Actual decline vs. learned helplessness...

I think that's really a difficult diagnosis to make.   And w/o being facetious, some people exhibit those symptoms and are nowhere near to having dementia.  They're just lazy, or don't care about their surroundings or lifestyle.

I think sundowning is a good indicator that changes have taken place though.   

You ask about learned helplessness; did this exist before your relative segued into these behaviors?   

You stated that this relative clearly has dementia but hasn't been diagnosed.   Is there some reason why this person hasn't seen a doctor for specific determination of dementia?

This sounds like actual decline in every instance and especially in those areas where this is CHANGE from this person's norm. The purpose of OT and PT personnel in any rehab is to find ways to engage and to guide a person in self care. However I am interested in the fact that you are not mentioning short term memory issues.
Without participation on those who are well, the person in decline will likely continue in this trajectory even to the point of all hygiene, the ability to dress oneself and etc. It requires the same sort of constant guidance much in the way that a toddler does to keep the person motivated, and with some dementias there is no motivation, and in fact pushback. Certainly executive functions such as mail and bills fall away very very quickly in many cases. It is time now for an evaluation that is complete and involves the neuro-psychiatric branch as well as some guidance for caregivers in maintaining as much self caring as possible.

Does your elderly relative live alone? They may very well have the beginnings of dementia or even a very mild case. When you say the sundowning is very prominent, what happens when it starts? What do they do?
I ask this because my mother (84) when it starts getting dark often starts working herself up into a panic attack. Rocking back and forth with her hands over her face like she's crying.
I completely ignore her of course because this has been going on since she was 40 years old.
It's a performance with her. Often elderly people give performances the same as a child when they're not getting the amount of attention they want.
Learned helplessness is a real thing. Her caregiver has to make her do chores that she is able to do. Like folding her own laundry and putting it away. The caregiver may have to assist, but make her do it.
As for not carrying dishes to the kitchen. There's no reason why she should be taking her meals anywhere besides the kitchen or a dining room if there is one. Instruct the caregiver to prepare her meal then call her into the kitchen to eat at the table. Never allow meals to be taken all over the house because it will become a habit.
Please instruct the caregiver on assisting your elderly relative with ADL's like reading the mail. Or putting the laundry away. Or properly wrapping up food to store it.
If your relative lives alone and the overly dependent behavior continues or gets worse, then they can't live alone anymore. They will need a live-in caregiver or placement in an assisted living facility.

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.

My Mom has dementia and as she's declined she behaves more and more like you describe.
Dementia really destroys the things requiring multiple steps to perform.
For example when you leave a dish for her to eat later, it still requires: Taking food out, heating it up (dangerous!), putting it on the table, getting silverware, cutting it up (dangerous) and then eating...it's a multi-step project that can be overwhelming.

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.

This all sounds like a decline in cognition. Have you taken on some of these role because you have had to?
Has this person always had problems with some of these things? Starting and stopping a project can be a sign of Attention Deficit Disorder. And many of the other thing you mention might well fall into that category as well.
Some of these could be an indication of depression as well
The only way to be sure is to have an examination done by a neurologist or a neuropsychologist.

I looked back on your last post. Is this your Dad? I know my Dad would have been the same way because my Mom waited on him hand and foot. He actually would have no idea how to do any of those things.

There is some decline as we age. Maybe he just can't keep focused. Boares easily. If you have asked him to reheat something or put his clothes away and he hasn't done it, he probably never will.

That sounds like myself. I am like that, also, except once in a while I will heat up a meal. I use Hormel ready to eat meatloaf and grave because you can just open the top and eat it without heating it. The reason I can't finish the clothes after washing and drying is my joints are too painful to stand for more than one or two minutes. So, I use clothes out of the bins. Dishes? I usually don't put things into the kitchen or dishwasher, but once in a while, do. Again, It is hard to walk and hard to stand. I use a walker, but still. At my age and in my condition, I do what is EASY or quick. I don't see it as decline or dementia. I see it as NORMAL problems of aging. Yes, I misplace or lose things, even mail. I've begun to actually do my whole life from my recliner that is near the computer. I have my medicines in reach, food in reach, phone, computer. That's my life, particularly now. I've self isolated for nearly 2 years now because of fear of Covid, and I think I know what it must feel like being in a prison and being put into isolation. But, with music and computer video streaming, I think I could handle it there. No difference between that and my own apartment. The idea is to let him be AS independent AS POSSIBLE, and stress this to him. My cousin did that to me to get me to even wash and dry my clothes once in a while. They do pile up, but with incontinence, I have more washing to do than regular people. No, it is not being overly dependent. It's REAL.

