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My elderly relative has not been diagnosed with dementia but clearly has it. Sundowning is very prominent. We have good days & bad days, as far as cognitive function. There is a subtle downward trajectory for sure, but we still have many lucid times & meaningful conversations. My question is how do you differentiate between a person's actual challenges, and learned helplessness? Examples:


* rarely initiates eating and does zero food prep (will not make a sandwich, or toast, doesn't serve a portion from a larger dish of something, rarely will heat up a plate left in the fridge) but eats when it is served.


* doesn't put clean laundry away...just takes from the pile which inevitably ends up strewn around/tipped over.


* doesn't carry dishes to the kitchen or put things in the dishwasher


* doesn't cover food appropriately


* misplaces mail or doesn't open at all


* stops and starts tasks without finishing them, often


I'm curious if it sounds like this person has become overly dependent on their caregiver, or if they are suffering from age-related decline and just need additional support.

In early stages we also questioned moms ability. I thought she was looking for attention. It caused me some frustration. I gradually learned she had little insight and struggled a lot more mentally than she told us. I have decided that at nearly 88 she has little life left and the inconveniences she causes me are really small. Other than nonstop doctor visits that she has always liked going to I honor most of her requests and needs…Someday soon I will hope she was alive for me to cater to! Just my thoughts……
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karenchaya Oct 22, 2021
OMG, you are SO ADORABLE AND SWEET and KIND. I wish I had a daughter like you. You are an ANGEL!!!!!!!!!
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Karen with all respect and sympathy the difficulties you experience are related to your numerous, very challenging health issues. They are not inevitable aspects of aging, not by a long chalk. And anyway 74 is not old.

To the OP - when supporting clients, we record their abilities in broad categories, thus:

I - independent, the client is able to carry out a task without assistance; not necessarily to a high standard, mind, but well enough that it does get done.

P - the client is able to carry out a task once prompted, encouraged, or verbally assisted. For example, we might ask whether a client has taken her medication; we might do a spot of cheerleading to give her confidence to stand up by herself; or we might confirm that a client has read the instructions on a packet correctly.

M - the client needs minimal physical assistance to complete a task. For example, the client can mostly dress himself but needs support to get his underpants over his feet. The key point here is that without the "M" support the task would not actually get done, even if the help required is nothing much. In this case we'll be looking for techniques or gadgets that will enable the person to manage alone.

F - full support. The client can't currently perform a task such as preparing a meal or washing himself in the shower. This category is further divided into AO1 and AO2 - assistance of 1 or 2 people respectively. I always record how far the client is able to engage in the task, though, because this gives us something to build on, and reablement principles can benefit all care receivers no matter what their level of disability - it stops people feeling like passive objects and reminds everyone present that this is an individual person we're dealing with.

If you suspect that your aunt can do more than she currently is doing, the best way to find out is to ask her. You mention meal prep as an example: I have a client who claims that he can't remember how to make toast, but if you make the toast and sit him down at the table with the butter and the marmalade he's perfectly happy to spread it himself and has no difficulty with it. Next time I'll hand him the bread and see if he makes his way unthinkingly to the toaster - I'd almost put money it. However, if we weren't there I doubt he'd even enter the kitchen. So, can he make his own breakfast? Probably. Will he, left to his own devices? Almost certainly not. Should he be encouraged to engage in meal prep? Absolutely!

Every task has component steps, and usually far more of them than we're conscious of in the everyday. Breaking tasks down and spotting where the hitches are can be a very interesting and revealing exercise.
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karenchaya Oct 22, 2021
You are BRILLIANT. What a WONDERFUL answer. I am in the "M" stage, and yes, I have lots of gadgets to help me. I have a sock "Put 'er on" thing that pulls up my socks and a long handled, metal shoe horn to help take off compression socks. I use a walker that has a seat and brakes for indoors and a mobility scooter for outdoors. I have an electric recliner to sleep in when I can't lift my legs to get into my hospital bed. I bought a child size toy broom set so I can sweep the floor around where I am sitting by my desk. Because how many and which medicines I take daily depend on what my testing numbers are (blood sugar and blood pressure), I can't use those weekly do it on Sunday pill boxes. So, I taped meds that go together, together with wrapping tape as a "set" of meds, so I can pick up each set and decide which one in the set I need to take based on the results of my testing. I have glucose tabs in each room of my apartment in case of a low blood sugar sudden drop. For incontinence, I have devised a whole set up in my bathroom for where the underwear goes, where the pads that go inside the underwear goes, and a place for "rags" which I roll up as "burritos" to stick over the pads which go over the underwear. For my itching skin and sores from the Lymphedema, I have various skin meds and lotions both at my desk and in the bathroom, and also in the basket of my mobility scooter. Recently, I had to buy special silverware for arthritic hands that has rubber over the handles. Yes, you are SOOOO right. I thank God for "devices". And for food, I have it delivered to me, and also our Office on Aging in my city sends me one free meal a day.
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I am 74 and have numerous medical conditions including CHF, COPD, Diabetes, Osteoporosis, Arthritis, etc and my joints are losing their synovial fluid, so the bones rub against each other. I DO ALL THE ABOVE that was listed and I DO NOT HAVE dementia. I have OLD AGE. Guys, listen up. BEING OLD is no joke. Those things that seem NORMAL to you get VERY, VERY HARD to impossible. That doesn't mean dementia. But, it does mean YOU ALL have to step up to help when you can, without feeling DISDAIN and DISGUST at your old person. This is not just for you, Iamexhausted. It is for EVERYONE READING this thread of an issue. OLD, OLD, OLD years are NO JOKE. What is forgotten is mentioning how HARD it is to take out your own garbage when you get like me.
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Sadinroanokeva Oct 19, 2021
I am so sorry Karen. People seem to be unable to understand everyones body ages at different rates. I have learned watching my mom that we need to not judge what they need but to help as best our aging bodies can. My moms nearly 88…I am 70..I have bad painful back days {8 damaged discs and I look normal} that make my helping more challenging..I slowly get moms needs met. I hope your needs get met. God Bless you
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Yes, it is EXHAUSTING for you to watch your old person deteriorating, and you having to take up the slack. The alternative is they DIE. Do you want that? I don't know how they are in character, but I told my family to please help when and how they can, and I love them even when they can't and don't. I KNOW it is not up to them to do things for me, so I push myself to do what I can, even if it is very slow and not every day. I do have a walker, but I also have to grab onto walls, onto handicapped bars on the walls, onto furniture, and be ready to sit immediately when my knee cracks and I almost fall. Some things I just CAN NOT do at all, so they wait for a month until my cousin can come and help me with those things. He can only come once a month, or every month and a half. I APPRECIATE it. I hope and pray your old person APPRECIATES all of you for what you do! It is selfish if they don't. And, it is selfish if they demand. Tell them I said so.
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The older you get the less "work" you want to do. If someone else can do it for you, you let them. It's kind of "what came first, the chicken or the egg?" You can encourage your loved one to do things independently, and if they want to and are physically able they will. It's good for them to use their mind and physical skills. However, it is very likely that left to their own, they would not have the motivation or will to do them. My wonderful mother - who never sat while she was younger -gradually forgot how to do the simplest of chores, yet still remained funny and charming and full of good advice. I raised the same questions, then learned to accept the fact that her will and her mind were altered in ways she (and I ) could not control.
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I feel there are a few factors at play.

