Hello, let's get straight to it. I have been a care giver to my mom for the last 1-1/2 years, and I find that when I get close to a "comfortable" routine, her persona takes a 90 degree turn and I have to catch up all over again. Mom is 84 and is in later advanced stage of alz. She is physicaly fit,the prob is her lack of reason. She has gotten to the point that she nolonger wants to recieve any medical assistance,(no more pills,dr.visits,etc.) and wants to just be "left alone". She is constantly picking fights with me, she knows that I leave her alone when one is brewing.
Sry, lost track. My concern is if mom has the means to take care of herself and just doesnt want to anymore, am I to just stand by and watch/help her choose a lesser quality of life?
We went to the eye dr. today and she has catract's so bad that dr. wont even consider diffrent glasses.
When we can talk, she claims that she wants to hang around a little longer, but she shy's away from anything that can help her.
Does anyone have any experince with phyco treatments, of advanced alz, or are we helpless?

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but I'm back to the what I belive to be the ethical question, If my mom is prepared to live "as is", and I "trick" her into a phyco treatment, and it has a positive affect,and it makes her more aware of her condition, have I helped her, or will I cause unessary duress?

Absolutely not you will not cause her any duress Otto all a Psych eval is is just what it says evaluation, they are monitoring your moms condition/behavior in a controlled setting and adjusting meds to get her on the correct meds and dosages for her and if those meds do the trick her quality of life will increase.
You've already finagled a few things in regards to her for a better quality of life and this is the least invasive of anything shes gone thru thus far.

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I did "trick" her into a gall bladder op

*chuckle* If you can trick someone into a gall bladder surgery, then you are no novice at this, otto!!

If your mom can still argue so convincingly about her refusal of a psych evaluation, perhaps now isn't the time... While we can "fight the good fight," each person has their own ideas about how they want to go and how much suffering they are willing to endure in getting there. Living "hooked up" might be a blessing for one person to grab a little more time on the planet and be hell-on-earth torture to another. There isn't a right or wrong. While there are AD meds that can help the symptoms somewhat, buy some time and quality of life, it is still a 100% fatal disease.

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have I helped her, or will I cause unessary duress?

You know your mom best and though you'd walk through fire for her, she might not want that for herself. I think you DO have to think about that aspect of things. If she says "no" perhaps she has more knowledge and experience from friends, etc. about the course of this particular disease. Perhaps she'd rather take things as they come... If she is aware of her condition and its prognosis and refuses treatment, I think she's stating her prerogative.

I see it this way: my job as a caregiver is to do the best that I can for my mom and comply with her wishes as closely as I possibly can interpret them. Sometimes, it's a tough call between what's best medical practice and what's best according to her wishes. I lean in favor of mom's point of view because she is the one to whom I gave my promise. I might choose differently for myself, but this isn't about me - it's about her, so I try to let her wishes lead me as much as possible in decisionmaking.

please excuse me for my manners. I wish to thank everyone for all the replies and words of wisdom. I intend to reply to others post and offer my help as well, I wish I would have found this site long ago. It does help to talk with someone that doesnt think care giving is a burdon.I hate doing this, but wouldnt miss it for the world. Thanks C

I'm sorry I havent introduced all the info to you.This thing with the eye dr. has put my back up aginst the wall. I have full control of my mom, dpoa+living will. This is my moms request's, that she be allowed to die in her home, she wants no treatments that will keep her going,no machines,no surgeries. She wants a natural death. I have made some decisions in the past,
that have strayed from those wishes.Out side the treatment for a couple of broken bones due to a fall, I did "trick" her into a guall blader op,and a few infection treatments,of witch put her out of harms way.I couldnt see makeing mom suffer and die from a hardened gall bladder or a normal urinary infection, something that could be fixed with pills or out pat surgury. I feel the same holds true about her eyes, if she could see better for the durration, why not? Her point on the phyco eval is that her mind is part of her, and if her brain is dieing, let it be. I have a better understanding of these treatments, and I want to disagree with her. I think that they could help her, but if I do this, then what? If her kidnees fail, hook her up, if her heart fails, hook her up. If I do all that, I have failed to her wishes.
My mom is very "old school". She lived mostly in urban settings, but has always held the country close to her heart. I was her only surviveing child, of 7 other misscarages, married for 44 years, worked for 16 years,(after I left home) has out lived all her friends and relatives/countless pets, and has had the strength to indure all. She is not sad that she is old.
Ok........I couldnt bring myself to writeing this,but here it goes. After her last c-scan/mri/x-rays, dr. sugested that it might be her last. He wants to keep running blood work, and of corse with alz, its anybodys guess. Sounds pretty close to me?
I know that I keep jumping around, but I'm back to the what I belive to be the ethical question, If my mom is prepared to live "as is", and I "trick" her into a phyco treatment, and it has a positive affect,and it makes her more aware of her condition, have I helped her, or will I cause unessary duress?

