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My 86 year old mom was recently diagnosed with dementia following a pretty bad UTI. Her behavior has gotten worse as the weeks have gone by. She has horrible delusions about my dad; he's an impostor and wants to cause her harm. This causes her to act out in truly mean ways. For example: spitting and slapping at him. Before all of this, she was the sweetest lady. I'm at a loss, and really hurting for both my parents, and I just don't know what to do. She also refuses to take food, water or medicine that he offers her. He's her only caregiver at night (sitter during the day). We were hoping that being at home would clear up some of the confusion, but it's just not helping at all. Any advice?

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Based on our experiences, I would agree with those above me. First, back to the doctor and make it clear what the behaviors are. Perhaps even start a journal where you write the date, time and what her behaviors were. A trial of medication that might help her calm down so she can remain at home. BUT...as I look back on all we went through with my parents, I would say it's time to start looking at qualifying for Medicaid or coming up with some more money to pay for a memory care unit, unless your Dad wants caregivers in the home at night too. Those two things....finding placement (which for us was private pay for over a year, while we used up all the 'excess' money) and the paperwork and all required to qualify for Medicaid, were frustrating and time consuming. It is going to have to be sometime, with dementia as very few can remain at home until they die. It's just too hard on spouse and family....as the person requires more like 24 hour care and doing all things physical for them. My Dad, with his dementia, went through all types of paranoid thinking about my mother. When she went to the grocery store, he would call me and tell me he was sure she had a boy friend and was sneaking around on him. He even said he had followed her to be sure, and YES she went into the store, but she followed a man out and they both drove off in the same directions in their separate cars, so he KNEW it was a plot! SO...not like him. Once he was placed and on some meds for all that agitation and paranoia etc, he now is very sweet and affectionate with Mom when she visits him.....wants to take her to dinner or have her eat with him and holds hands with her. It was so hard for Mom to be witness to his actions at home, that she has literally hidden away and denies they ever happened. But she has her own dementia and I think this denial is just her own coping mechanisms too. She only remembers what she perceives as good and that is not much these days. Short term goal: doctor, meds to see if she can calm down and stay at home. Long term goal: start planning with Dad in case she will need placement in the future. If he desires them to be together there are many AL places that have memory care under the same roof, so he could be in AL and go be with her or bring her with him whenever possible, but would have staff support with all of her needs.
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There are medications for delusions such as hers. Please talk to her doctor. I was at my wits end with my dad, until I went in alone to see his doctor, who seemed surprised that my dad was having "psychotic" episodes (the delusions and hallucinations) and put him on a medication that we sneaked into his pill routine. It really helped calm him down, but did not completely end the "people" he was seeing in his home. Finally, we got him into a memory care center where he was secure. He would not have left home willingly, but we told him he was going in for rehab for awhile. Your father deserves a better life than your mother's illness is giving him now. So do you.
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It must be very difficult for your family to see your mom this way.

I would begin looking into memory care facilities. Your dad can't go on being treated this way by his wife even if she can't control herself. He shouldn't have to live that way and it sounds like your mom needs more care than your dad can give her.

From what you described it sounds like Alzheimer's.
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She needs to go back to her doctor. Either the UTI has come back or her dementia has gotten far worse.
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