Balancing safety and independence. Any advice?

When you say she had a neuropsych, you mean 3 hours of paper and pencil testing?

If no, that's what she needs. If she had one several years ago, it's time for a follow-up.

Maybe get a tracker device like the ones you put in luggage to put on her scooter. You may be able to hide it where she won’t see it like under the frame somewhere. If she goes missing you can track her with that.

I have found that you have to pick your battles. When my father was first diagnosed with ALZ I was in high alert about every little thing. Now, I realize that I can only control so much and the only way to keep him completely safe would be to be glued to him 24/7. He lives alone but his girlfriend is there on the weekends. I live far away from him and I don’t plan on upending my entire life to move across the county to live him him. His dignity and independence must be weighed against his safety. I know my father, and the former is what is winning out. For now. He will never, ever, agree to placement so I wait. I will have to wait for an event that triggers placement and I will have to deal with the fallout then. You sometimes have to let go of what you can’t control.

Regarding Mom's independence & your own anxiety trying to keep her safe. While I haven't found a simple answer or solution, I have moved to a position of;
- doing what I can
- letting the rest go

Under the 'Doing what I Can' heading was arranging an OT for a Safety Ax to suggest equipment & home improvements. This also included a Functional Ax. This concluded things like supervision was required out of home (by family or a paid aide), personal care assistance & a meal service would be beneficial.

Of course there were many refusals - I imagine will be for you too.

Under the 'Letting the Rest Go' heading I have now filed things like cancelling services, refusing hygiene, buying unhealthy food, choosing to go out without assistance, falls when out alone, falls when home without using equipment.

My LO has not sustained (yet) any serious injury.

I feel for you regarding your Mom's serious accident & the worry this causes.

Choosing between safety & independence IS hard.

I have tried to put each activity into a sort of risk matrix. How likely is a bad event & at what severity.

So without taking away or stopping activities (I couldn't anyway) I have tried to;
1. identify the most dangerous
2. reduce any known risks
3. increase safety measures

That could translate to taking a trip to the mall with Mom. Examining the pathway, choosing the best crossings with her. Trialling a support worker x 1-2 morning /afternoons per week to go with her.

Just my initial thought. Others may have more..

As time goes on, you may find you need a little sneakiness to add safety in 🤗

A stroke can cause Dementia as can years of drinking. Not being able to reason with her is a sign of Dementia. Dementia is not hereditary. IMO its caused by life style and somekind of brain damage caused by an accident. ALZ is hereditary.

I think my Moms Dementia was from years of Hormone therapy from having a hysterectomy and the use of Statins for cholesterol. A head injury at 83 progressed it.

No point in reminding your mother of her alcohol abuse or of her limitations. Assess what her needs are now and how to best keep her safe.

You can't keep your Mom in a bubble. If she has a scooter, Mom will go. Would it be possible to ask her to call you before she goes out and when she returns? Could you leave a note with your number on her scooter? This would be a reminder for her, also a number to call if she is injured or lost.
Could you accompany her to the mall, maybe once a week for a meal?
I suggest that you not bring up her drinking past, it can't be changed and only causes her to become defensive.
Best wishes and let us know how things work out.

So sorry you have this hard situation. You have identified the problem very well - safety vs independance.

Re: Dementia and Alzheimer's. Only a small proportion is hereditary (mostly a certain type of Alz).

However, stroke is a known a common risk for dementia.

Dementia is an umbrella term, covering all the sub-types - Alzheimer's being the most known & common. Vascular Dementia is 2nd most common but less known. Dementia is just a term for damage & it it really depends where the damage is to what functions a person has trouble with.

Eg my stroke survivors LO has trouble with spacial awareness, processing & some memory. How does this plate fit in the fridge? (Not Alz - I can't find the fridge).

Very very hard for a Doctor to pick up in a short cog screening test. Can name the President, the day/date etc. But close family WILL see it.

So despite not knowing you or your Mom, I totally get that you will see 'holes' in her thinking.

Vasular Dementia can be caused by any of the reasons for stroke (a vascular event). Blocked arteries, high chol, micro brain bleeds.

Important to know, a person will not know or feel this. Cannot feel this micro stuff in their brain. Therefore from their perspective, THEY are normal - YOU are the crazy one!

This *lack of insight* is called Anosognosia. Have a look at the care topics for this & see if this helps you.

https://www.agingcare.com/topics/295/anosognosia/articles

Dementia from a stroke can coexist with Alzheimer’s or another type of dementia. If she’s been a heavy drinker, that’s another source of brain damage. With all that going on, no wonder the dots don’t line up. If you could have a discussion with her doctor or at least send doctor a note, that might help the doctor to set limitations so they don’t come from you. She’d be better off in assisted living or memory care, and you’d have life easier if she’d go. Sorry, it’s sad, but I don’t see this going anywhere good.

Dementia can be caused by strokes as well as Alzheimer's disease and Parkinson's disease. You have described that she has judgment impairment that is suggestive of dementia., Please get her a referral to a neurologist for further evaluation and treatment. She may have had another stroke or developed Alzheimer's disease on top of her prior stroke.

No matter the cause, you need to put plans into action to protect her from her own poor decision-making:
1 - She will need to have a chaperone for all her adventures out of the home.
2 - You will need to make sure her bills are paid (get as many as possible on auto-pay).
3 - You (and she) will be better served if mom uses a reloadable debit card for her purchases rather than a debit card, credit card or checkbook.
4 - Create a streamlined home. She will be less likely to "lose" things or have things "stolen.
5 - Create a consistent schedule of daily activities for mom... consistent time for meals, consistent times for bathing, consistent times for sleep and wake, consistent times for "outings".

I talk to my Mom health care providers when I am in this situation. I am overly cautious about her mobility and in general they are more open to her taking responsibility for her movement. Basically I get a second opinion because I too want her safety and less stress for me worrying about her when she is out but I can be unfair.

We negotiate on things like taking her cell phone and answering it, but there are other things you can do, like find my phone service, put a cell based GPS tracker on the scooter, and she can carry a remote fall button. My Mom was very ill and fell, and she had her fall button but did not press it. It was an important discussion we had that this button is there for her to use, so please use it. Same with her cell phone and she was lost, there is a big call me button to get help, and second time this happened she used it but when she called us, someone in the area heard her and helped her get back to where she should be.

Some days my Mom is not making any sense, something is not working and this is very frustrating for her and me, this is pretty normal for anyone and my Mom has aphasia, so just trying to have a conversation about what does not work is a challenge. Keeping routines in place is very important for us, the more routines, the less stress she has, getting good sleep and eating well seem to keep these incidents reduced. Stress and changes are very disruptive. I also try to reward good behaviour instead of focusing on negative past behaviour.

Hope this is helpful, to reduce your anxiety over someone else activities, you can talk to people, this is something that you must address for yourself. You do not control anyone else behaviours, you can provide a safe environment for your parents but if they are able and still have choices, they will make a call for help or not.