Welcome, Otto. First, for your mom to receive the diagnosis she needs to begin the treatment plan she deserves, she needs a thorough "systems check," like when one takes a car in and hooks it up to the computer and pushes the "test EVERYDANGTHING button. MANY specialists will be involved with the testing, not just psychological or cognitive folks. After the testing is completed, the specialists all pow wow to arrive at a comprehensive diagnosis and recommendation for treatment, or treatment plan. At this point, you (as her caregiver with DPOA - and not just POA, I hope1) will be presented with the findings and the proposed treatment plan. THEN your mother will be informed of the findings to the extent of her ability to reason, participate and make decisions for her care. If your mom has any physical issues plaguing her, THAT is the way to sell the in-patient evaluation. I wish her doctor had not tried to sell it to her as a "psych" workup because NO ONE wants to think or have anyone suspect that they are "crazy" or that something's wrong with their mind!! Unfortunately, many folks cling to the notion that AD and other dementia-producing diseases are mental illnesses - they are NOT. They are physical, neurological diseases that cause progressive brain damage, which, in turn, causes physical decline as well as psychological and cognitive decline. The stigma of these diseases prevents many people from getting the testing and treatment they need to try to keep what they've got for as long as possible and to anticipate their future issues and needs. They wouldn't have trouble going to the eye doctor to check out issues like macular degeneration or to the cardiologist for testing to determine their heart function, but a psych evaluation is interpreted as meaning "y'all think I'm crazy and I'm not gonna do it!"

It's time for you to have a talk with her doctor WITHOUT mom present to understand all the issues of concern and to agree upon a way to get mom in for testing.

TRY to sell her on this idea by pointing out to her that the psych component is only ONE of the systems that will be evaluated. Downplay it. If push comes to shove, tell her she's going in for cardiac testing instead, or to discover why she is trembling more.

You brought up the concept of "ethics" in the title of this thread. Caregiving for elderly people raises concerns about protecting their rights while ensuring their care. Many folks say often in the early days of caregiving that they feel uncomfortable with "lying" to their parent. There IS such a thing as therapeutic lying, redirection, obfuscation and forgetting to mention ALL the details. Yes, it is manipulative and yes, certain manipulations ARE ethical if they are done to accomplish a greater good for the patient.

Nearly every person fears incarceration or internment. It is up to you to become your mother's comforter and reassure her that you will not allow anyone to simply "shut her away" against her wishes. There ARE solutions other than putting old folks in nursing homes and forgetting about them (except for mother's day, birthdays and holidays). Reminding her of these other solutions - day care, homecare, etc. may help allay some of her fears, but more importantly, you need to step up and become her champion, someone upon whom she can rely and with whom she can relax and let THEM do the driving! Sometimes, that very metaphor can be used: "Remember when you learned that I could drive you safely, Mom? Well, I can watch over you through this, too." Gaining her trust is very important. Learning what to discuss with her and what to keep to yourself is important. Your relationship and way of relating has to change.

Your mom doesn't sound anywhere near end stage, but rather at the point where she is going to need supervised care and have some of her business needs and tasks taken over by others. This sounds more like the beginning of the journey to me rather than the end of it. This may be the end of her independent life, but not necessarily her entire life! Accepting assistance and leaning upon others to care for one doesn't mean life is over - it means that one has become too old or ill to keep up alone. She needs to know that she can trust you to walk closely with her along this part of the road and that you'll protect her. There is no program anywhere that can protect and ensure your mother's individual care like a close family member can do. One cannot simply turn over the reins without close supervision of her situation. No one will ever know or love your mom the way that you do, even if they do provide excellent care.

It's a long, rugged road, but we're here to stand beside you as you struggle to do the best job you can for your mom. Many blessings to you and I hope you'll return often as you take on this most mature of adult tasks in life.

This message has been edited. Last edited by: Moms_Buddy,

Welcome, Otto!
I'm the one here who usually makes folks shake their heads and mutter, "What the BLEEP is she THINKING?" because I come up with really insane ideas some days.
You did say that Mom was resisting a psych eval because everyone just wanted to 'put her away'.
Do you think you could get around that by telling her that (the mysterious) They have to tent both of your houses for bugs, and neither of you can stay while it's being done, so you've found a good place for her to hang out?
If she looks at you like you're nuts, chances are pretty good that she's not in mid/late alz stage. (Too bad BillyG hasn't checked in for a while. He is caring for his wife, who IS at that stage.)
My husband got his diagnosis from an office visit to a psychologist. Perhaps YOU could have an appointment and ask Mom to come along as the "official historian." That's a trick that many here have used. Of course, the offer of a meal or special treat after the visit never hurts either!
And I will tell you this - all of us have our helpless moments. Never feel like you're in this alone. Most of us are miles apart and can't physically step in and help one another, but this is where we go when we need support.
Don't forget to breathe!

