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In addition to BPD, my Mother also has Intermittent Explosive Disorder, which falls under the umbrella of OCD. She drags her caregivers out to shop and then returns bags of unwanted items the following day yelling "Bitch" at the store clerk when she questions why Mom didn't sort out all the receipts and items before coming to the store causing long lines. Some of the receipts were from different stores. She can no longer walk very well, losing control of bowels, she's driven up on the sidewalk, memory impaired, paranoid distorted thinking, and calls 911 on a weekly basis and goes to the hospital for breathing issues. Her careprovider who just quit said she was selling her pain medication as well. I have informed her support team, and all agree she needs assisted living, but Mom is hell bent on staying in her apartment. She insists she has all her faculties, and clearly she does not. She is not going to go willingly. How are these situations handled??? She cannot stay home abusing care providers. I am supposed to take her to her doctors appt. today; I've never met him before, but today is supposed to be the big day he tells her it's time. Thanks for any support!

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Thank you so much Pink roses for your support! Recently, Mom went to visit my Sister six hours away, and my Sister called me crying one day, she couldn't take my Mom's abusive behavior. Mom stormed out of her place, fell down and hit her head and rear end causing bruises, and a lump on the back of her head. She thinks this is why her memory and behavior are impaired. When she went to the airport with my niece to catch a plane home, the flight was delayed two hours and Mom went loony, yelling at staff, etc... so my niece called 911 and off to the hospital she went where they had her placed in an Assisted Living facility. (just as you suggested) She was mean and vicious while there, and sadly seen pushing her suitcase toward the door, but didn't make it due to weakness. Because Mom's MRI showed no dimentia, the doctor said her placement was voluntary, so eventually with the help of the facility director, she made it back to the airport and home where we begin all over again! Exhausting! You know, we kids have tried to love our Mom, but it's like she wouldn't let us. She's made us out to be monsters, but that's changing now since I'm speaking with all these people for the first time, and filling in the puzzle for them. (One day Mom looks like she wants to kill me, and the next she's crying saying I'm so lucky to have you for my daughter.) It's been worth the effort to get everyone on the same page, so we can do what's in everyones best interest. I've felt a bit sick these last few days knowing I was going to see her again today. My Mom thinks she's just going to the doc today for yet another prescription to add to the other 24; I'm counting on her doctor to stick to the plan we discussed over the phone a few days ago. Suggest she go to AL to rest and go from there? I'm the only child (52) that lives nearby, and despite my better judgement, I'm doing what I think is morally right, and that is to help see this situation through setting boundaries as (always) needed.
Also, want to add that I spoke with both her doctors, and stressed the fact that regardless of the MRI not showing Dimentia, BPD should clearly show a reduction in grey matter in four areas of the brain. Also, there is a new medication just out called "Tapentadol" which works on Aggression, Pain, and Depression. Studies FINALLY confirm that abused people have a deficit in natural opiates, inhibiting feeling pleasure, so this low dose of opiate may help many sufferers. Thus the opiate epidemic....Hope this info is helpful to readers.
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Hugs and hugs to you. As you realize, she will fight it about going to assisted living; unfortunately, there is not much you can do about how she reacts. Is there anyone other than you that can help with this? My mother transitioned from hospital to rehab to NH in that order. So, it was easier than directly from home. Maybe if you call elder services they could provide you with assistance and suggestions. They deal with all sorts of scenarios and are very experienced and have heard just about everything.

I had posted this before about how a neighbor of ours whose parent was extremely difficult and needed the care of a facility; would not leave her house. It is extremely sad when this happens, they had all four siblings there to help her move and finally had to resort to the doctor giving her anxiety medication so that they could get her to agree to go.