How many medicines is she taking? All you described can be from the combination of medicines and their combined side effects, also.

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.

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.

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.

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……

The older you get. the more tired you get so you do less.
Then factor in a little dementia and you see they need help.
The best thing is to let them do what they can and what they want to do even if it takes them longer.
If they can feed themselves, let them even if it takes them an hour to eat.

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.

One thing I've learned with my Dad is that motivation is a big factor in what he can and cannot do. If he wants to do something then he can do a lot of stuff but if it's boring or annoying to do then suddenly he's helpless. So sometimes I have to remind him, you used the phone yesterday to call your friend, you can use it today to call the bank.

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.

Does it really matter which it is? Neither dementia nor “learned helplessness” is going to improve. All the adjustments will have to made on the caregivers side with deciding which battles are worth fighting.

Sounds like this person has dementia. He/She could benefit from an evaluation from a neurologist to evaluate, diagnose and treat the type of dementia. In early stages, most forms of dementia respond to treatment. If dementia is ruled out, then get this person evaluated and treated by a geriatric psychiatrist. Seniors are prone to depression.

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!

It's probably a mix of both. There is decline that you described and you will find that most caregivers tend to step in too early to help - because it's faster. Caregiver, even in a nursing facility, tries to get a task done quickly even though it is better for the patient to struggle a little in getting the task done by themselves. Kind of like a child. The child is fumbling with the buttons, so the parent jumps in to get it done quicker and correctly the first time. My guess would be caregivers have done things for your relative: pick up the plate when done eating and carry it to the kitchen. Now the plate carrying task belongs to someone else.

My rule of thumb is if you remove a task from someone more than once, it becomes your task and you are actually 'disabling' the person quicker. Very similar to the lift chairs. Better to let them use muscle and be a little slower getting out of the regular recliner than to have a lift do all the work and create more atrophy of the muscles used in lifting yourself up. In fact, the recliner thing is what opened my own eyes as to how we disable people we're trying to help. My mother made the comment that she did not want a lift chair because she would lose her ability to get up and down. The lightbulb went on for me to in regard to all of the personal tasks.

As for your relatives other things that she forgets or fails to follow through on, that may well be dementia at work. If she can no longer remember to open mail or pay bills, that may be a task you really do need to remove from her.

Don't assume the worst of a person especially when dementia is clearly present.

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!

A person with dementia lacks executive function and therefore anything they do or dont do that seems out of place is due to their dementia.

Their brain is deteriorating and normal function and ability for sequential order isn’t happening

I’ve wondered the same sometimes because:

When I’m home, Mum won’t initiate eating and or put dishes away. She will actually call out and say “I got some rubbish here” or “Here, I’ve finished with my plate and try and shove it to me”.

However if I’m not home, suddenly she has managed to grab herself some snacks from the fridge, cupboard and put away plates/rubbish.

I would say perhaps the task is more challenging and therefore it’s easier to ask the care giver to do it. However I try and reject at times and say “c’mon Mum, you know where the bin is and point to it. I’m not being rude but just re-enforcing the routine so that it wouldn’t be forgotten. I have observed her through security cameras if not home and I can see sometimes there’s more walking around, ie she takes the long way to the bin.

Mum is the same with laundry and she says she doesn’t care. I’ve just started putting it all in her cupboard because yes otherwise eventually it all ends up on the floor somewhere and then it makes my life harder sorting out what needs washing.

Mum is the same, dementia came knocking after losing her son. She probably had signs before but the passing of my brother really did a number.

Sandy5691: Imho, perhaps your elderly relative is well past the ability to perform ADL's. Without a dementia dx, it's difficult to say whether the individual can NO longer perform certain tasks or is just dependent on them being done for them by someone else.

This definitely sounds like cognitive decline. He's probably not brushing his teeth either. He is in need of someone in the home 24/7 for his health & safety. He is probably in need of someone to help with ADL's due to his inability to recall those steps anymore. Schedule an appointment with his PCP for a mental/cognitive acuity test & then decide what steps are necessary for him. Contact your local agency for aging for assistance.

Sounds valid for decline cognitively. possibly depression. Have it assessed.

As opposed to learned helplessness like my mother, meals on wheels and throws most of it away then complains she doesn't eat. Calls and cries that she is lonely yet refuses to go to asst. living. When I go she orders me around to show her the clothes she has and put them in her drawers . Has groceries ordered in and then leaves them spoil. Was an only child. Ordered my dad around till he died at 60.
Learned helplessness is manipulative.