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She is also starting to show signs of maybe parkensens. She has slight shakes in her extremities

Oh sweetie we got a few folks here that have dealt with this and can help you more hang on they will show up shortly.
As for giving up on her sweetie we wouldnt think that, your here after all asking the tough questions
There are alot of people out there that dont ask or seek help simply because their not willing to hear the unvarnished truth.
Funny thing is the folks here myself included still admit when we need help that is beyond our experiences, we are all human, sometimes we dont have all the answers and when that happens we research until we find something to help...
I have learned so much in this journey with the help of our family here, without them I know beyond a shadow of a doubt I would have failed by now.
Be kind to yourself otto you can not control this, its a disease with no rhyme or reason if something snaps you had absolutely nothing to do with it. (((hugs)))

Welcome otto, please breathe. It is clear you care for your Mom. The world of dementia, what ever the cause, is devastating and confusing for all. I am not very experienced but it seems if she is able to act like that she is not in the late stages. Nonetheless, she needs you more than ever and it is not going to be easy. Chances are good that tomorrow she won't remember being angry or why, if she is that deeply affected.

Show up with a treat she can't resist tomorrow, maybe ice cream, maybe flowers, maybe cake. Just be there for her for a bit like you have been. Chances are she is reaching a point where she cannot be alone and she does need a full evaluation, not just the opinion of a general practitioner.

Hang in there and breathe. You must be rather upset after that scene yesterday.

Thank you both for responding, My mom lives in her own home, I live in my own home, we live about 3 miles apart. For the last couple of years I have had to increse the amount of time that I spend with her. Again my mom is very active and is consistantly doing something. My father passed back in 99 and she has been semi on her own since then. I have made myself available to her based on her needs. When she wants me there I am there. When she wants I have gave her her own time.
Around 2005ish she started showing the sign of early alz slight forgetfulness,loosing things, worrying about money etc. I have alway's been there for her, but I let her run her own life until it started affecting her bills, meds, food,etc I do have a poa that covers everything. Understand that I am her only living relative. There are no other family members left.
When it was sugested that the on set of alz. was a possibilty, I researched, and read everything I could find on alz/dem. I even went to a couple of local support groups on alz-care givers and tried to learn all that I could.
We have survived very well, until just recently. About three weeks ago her dr. sugested a temp in hospital physco eval of witch would be volentary. Now she has withdrawn to beliveing that we all want to just put her "away" and take her from her home.She has stoped takeing her med's all of them. I dare say she is prob not eating right again, and yesterday after her eye exam she got out of my car and walked to a neighbors house and called the police to have them remove me from her house. I didnt see that comeing. The police told me that maybe it was time to send her somewhere. I had a friend try to call her today with no answer. I know she is ok, I have driven by and seen her both in and out of the house.
I think she is in advanced+ stage based on what her drs. say. According to her ct scans, her brain has shrunk alot from last years scan + the ammount of pac's has increased considerably. She is also starting to show signs of maybe parkensens. She has slight shakes in her extremities, that hasent been addresed to her dr. Just started. My moms short term is all gone. Her long term is very vague. and the events can be counted on one hand. And now with the new symtoms, and her fighting any and all help.................?
Dont worry, I will not turn my back on her. she is all I have. I have worked hard to try to keep her in her home, I am takeing a couple of days to step back and see witch way I need to go now, thats why I am here now. I did a lot of surfing to find this site, It seems to be the onlt one with heart. Belive me I read a lot of the post here before I posted,
I need to get her to a program that can help her, and her fears that are beyond my abilities. I am afraid that her reaction will either snap the few threads that she is clinging too and/or the program will lead her away from her home for good. Yes I am having trouble with that.

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I find that when I get close to a "comfortable" routine, her persona takes a 90 degree turn and I have to catch up all over again.

Uh huh Boy do I know this behavior
And I will also ditto what MB has said.
Tell us a little more about mom, who has told you she is in latter stages?
My own MIL would have been put in the same category of stages but because we actually see her routine everyday and a PCP doesnt they are more apt to label the disease worse than it really is.
Medications REALLY do help our LO's out in this, often times its a little hit an miss in the beginning when trying different meds to find a happy medium so I and others here dealing with this particular disease will tell you to never give up till you find the correct meds and also please do take her to a specialist who deals with AD.
Some AD meds actually exacerbate the behaviors in a negative way & if this is her PCP that has given her lets just say Aricept only without proper testing/in patient evaluation then he/she only has a basic knowledge of AD.
Geriatric psych is the first step in this, approach her PCP for a referral but in order to do this as MB asked do you have her DPOA? *Durable power of attorney* If you dont please get one on her, without it you are not going to be able to legally speak with any of these physicians about your moms care.

Welcome. Otto. If your mom is "in later advanced stage of alz" she cannot have "the means to take care of herself and just doesnt want to anymore." When someone is suffering from the end stage of AD, they are not able to care for themselves.

Do you have your Mom's DPOA, etc.? Does she live with you, or you with her or is she in a facility, etc.? What makes you think she is in the later stages of AD?

If you can fill us in a little more, we can be more specific.