From all you have said, she clearly needs care and to live at a facility. Maybe someone else on this forum will have other ideas. Thinking of you and hope the doctor visit goes well.
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A friend of my husband's had to Baker Act his mother in law. I have no idea what this is or how it works. But the poor MIL was such a mess. Would not live with them in the house, slept in her car. Wandered off and wasn't seen for days. Finally, they Baker Acted (?) her and put her into a nursing home. She died no soon after. I know this is the extreme but there is something you can do with very hard cases. Maybe someone else knows details about this and what you have to do. I am curious, just in case I ever have to do this. Anyone?
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I agree the MRI for detecting dementia is a pile of crap, and probably just a way to pay for the MRI machinery. My Mother had an MRI, and nothing showed. She definitely has dementia, not bad, but nevertheless, it's there and obvious.
I too love this forum for support because I do the caretaking alone and it's real hard. Sometimes you need to hear from others about how to handle things. We are born knowing how to do this.
I also had a discussion with my nephew about putting my Mother in a AL or NH because she is taping me out. I'm not sure how much longer I can stand this crap. My temper is hair-trigger because I've been used hard like a recehorse and put up wet. Yet, more demands are made like a machine that runs flawlessly 24/7/364. (Not happening.) I've been to the emergency room 4 or 5 times since last November with stress related illnesses and last time they sent me to P.T. because it's affecting my physical health. My emotional health is pretty ragged too despite my being a very strong person psychologically. We all need each other.
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Oh,THAT CYA. lol...........Sandfox, I wrote you back yesterday, but for some reason my message didn't post, so I'll try again. You have every right to be happy, and to feel whole. It is your God given right. You have been doing the noble thing, and I commend you for this; however, your situation has clearly taken it's toll in every area of your life. I'm afraid if you don't take further action now, you will only continue to suffer. You know this! Speaking in generalities, all of us, myself included, must take responsibility for our own health. We can't blame the elderly for our choice to help them. If we weren't here, someone would step in. All any of us can do is do our best in any given situation, and our best fluctuates from day to day. You have gone beyond your best to the jeapordy of your own health/wellbeing, and I hope you love yourself enough to take the next step for both of you. This situation can't be healthy for Mom either. Sandfox, I hope you give yourself permisssion to love and value your-self. xox
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clmtqm, CYA = cover your (ahem) anatomy.

MRIs rarely show dementia. A clean MRI DOES NOT MEAN no dementia.
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Dang, Jeanne: I was hoping I could answer the CYA question.

Clmtqm: If the doc does not do something serious about your mom's situation, the least he/she can do is take steps to help get her drivers license revoked. Ask him about that by phone. Also, a referral to a geriatric neurologist could be very helpful to assisting your mom's situation. Jeanne can tell you a lot more about that as she has gone through 9 years with her husband and his specific form of dementia.

There are medications that can help with dementia, but your mom has additional emotional problems and someone who can grasp the big picture would be best. Some drugs might be eliminated while other added and then it is a wait and see.

It would be great if you could have your mom someplace that can be sure she has her meds and is followed carefully to rule things in and out. My guess is that would be a closed facility suited to those with mental issues. I don't even know if such things really exist and getting your mom there would be next to impossible if not doctor imposed.

Take the first step with the Assisted Living. So sorry for all you are going through and for the many issues your mom suffers with. Sad to say the least.

