Thank you for asking this question. You are learning to listen to your mother, even though she is not well. So many families have shared their stories. When I listen, I may only hear Alzheimer's and refusal of care.

Does she suffer from Alzheimer's or from some other conditon? Reserve your judgement. The important point for you right now is this: Your mother has a strong will. Her life has not been easy.

Don't try to oppose her now. Try the light touch.

Spend some time engaging in activities that you know she enjoys: tea and cookies, coffee and doughnuts, looking at birds, going for a ride.

Try to get your mother talking about her work, the physical therapy or the nursing home. Try to find the parts of her life that she feels good about. Let her air some of her regrets.

Find what makes your mother more relaxed.

For now, don't try to plan ahead. Don't oppose her unless you have to, even if her personal appearance starts to slip. When a need arises that she accepts as real, she will see a doctor or accept some care.

But a word of caution. If your mother becomes too restless or you feel that she is in danger of wandering, you will have to act. You will have to say, over and over, "Mother I love you, I don't want to go against your wishes, but I am afraid that you will run away. I am afraid that you will get hurt."

Sometimes listening means letting a person talk, hearing what is said and then listening to a bigger view. Listen to a combination of professionals, ministers, friends and family. If you decide that you have a job to do with your mother, don't hesitate. Listen to your heart. Get the support that you need to do what needs to be done.

One of the questions I hear most often is "How do I get my family members and/or the patient out of denial?" This query concerning a reluctant patient refusing to get medical attention is also at the top of the most-often-asked list. I think the two questions have a great deal in common. Denial serves a purpose. It protects us from having to deal with the truth - at least for a brief time. Refusing medical visits does the same; it keeps us from having to make plans and to face the uneducated horror of dealing with a disease such as Alzheimer's (AD). In fact, the earlier the diagnosis, the easier the trip. The more information we gather, the easier the journey. One of the major reasons for wanting a diagnosis is to rule out possible treatable causes of your parent's decline. Many medical issues can actually mimic the signs of diseases such as AD but are readily treatable and frequently reversible. The quicker they are discovered, the quicker treatment can begin.

Having talked to hunderds of early stage patients over the years, I believe almost every person experiencing intellectual decline is aware that something negative is happening and that the failing ability to function is not a normal part of aging. Some seek more information from friends and family and online, some rush to the doctor's office, some do not want to discuss it at all. Perhaps your parent is in the last category where most folks feel if they ignore the manifestations, it is not real or really happening to them. As a person with cognitive issues, a diagnosis pushes us into admitting our ongoing demise and forces us to admit we may need help.

There may be no way you can make your parent go to the doctor but there may also be some paths to pursue that could be fruitful. First, try asking her to accompany you to the doctor by suggesting you have a medical problem and would like her to be with you. Find a physician who will work with you in this bit of subterfuge. Your local AD chapter may know the best physicians to contact. Be sure to alert the doctor before your appointment and list all the changes you have noticed over the past year. Secondly, suggest to your parent that you are concerned about her blood pressure, or a previous illness, or a disease that may run in your family and ask her to check it out 'for you'. The less focus on your parent's cognitive issues, the better!

Consider her long -standing personality. If she has always needed to have a sense of control over her life, don't expect this to change. This just may be her last stand against perceived interference by family and others as she feels the power to direct her own life slowly slip away. She may think of it as myself defense.
You might also consider using another person as the scapegoat. Frequently, AD folks and other elders will do something for a stranger that they refuse to do for a family member since there is no history of parent/child behavior to rebel against. A Geriatric Care Manager may be a viable choice as they have training and practice in loving manipulation. Check out www.caremanager.org for further information on an experienced professional in your area.

Try not to reason with your loved one related to the need for a docor's visit. Remember, her ability to think rationally has been impacted by whatever is happening to her intellectually and the ability to reason is affected early in diseases like AD. Trying to force your parent to deal with an issue rationally may only increase her obstinance. The accuracy of the information you offer is not half as important as helping her maintain her self-esteem and sense of control.

If nothing seems to get her to the doctor's office, seek a physician who might make a house call - Yes! They do still exist!