaning at the sink -- Humor can go a long way. Goodness, Mom, who raised you? Wolves? Go to the bathroom and do it. Keeping it light keeps it from turning into an argument.
Your husband sounds like a jewel, but you'll have to let him know that denying her activities won't teach her anything. It may just make her become disoriented and anxious. This happens with my mother if we have to miss church and going out to eat on Sundays. She orients her life to Sundays. It would be really hard on her if I stopped taking her to church and to eat. Keep doing anything she enjoys or let someone you know do it with her.
Has she been seen by a geriatric psychiatrist?
Dementia is a disease that destroys reasoning skills, not just memory. Your mom's perception of what is "better" may or may not be accurate.
I think that my husband's ideas of setting limits is not going to work because she cannot really learn anything new. However: he feeds her, bathes her, and is playful with her in ways that I simply cannot be. We take her to concerts, to the movies, and to restaurants. So he's actually not a jerk.
And yeah, it's getting to us. It's finances. Getting her adequate help is proving very difficult. We have now been staying with her for several months now, after her doctor said she could no longer live alone. We aren't sure what do with our place, her place, anything. I am trying to apply for aid from the VA; everything is in flux, everything takes forever. And yes, I've heard of sundowning. And I've spoken with an elder law attorney, social workers. I've joined a support group. And we started her on meds for anxiety a month ago. I thought it was helping, but the last few days have just been bad.
Time for your hubby to read up on Alzheimer's/Dementia. Scroll to the bottom of this page to the blue section... click on ALZHEIMER's CARE... now scroll to the articles and have him read, read, read. If one is armed with as much knowledge they can get on the subject, the better understanding what is going on.
My Dad just started with dementia and the sundowning, and I know it isn't easy to get use to. I found if my Dad's mind is off in the weeds somewhere, I can bring it back for a while talking about "weather" as he is still up to date with weather national wide.
A snack portion of applesauce? A snack of jello, a little medication, and t.v. distraction in the hours prior to dinner?
A popscicle, lemon to prepare her palate, ha ha, said to make you laugh.
Just give her a pop-tart then.
One cannot always determine why, or the motivation. But please try feeding her early, put her to bed early if you must punish someone.
1. What reading have you and your husband done about dementia? Has someone told you that your mom has only a short time to live? Lots of posters on this board have parents who've had full blown dementia for more than ten years. That's a long haul to my way of thinking.
2. Have you ever heard of sundowning? The fact that your mom exhibits agitated behavior late in the afternoon suggests that to me. Talk to her doctor about this agitation. Meds can sometimes work wonders.
3. How long do you plan on staying at her house? Are you keeping your house? Since this is most likely not a short term project, you might want to rethink some of your plans.
4. I'm glad that your mom can keep going to some activities. I doubt it's making her feel like she's in charge. But it suggests to me that 1. Your husband doesnt understand dementia and 2. He's wearing thin ( i would be too; the world should not revolve around your mom).
5. It feels to me like it's time to rethink, assess mom's living situation and assets and figure out where she should be cared for, and by whom.