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Any hospital stay requiring pain medication or anesthesia can alter brain function (fog) and last for quite a while, sometimes several months.

Her General Practitioner doctor did not diagnose our 87 year old, we had the GP give us a referral (after they did a cat scan) to a neurologist (then to a neuro-psych) who then gave her a neuro-psych evaluation.

If their answers seem to general, like I ate left overs, means they are not remembering what they ate or likely did not eat, or weight loss from not eating...
Repeating themselves, asking for things over and over, in dementia the short term memory goes and boy does it go...(ex.) The baby shower yesterday is forgotten as soon as they walk through the door of their house, where have you been? I have been here all day with you...

Get a medical power of attorney, by all means...


During dementia the brain shrinks...
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Definitely get a POA ASAP. A durable POA is preferred because dementia is a slow decline and there will be many things your mom will be no longer able to do as the dementia progresses though, overall, she wouldn't be considered incapacitated. For example, my dad cannot make a logical decision about his cable plan (he signed up for internet even though he doesn't have a computer or know how to use one). I was able to change his plan to just TV and phone because I was POA (they wouldn't make the changes without that).
So, a durable POA is the most useful, but if a springing POA is all your mom will agree to, then it will do the job when it's most needed.
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When you mention incapacitated and say coma or vegetable, what about Alzheimer's and Dementia ? Are they not incapacitated ? My dad was not taking his meds correctly or at all, couldn't cook for himself, so his diet was awful. Ended up really sick and almost died. Is that incapacitated ?
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Have her doctor refer her to a psychologist they can test her and see where she is at. (Medicare should cover it). My dad had it done and I got a copy, diagnosing him with mild dementia and the Dr. opinion of what they are capable of, where they fall in their age group average and what care they need. Of course my dad, he doesn't agree with it !
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Stargazer, "A Durable POA is exactly as the name says. It is durable which means that it becomes effective immediately upon you creating the document and survives and stays effective even if you were to become incapacitated. This is very useful when planning for incapacity. While you are healthy and of sound mind, you can chose any person that you trust to serve as your attorney-in-fact in the event that you become incapacitated (either a coma or vegetative state). A Springing POA on the other hand does not become effective when you create the document. Rather, it “springs” to life only upon a certain event that’s designated in the POA, most often, it is your incapacity. So in theory, if you were to be in a coma or in a vegetative state, your attorney-in-fact will then, and only then, have the power to speak and act on your behalf." (boston-estate-planning/power-of-attorney/durable-power-of-attorney-vs-springing-power-of-attorney/)

One of my siblings had a POA for many years & misused her authority with Dad's assets, including misappropriating assets that were entrusted to her, and ended up in her name.

As I've explained to Dad, giving someone a POA, especially a FULL (unlimited) is like turning over your wallet, credit/bank cards, all your assets and possessions to them.
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With my mom it was inappropriate behavior.....she became obsessed with the UPS man, she would call the kid next door and insist that he get up! She stated that a neighborhood boy was in love with her. Hindsight is 20/20 I wish i had known the signs back then. also I have heard the phrase it is not where did i leave my keys? but more.....what are these keys for?
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For my husband I first noticed when he couldn't balance the checkbook and got "upset" about it. He was angry at first and then kind of defeated, almost cried because he couldn't do it. Also had a tough time making decisions about big things. …….like going on a vacation, or how to put something together, putting things off for a long while.
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There are two types of POA. There is a durable POA which is effective immediately. Then there is a springing POA which only takes effect when the person becomes incapable.
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If you have notice changes or odd behavior, start documenting while it is fresh in your memory and send it to her dr ahead of time for him to review in advance. Then make appt and have dr do a mental exam --specifically ask him/her to complete a mental exam for cognitive impairment. Then take her in. That's what I did and he asked mom very specific questions related to some of the paranoia, socialization, current events, etc. and diagnosed her with early dementia. Then referred her to neurologist to confirm. Mom didn't accept the diagnosis --obviously scary for her...but it let me know what I was dealing with enough to prepare some and watch for other signs, help manage finances etc.

