Mom is between level 5 & 6 dementia and she refuses help. What can we do?

2 answers | Last updated: Sep 16, 2016
A fellow caregiver asked...

Mom is 91. She uses a walker. She is between Level 5 & 6 dementia. She has depression. She is no longer able to consistanly perform ADLs without assistance. She can no longer consistantly comply with taking her medications. She has had several incidents of slapping, pushing, & throwing things at staff & residents while dinning in her retirement community's restuarant. She refuses help & throws home support staff out of her independent living apartment if we schedule them to visit. She refuses to move to assisted living or higher level of care/support places to live. She will get sick, hurt herself, or someone else, or be evicted if she she can't legally be forced physically to accept help. Sometimes she goes for hours or days at a time acting more like level 1-3 dementia. What can we do to prevent her from endangering herself or othersr?

Expert Answers

Ron Kauffman is a certified senior advisor (CSA), senior lifestyle radio host, syndicated newspaper columnist, and the author of Caring for a Loved One With Alzheimer's Disease. In addition, Kauffman is also the primary caregiver for his mother, who has Alzheimer's.

Dear Anonymous Caregiver:

I'm sorry to hear of your growing challenges with your aging mom.

The behavior you describe, the increasing agitation and the aggressiveness, really need to be discussed with your mom's neurologist. It's possible that some anti-agitation medicine may be the short term solution to her acting out, and it may help with her depression, which also needs to be treated. But honestly that is just one step that may be added to the better answer to your problems.

You state that your mom is a level 5-6 dementia, with depression. But you describe a patient who is much farther down the path of dementia, in my opinion, closer to a 7. In such cases you have to be the adult and unfortunately, have to do what's best for mom "“ even over her very vocal and angry objections.

She sounds like she might be appropriate for a Memory Unit in an assisted living facility. There they can provide medication management, daily ADL assistance, and much closer oversight and care than what she's receiving at her current independent living facility.

If in her belligerence at her current living facility she injures staff or a resident you could be held legally liable. If her behavior continues to be disruptive, the facility management may deem her inappropriate and force her to be moved out. Add to that, her inconsistent compliance regarding her prescription medicines and you have what appears to be the formation of a perfect storm.

This may be the point where, for you mother's health, well-being and safety, and for the safety of others, she loses her "right to vote" on what steps are taken regarding her care and placement.

It's a tough decision on your part, but you're really running out of options.

Your first step has to be a visit with her neurologist, and bring a complete written list of your observations as well as those of the staff from her current facility. Depending on what her neurologist finds and/or prescribes, you may have to do the right thing and place her in an appropriate facility for her dementia and care.

You'll also have to accept that you'll have to face and deal with your mother's anger. That, unfortunately, is part of the role of a loving care provider. Your answer to her upset is, "Mom, I love you, and I have to do what is best for you. I'm sorry you're angry, but I want you to have the best care and to be safe."

If/when you do move your mom, be sure to share all of her "issues" with the new staff, management and nursing personnel so they will know what they are dealing with and can help your mom adjust and adapt to her new situation.

Best of luck. I've walked in your shoes and it's never easy.

Community Answers

Nana4nana answered...

When they refuse to swallow pills- thats a tough one. I asked her GP if I could crush her meds into her food- like ice cream - or whatever she loves. When he called me and i explained my problem, he said he understood and would call in a script. Then he said "I have to tell you not to crush pills since you just informed me that is your intent". I said "I understand". He added "I'm not giving her time released capsules, but a pill that you can break in half if needed". This is called plausible deniabilty on his part- he was telling me that what he prescribed could be broken up (crushed, dissolved).

It only took 3 days and she was suddenly agreeable to take her "vitamins" which I told her that she would feel fantastic again.

Her anger completely subsided and her demeanor was very pleasant. After i succeeded in getting her to swallow pills, the doctor then adjusted her dose.

She still thinks to this day she is getting multi vitamins.

Another recommendation- if after a time you notice her anger, impatience, etc is returning - DONT WAIT- CALL THE DOCTOR IMMEDIATELY AND GET HER MEDS ADJUSTED.

Anyway- remember that meds dont help Alzheimers patients make sense. Agree with all the nonsense they say or do if they are not hurting anyone or themselves. Love them a lot and learn to be still and listen. I've found asking mom about her past sends her into fond memories. I take advantage of these moments, I touch her hand or shoulder and give her lots of love. It's amazing what I can then get her to agree with. Best of luck and remember - don't crush pills ;-)