My mom's "inner clock" has slowed down and her antidepressant medicine has helped slightly but she still spends all day sitting in a chair. What can I do to help her?

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My mom (88),who lives next door with my dad (90), suffers from some type of dementia and/or depression which has drastically changed her in the last 8 months. She doesn't initiate anything for herself, her appetite has decreased, attention is easily distracted. If she gets through a meal (which she often doesn't finish), it takes up to 4 hours without someone cuing her.
She gets angry at Dad's suggestions, and when he goes outside, we find her still sitting at the table hours later. My sister and I are both very busy but helping them a lot with meals, laundry, etc. Neither of us can be there all day, and just calling on the phone doesn't help much. We're in between caregivers, but she balks for them, also.
Would a routine be helpful, even if it takes more work? (i.e. Exercise at 11, work outside at 3). Her antidepressant has helped slightly and she was taken off another med that might have affected her appetite, but she has lost 30 lbs. in 7 months, no turnaround yet.

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It's possible that a different antidepressant should be tried. Some work better than others with different body chemistries. Also, dementia is part of the behavior. You are doing everything right - routine is good. Seeing a doctor. Encouraging her to eat. But she may be getting to a place in her life where she will need a nursing home (which both of your parents will fight). There's only so much you can do, but keep working with her doctor. He or she sounds smart - taking her off meds as well as trying new ones is a very good sign.

At your mom's age there could be several reasons for this change. I hate to hear it's gone on 8 months with no investigation. She could have a urinary tract infection, had a mild stroke - or several mild strokes. Anemia can also cause fatigue. Take her to a physician and tell them exactly what you told described above - ask for all the blood work possible, blood pressure and check for various infections.

It's hard to hear but it might be time for a nursing home. My own criteria for saying that over recommending assisted living is their advanced age and the fact that you feel they need someone with them all the time. At that point, it's too much for assisted living. If you see some improvement in your mom, then assisted living might work well for them. At either place they can probably share a room together which may make the transition easier on them. Best of luck to you and to them.
I should add that Mom's internist has been excellent, is trying whatever she feels might work, while taking Mom's increasing fragility into account. This all happened relatively quickly--was on low dose steroids for inflammation last fall, diagnosed as diabetic in Dec., went on Metformin in Jan., then off it a couple weeks ago to try to help appetite and stop weight loss (her blood sugars are not that high, and the weight loss has made Metformin less necessary).
She had a TIA in Feb--at that time they found evidence of previous strokes, so she most likely has a type of vascular dementia. Last fall when we were concerned about her (less severe) memory loss, the dr. put her on Lexapro, felt it was mainly depression. Now she is on Remeron (just bumped up to 30 mg) and again Lexapro (5 mg) to help her appetite and mood.
I know assisted living might be needed sometime; we had considered moving in with them before that is necessary. After all her system has been through, I hope part of this may be depression from stroke and diabetes. Hoping in a few weeks we might see at least some desire on her part to "do" things (like eat better, walk around). Her behaviors and perceptions of things aren't what I think of as Alzheimer's (at least not later Alz.), she mainly loses track of time and details of short-term memories and has become a listless spectator, rather than a participant.

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