Caregivers, by nature, want to care, help, ease burdens, but can sometimes unknowingly trigger an enabling loop for the Senior to establish expectations based around their Caregivers’ support style.

Now, if the caregiver(s) is receptive to feedback - I would challenge them to take a more inclusive approach to your loved one’s abilities in the day to day.

Some examples of this could be,
-“Let’s do this _______(task) together”.
-“Can you remind me/help me/show me how to to this [task]?”
-“I wonder what’s in the mail today! Let’s find out!”

With engaging the Client and including them in these day to day tasks, you may quickly find your answer of whether it’s a true decline or dementia disease progression vs. the learned helplessness cited.

I also would not rule out depression as a root cause of what you explained.

This is an under-asked question.

Many families will make the assumption of physical/cognitive decline and fail to consider other factors as you did.

I hope you find answers here that best serve your loved one’s needs!
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kevinwu Oct 19, 2021
I really like the idea of engaging and including the person in the task as a way to test whether it's true decline or otherwise.
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All of these sound like my mother.

She was starving herself to death. She managed a bowl of cereal, and a dish of ice cream per day, and that was it.

Her condo became filthy.

One of the effects of dementia is lack of initiative.

Besides the “want to” that can disappear, the “how to”, can leave as well.
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I can't say for sure because I am not qualified to make the diagnosis, but my mom also has all of these behaviors and was diagnosed with dementia a couple of years ago. Like you I am often confused whether this is just helplessness or the disease. In the past two years since she was diagnosed, I have come to see these behaviors as progression of the disease. It's not that she doesn't want to do these things, it is that she is becoming increasingly less capable of doing these things.
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karenchaya Oct 19, 2021
I am 74 and have numerous medical conditions including CHF, COPD, Diabetes, Osteoporosis, Arthritis, etc and my joints are losing their synovial fluid, so the bones rub against each other. I DO ALL THE ABOVE that was listed and I DO NOT HAVE dementia. I have OLD AGE. Guys, listen up. BEING OLD is no joke. Those things that seem NORMAL to you get VERY, VERY HARD to impossible. That doesn't mean dementia. But, it does mean YOU ALL have to step up to help when you can, without feeling DISDAIN and DISGUST at your old person. This is not just for you, Iamexhausted. It is for EVERYONE READING this thread of an issue. OLD, OLD, OLD years are NO JOKE. What is forgotten is mentioning how HARD it is to take out your own garbage when you get like me.
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We will do things all the time that don't really want to do because we can reason out the consequences of inaction - if I don't eat properly I'll be less healthy and it may lead to obesity, diabetes, heart disease - if I don't open my mail I'll miss payments and lose services - if I don't do laundry I'll look unkempt and smelly and people will avoid me etc.
In some dementias a person can seem to be fine in other ways but they've lost their executive function: the ability to put together what is happening now and the consequences of that action/inaction and the ability to make plans and execute them.
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I am not a doctor but your experiences with your mom are very similar to my situation with my mother. A couple of yrs ago I took my mother to a specialist who said she didn't have dementia. She advised my mom to be more active socially to keep her mind intact. Unfortunately after the death of her long time friend my mother was very lonely and isolated. My mother is now 93 and her memory is very poor. She hasn't been reassessed but I'm sure she now has dementia. She now lives in a retirement home where there are people to talk with and do activities with. My advice to you would be to encourage your mom to socialize and do things that help the mind. Social isolation hastens decline in seniors. It also wouldn't hurt to have her dr. review all of her meds. I hope this advice helps. Good luck to your mom and you. Growing old is not easy!
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