Stay in touch, Cattails
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Just want to say thank you ladies for your support yesterday regarding my Mother. What a crazy day it turned out to be. I called her yesterday morning, and after five rings she picked up. I thought she was speaking to me, lol but it turned out to be a recording she had left a week ago! It said in a desperate like crying voice, "my doctor told me to call 911 and go to the hospital. I don't know who will hear this message, but I will be at the hospital." I called my brother and sister and told them she was going to the hospital, and then called the hospital, and they said, no she isn't here. I was confused. My brother called her Apt. Mgr. and she said, someone saw her leave in her car earlier in the morning. So, now I'm wondering where she is, and whether she will show up at her noon doctors appt., as her doctor planned on telling her she needs Assisted Living. Well, she did show up, as he explained in a phone call to me yesterday afternoon. He told her she could stay home IF she meets three conditions.
1. She must wear a life-alert monitor around her neck. 2. Must have full-time, max hours care provider. 3. Must take and pass a written/drivers test within the next few weeks. If she can't meet any one of these obligations, she goes to Assisted Living. Mom asked the doctor, who's going to put me there??? He said, you can go voluntarily, the easy way, or the State will take you the hard way if you can't control your behavior. (which she can't due to Intermittent Explosive Disorder, and BPD. Without DBT therapy training tools, this will never happen.) The doctor doesn't expect her to pass the driving test, and to be honest, he actually said, "I set her up to fail, because she HAS to have the kind of help AL provides." Seems he was giving her a tiny bit of space to process the reality of the situation? She cannot keep calling 911 2x a week, falling down, abusing and chasing off care providers, and endangering herself and others driving. She said, "I have a beautiful apartment, and no one is touching my canopy bed!" He said, it will be moved to AL. I would think she's in a bit of a panic. She did call last night and apologised for leaving that message on her recorder, and to tell me the doctor visit didn't go well, but wouldn't elaborate. I think the doctor handled the situation well. Any feedback is appreciated.
Hope everyone has a great day.
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I think that doctor is pretty darn bueno! AND so are you. How terrific to set her up to fail, so she takes in the severity of her situation and gets into AL, leaving open the idea that there is some choice here: "Choose to go yourself, or choose to be put there." I wish all doctors were as useful as this one is.
Now you have to let her situation unfold. Maybe you can provide information on AL facilities, or have your brother do it. Maybe you just stand back and watch now. But getting others to help, like this doctor has, is exactly what is needed. She will fight you the same old ways. She will fight, but less effectively, people who are not her kids.
Keep expecting her to behave the way she has, rather than expecting or even wanting her to change stripes. That will make visible whatever the next steps need to be. And it will make more visible the steps you no longer need to take (going into a personal code red, for example, when you hear she has gone to the hospital or called 911).
You're doing great. You really are.
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I'd be on the alert that the AL will suggest that she needs a different level of care than what they can provide. It sounds like she is on a lot of meds and has so many different aspects of OCD, etc, that the AL might find she is too complicated.

DEMENTIA TESTS: 3 main tests. Different yet similar….
1. Folstein aka Mini Mental State Exam (MMSE) - 30 point test. Takes about 10 - 20 minutes & looks at math, memory, orientation, basic motor skills. Is copyrighted & needs training to do, so usually done by residents, student MD’s or trained staff @ teaching hospital or nursing home with teaching hospital staff.

2. Mini-Cog: a 3 item recall & a clock drawing test. 2 -3 minutes to do. Should not be used alone as a diagnostic.

3. Memory Orientation Screening Test (MOST): 1. Memory -3 word recall; 2. Orientation - to year, season, time, month etc.; 3. Sequential – memory for a list of 12 items; 4. Time – organization and abstract thinking using a clock face. Takes 5 - 7 minutes. Gives a score from 0 – 29.

Other tests: If Frontotemporal dementia is suspected, can have an Addenbrooke’s Cognitive Exam done. Not all dementias are the same: orientation, attention and memory are worse in ALZ; while language skills, ability to name objects and hallucinations are worse in other dementia’s.

Data analysis found the MOST to be more reliable over time and more accurate in identifying cognitively impaired patients than either the Folstein Mini Mental State Exam or the Mini-Cog. The MOST also measures changes in a patient’s memory over time. This permits the doctor to identify progressive loss or positive responses to treatment.

Having a baseline tests done & repeated is really helpful to be realistic about what careplan to take and see if medication is making a difference over tme. Same with scan on brain shrinkage & what part of the brain. As Jeannie and others have said an MRI cannot diagnose dementia. There is no 1 test that can do that as there are many types of dementia. If there was I'd buy stock in the company and stand back and watch the cash flow in.....lmao!

My mom still has the mini cog done about every 90 days and until last year had a MOST done regularly (her score got to 12 or 13 twice so only once a yr for her now) but she is in a NH and her MD is with a gerontology practice affiliated with a medical school so is a part of a larger study.

Good luck and keep a sense of humor through all this.
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