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When dementia based behaviors mimic previous dysfunctional behaviors, how do you separate the two? Now the folks are ill, so intellectually I know the behaviors are out of their control. However, growing up, some of these behaviors were also exhibited in the family dynamics ( explosive outbursts, OCD, belittling, denial, passive aggressive actions) so the behaviors are familiar but the cause is not the same. When I have the knee jerk response to the negative behaviors it is inappropriate given the circumstances have changed. Any ideas of how to interact positively when dealing with the people now suffering from moderate staged dementia who can be combative and have no reasoning skills left?

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Alzh, from what I've read on these boards, it's very often the "unloved child" who stays the longest in an untenable caregiving situation, always hoping to win love.

It doesn't seem to happen often.
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Funny how life works. I wouldn't say I was unloved but will say it was hard to feel loved with yelling, stress, and family dysfunction.
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People don't fall into dementia all at once. They grow into it. If someone was abusive before dementia, they'll most likely be an abusive person with dementia after. My mother is the same person she was before dementia. The dementia has just made it worse.
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You are all affirming my situation perfectly...I am hearing the same cruel words today and remembering the deep hurt and confusion as a child stuck in a sad, dark home. Mom is sober now at 88 but the dementia mimics her alcoholic blackouts full of terrifying angry outbursts, criticism and exhausting demands. As a little girl I just couldn't put it all together. People have stated I have all the earmarks of an abusive childhood. Today I have acquired the tools to defend myself and my own home.. a sanctuary to walk into safety!
She no longer has the control switch..I am free, though her Alz symtoms grow daily. Very sad to watch. My brother finally overdosed for the last time 2 years ago. He was her favorite. Its ok.. my faith is healing all my hurts. I walk out of her house when the vitriol starts and release her in love.
This has been quite a journey..may my healing and recovery encourage others that there is a way out of horrific dysfunctional cycles of abuse.
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Also, my childhood was a horror show of abuse - physical and emotional. At some point I realized it wasn't about me, and no matter what I did or didn't do, I would never change her attitude towards me, so I stopped bending over backwards to try to get her approval. When she said terrible things, my inner voice said "that's your opinion - no one else has that opinion of me" (not daring to say it out loud). I have to say, realizing that she was mentally ill and I was simply a victim, helped with my self esteem. The worst part was then getting into relationships that mimic'd her abuse, until I again learned there was no pleasing them and I was repeating a pattern (THAT is something in your control - don't let it happen to you!). I took assertiveness training which helped tremendously. I also found ways to calmly and coolly respond - for instance, in response to a running list of putdowns "those are very kind and encouraging words to say to someone you supposedly love". (I did not want to step into the gutter of responding with my own putdowns). When I was told I was deficient in some way or that "no one" liked me, I would respond that he seemed to be the only person with that opinion, since everyone I knew had totally opposite opinions, and that while he was entitled to his opinions, I did not have to listen to them so please keep them to himself. (That coming from someone with NO friends; me -- I am blessed with so many wonderful, kind people who are there to help me in a heartbeat - so grateful). The key is to not internalize those repetitive negative comments about you. That will give you the strength to let the comments go - just meaningless words in the air. Or try my responses - it usually leaves them in a quandary when they can no longer push your buttons. Or even try saying "That may be, but I still love you." If they say "I hate you" say, with a smile, "you are entitled to feel however you want, but I still love you." You would be amazed at the effect it has.
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Alzh - my mom's reality: yesterday she told me she could use a vacation!
She lives in a Memory Care facility where her every need is taken care of by staff. And the things they don't do, I fill in with. A vacation from what I'm not sure.
On my one day "off" this week I spent it placing orders for her for winter clothes and Depends, paying her bills, making phone calls to her insurance company, her Medicare plan, pharmacy, etc. So I guess I could use a vacation too.

Yes, my mom's reality is that I'm here to serve her. She's always been this way. Alzheimer's has just enlarged the pedestal she puts herself on. My coping mechanism is to do what's necessary and head for home when she gets nasty. When I feel the situation falling into her old patterns of putting me down and having no interest in anything but herself I have a hard time saying it's the disease - just too familiar. So I say to myself "some things never change" and count to 10 as I'm imagining myself on a beach in Hawaii.
I also have siblings that are not engaged with the day to day of mom's care. They get to live in their reality too. One of them still doesn't accept the Alzheimer's diagnosis after seven years.
It's hard to not let it get to you. The baggage from childhood tips the balance some days and then I take a mental health break and do something for myself. Even if it's just a cup of tea.

I say in your situation - speak some truth to the fact that you won't tolerate abusive behavior. It'll make you feel better to stand up for yourself - something we couldn't do as kids.
Back to the beginning, I told my mom that I'd be taking my vacation first and when I got back she could go on hers. It actually made her laugh.
But for more practical tips on dealing with the dysfunction -- in the moment -- change the environment by distracting your parent. Give them a treat (I keep small individually wrapped chocolates in my purse), turn on tv or turn it off, even just adjusting the blinds or opening a window can change my mom's tone. Sometimes all I can do is say "sorry, have to use the bathroom. Be right back." Then I stay in there as long as necessary. And I take out the trash a lot - her waste baskets are always empty. It was one of my hated chores as a kid. Now it's a respite.
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Thank you all. Yes, I am removing myself from a no win situation. I guess it's so ingrained to be the good daughter at all costs.
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That is the truth. Women are especially made to feel like they're doing wrong if they can't care for their parents. Sometimes it isn't possible because of finances. Other times it isn't possible because a parent is too ornery. Taking care of someone who was abusive or neglectful, I think, is going beyond what anyone should expect of an adult child. If someone chooses to do it, it is out of the goodness of their heart and will most likely be unpleasant for the caregiver.

BTW, sometimes behaviors get better as dementia progresses. My mother was particularly mean up until the past year. Now she is just mean sometimes, usually when she thinks I'm trying to control her. (Asking her to take her sugar reading can set her off now. She's diabetic, so it's a necessity, but she sees it as nagging and controlling.)
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My mom was exactly like that. I won't say she was a "bad" mom. I knew she loved me and I was very wanted. However, she was always negative, paranoid, dramatic and had no real friends. When she was first in the grips of dementia, I didn't even notice. It wasn't until she became truly delusional that I realized something was wrong. I wanted to be a good daughter, just like you. But I knew it was time for me to become the parent because Mom had become a child. It wasn't easy. As an only child, and a child of the 50's and 60's I had a lot of rules to follow, most of them centered on respecting your elders and obedience. But at some point, I realized it had to be done for my mom's welfare. Mom was only physically combative when she had a urinary tract infection. But she prided herself on nasty remarks and sulking to get her way, like a bratty little child,which, even at the age of 92, she was. There really is no way to separate the behaviors because this disease is so unpredictable.
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Most important is to get a geriatric psychiatrist and provide the background information, as well as current medical records. They can determine which medications are best for the behavior, taking their physical condition and current meds into account. I had the same issue to deal with - a lifetime of paranoia, never treated, was attributed to alzheimers. With the proper medications in the right doses, a marked improvement and stability in emotions. Also, always check for UTI's with any increase in aggressiveness. I only wish that the person, who I love dearly, had been willing to get help and meds early in life - it would have saved a lifetime of crying and being terribly upset thinking people were talking or saying or doing bad things directed at my loved one, who is now happy for probably the first time ever.
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