Cognitive disruption with moments of rationality equals very angry Mom. Anyone else experience this?

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After surgery for broken hip, mom emerged with moderate cognitive impairment. She refuses physical therapy most of the time. During her rational moments, she understands she can't go home if she doesn't do physical therapy. Those times, she's agreeable but those times aren't enough. I just had a meeting with the director. After 6 weeks, Medicare will not give her an extension because she has not met the guideline for progress- which is sad because she is physically capable. The option presented- she needs to be moved into a nursing wing- where she will be a patient for life. I offered her a full time nursing staff at her own home "private pay". She became angry and told me absolutely not- its her home and she wants her privacy. She wants me to return her to her home and when I explained she isn't even capable of using the restroom by herself, she told me to get out and accused me of wanting her money. She's delusional and thinks I want to "throw her away". No amount of my pleading with her- to allow me to arrange for in-home care- worked. She became irrate and called me names, and started throwing things which confirmed what the staff had documented. She refuses meds and at time food. I spent everyday for 2 weeks with her thinking my presence would help and although I made some progress it wasn't enough. I am fortunate that her facilty is exceptional and they have worked with me but now the day is here- she thinks the facility has "brainwashed me too".

Anyone have a similar issue where 50% your parent is delusional and its during the rational times they think you are betraying them? Of course she can't remember when she thinks people are hiding under her bed, there are parties in the hallway with people smoking and drinking or the middle of the night phone calls demanding I come take her to the bathroom. My heart is breaking.

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As countrymouse said; post surgery pain meds (Vicadin in particular) can send someone over the edge of rational thought, especially when those meds are cut off. My mother literally hissed at me like a snake.
A low dose of Zoloft (25mg) is a good place to start. She may sleep a little more but calming is better for her as well as you. There is such a thing as traumatic dementia. Consider this as a condition before putting her on anything strong permanently. She MUST be evaluated first before any meds are given but this may be a temporary condition. Discuss this possibility with the doctor.
God bless you both; keep you in His hand and under His wing.
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There are meds that can help with dementia - but there are also meds (and possibly post-surgery complications?) that can cause bizarre symptoms. Is your mother being given hefty doses of pain relief meds, or anything like that? Was the surgery straightforward?

If you have every confidence in her medical team then the last thing I'd want to do is undermine that. But to me it's a bit too much of a coincidence, if you're sure she was fine before the hip surgery, that she "emerges" with this array of mental symptoms. I don't know the circumstances, of course, but if it were me I think I'd want to hit the 'Pause' button and get her reviewed holistically - ideally with input from her own PCP/GP or other doctor who knew her well prior to the hip break - before any irrevocable decisions get made.
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Nana: Babalou is right. I don't know any 'related' caregiver that hasn't had that thought..."but I don't want my loved one all doped up on meds". However, Bablou spoke the truth as I have recently learned. There is a real danger to them each time they have an 'episode' (I call them). From physically harming themselves (falling) or worse...having another stroke! It may take several experiments with different meds to find the effective ones, but you will. And she will have a much more peaceful end of life, which is what we all want for them.
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Nanny, my heart goes out to you. Yes, go get the Guardianship, we had to with MIL because she insisted she was going home and we knew that was impossible. Check your own BP, and if you need BP or anxiety meds from dealing with this, get them. It helped my SIL cope with her mother.
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Nana; My heart goes out to you! This is very tough when the people we care for the most think we're trying to do them wrong. It's very easy for us to say "don't take it personally" but it's like daggers when it's going on. Sometimes, you just have to go out of their room and either laugh or cry hysterically; I did plenty of both when mom was in rehab!

My personal opinion? Your mom would be better off, at least short term, in a facility with personnel trained in dealing with dementia patients. When a patient is at home, even with the best caregivers round the clock, many seem to find ways to escape, to "fire" the caregivers, to call the cops and get their relatives and caregivers accused of abuse. In a facility, there are many eyes and generally an abundance of training.

I can't say enough about the benefit of psychiatric meds; I know, I know, we all want our parents to be on as few meds as possible. But for my mother, the constant anxiety, agitation, worry and hysteria were going to cause her to have another stroke. And there was NO amount of reassurance in the world that we could give her that there weren't dead bodies being transported into her room at night, that there wasn't a flood every evening; that there was an evil union coming to take over the facility; that she was responsible for getting her own meds (this was while the nurse was sitting at her bedside, giving her meds, telling her what each one was; mom announced "and you know I have to take care of my own medications! I asked her what she meant and she pointed imperiously to her plastic water pitcher! That explained everything!).

We transferred her to a lovely assisted living facility (she tried to grab the steering wheel from my husband; please do NOT try to transport your mom yourself from here on in) Unfortunately, she broke her hip, because she couldn't remember that she wasn't allowed to get up without assistance (there were two aides in the room at the time) and is now in a NH getting good care. She's had several bouts of pneumonia which they've caught early.

You're among friends here. I wrote the above not to scare you, but to give you the benefit of my experience. Yours may be completely different; we are not professionals here, just folks in the trenches! Best regards to you and your mom.
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Thank you babalou- although I have the POA, I was wondering about guardianship because their was a moment when mom refused care she needed and I was told that if she refuses ANYTHING, I don't have a say because the POA keeps her primary. I do need to speak to a professional as I'm on new ground. TY for the tip on meds- although I have done my best to keep her med intake minimal bcus she's hardly taken an aspirin in her 91 years- my heart breaks when she is so afraid. I took care of her for 2 years everyday and she now thinks I'm abandoning her and can't see her current state is beyond my ability. It is so sad too because I had a staff of 4 qualified caregivers ready to keep her in her home- but she doesn't want anyone invading her privacy at home and told me she will "fire them all". Boy, this is a hard time. This experience has really opened my eyes to the tough decisions all you beautiful people are faced with. My care of moms problems evolved over night to a sad, sad level.
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Get the geriatric psychiatrist in to see her. There are meds that can help. Are you POA? Consult with her lawyer about what you can and cannot do as POA, ie, can you mover her to nh, hire aides. Sadly, you nay need to seek guardianship.

Also, consult with sw staff about backing off and letting her settle a bit without your assistance. We went through this with mom, post stroke and after vascular dementia was diagnosed. Fortunately the delusions and paranoia with regard to us abated. But it's heartbreaking while it's happening.
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