Mom continues to live on her own and for the most part is managing. It's been 2 yrs. they can prescribe medications that some have found to help. They didn't help my mom although she wasn't on them long enough to give a fair evaluation. Actually, she went off all her maintenance meds ...she's 91 and amazingly she is sharper now than she was for the last 3 yrs. I can't explain that except to say she likely shouldn't have been on some and secondly she likely wasn't managing her meds and taking them regularly as prescribed because of the dementia.

I live long distance and don't see her everyday, so I would visit and notice major changes. Paranoia, confusion, bad food in fridge, late bill notices, hallucinations were major flags.

Get HIPPA! DPOA for financial and medical current and in order and make sure you have copies in your possession. Start talking to her about what she wants and if she has plans when she can no longer manage. See if she will add you to her bank accounts. Visit some care facilities on your own, then narrow down to 1 or 2 and visit with mom well in advance of her needs so that she gets a feel for what she likes or wants in the future.
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It is wise for everyone to have a POA. When you need it, it's too late if you don't already have it in place. That is the place where she can express her wishes to you regarding her care. Make sure she understand that the POA only kicks in when she is unable to make her own choices!

As to dementia, there can be many causes including hardening of the arteries and small transient strokes. Medicine is still learning about the causes and effects. Regardless of the cause, when someone becomes a danger to themselves, they need supervised care.

Good luck with this. It isn't easy.
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Personally, I would get a medical & durable POA on your mom.
So many have a cardiac blockage in their 20's. It's common.
IT STARTED....
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Pamstegman... Thank you. I noticed a lot of changes in mental state during the period before her heart attack (hence checking out NH's) 80% blockage in heart. Heart surgeon said she wasn't getting blood to her brain. I have seen great improvements in her thinking. She doesn't remember much 3-4 months before the heart attack but remembers everything else in bits and pieces since. She seems to remember Alabama life real good. Today is the day I approach her about the different paper work ...health directive, ROI and hopefully a new will. Pray prayers of positiveness.
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If she is recovering from surgery or injury, it does take a long time, months, for them to resume full functionality. Mom had a stroke and had visiting nurses for months, from May to December. She made progress. Winter really set her back and she agreed to try an ALF this March. She really liked it. We knew she had dementia when she put potting soil on the steps instead of ice melt. We knew she had dementia when she was hiding bills and not paying them. We found ashes next to the stove with no explanation for them. Rotten food in the fridge is another hint. Overbuying groceries. A skin fungus from not bathing. Really screwing up medications. Lots of little things that are more than just forgetful. The final straw was when she turned on the gas cooktop during a power failure, expecting it to light a candle. Very scary.
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PS We are on the tenth day of in home skilled care.
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AssandAche7 That is a good site.
Margaret What would be considered a medical professional of this specialty or would her family doctor do? I have asked her about her care, and she wants to stay with me. But realistically and reading different subjects on here, I need to know she understands I can not provide the best care for her. I am reading the Care directive and the Nurse is going over it with us soon. She doesn't want a POA ever again. Mom already put my name on her check book because she has trouble spelling her name, and writing a check. She opens her own mail then brings them to me. She can not cook a meal, she can't put a cap back on a tube, she sometimes asks what day of the week it is, or where I have been. She doesn't remember if it is time for medicines, I watch that and fix her pills. The RN who comes says she won't document anything of her concerns of dementia as mom signs her timesheet . This made me think about it strongly.
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You would need a Dr. to diagnose her but I always found that personality changes are a red flag. Everyone has bad days and everyone gets crabby but if there's a subtle shift in personality I'd get to the Dr.
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Plus there are other forms of dementia, besides Alzheimers.

Dementia can creep up very, very slowly, doesn't follow a strict pattern and doesn't affect everyone the same way. But in general forgetting, repeating, personality changes, difficulty with sequencing of tasks (e.g. cooking a meal) are all signs of dementia. For the purposes of competency, a proper check by a medical professional is necessary. You should discuss her wishes with her and get her legal affairs in order now, while she is still able to discuss it.
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http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
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