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I'm not talking end of life dementia. I'm talking about someone who is living independently. They are not ready to be locked up, but if they continue with their abusive temper tantrums, I am afraid they are going to be prematurely locked up so that they are not a menace to society. I'm talking about someone who still drives, dresses and can pretend to be normal. They ask the same question 30 times, but make inappropriate comments in public, and if angered, can obsess to the point of a temper tantrum. What do you do with these people? This person is on memory medication but refuses to allow a care giver to come into their house.

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It sounds as though you are being regularly embarrassed by the person you care for, is that right?

What you don't do is take responsibility for his or her inappropriate remarks, bad manners or public outbursts. You are not the person behaving like this, and you cannot reasonably be blamed for it. If you really can't bear to be seen in his or her company, don't go, or don't take him or her with you, whichever applies.

What you do do is be vigilant about matters of real importance: his or her and others' safety (intervene as soon as you have reason to believe that driving is no longer safe); his or her wellbeing (look out for self-neglect, seriously poor hygiene in the kitchen or bathroom, evidence of taps left running or appliances switched on); the ability to manage personal finances (are bills going unpaid? Are people conning him or her out of money?).

Most of all, your question carries a suggestion that if someone with dementia is not too far gone, he can be expected to pull his socks up, be reasonable, and mind his manners. Not so. Forget it. Loss of inhibition is a common early feature in dementia: the person cannot be held accountable for it.

See Teepa Snow for useful tactics for managing specific situations. As far as sweetening or mending relationships with other people goes, I'm afraid it's the other people who have to make all the allowances necessary - if they don't like it, they'll have to lump it or leave.
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How do you hold someone with dementia accountable for their actions? You can't. Just like we can't rationally discuss something with someone who is irrational. It just can't be done and is an exercise in futility. All that gets accomplished is we grow impatient and frustrated and they act out and nothing gets done.

Someone with dementia who is still driving IS a menace to society. If "this person" asks the same question over and over because their memory is so bad they need their keys taken away.

My grandma had Alzheimer's and for many years she would look so nice and her hair would be done and she could carry on a very superficial conversation for a short period of time but scratch the surface and you'd see someone in the midst of losing their mind. I don't know if there have been any studies on this but it is my personal belief that social skills are some of the last to go when someone has dementia. Like someone trying to appear sober when drunk. A quick glance and all looks well but look a little deeper and you'll see things are not as they appear.

Does "this person" have family that can step in and discuss bringing in a caregiver on a regular basis? Having a caregiver come to the home is a great alternative to a memory care unit in a nursing home.

I hope "this person" has designated someone POA. Dementia progresses and it's better to have the POA right now and not need it than to need it later and not have it.
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I don't think you can fully hold them accountable. I empathize with your experience and experience same. I sometimes "call my mom on some of the outlandish things she says" especially if she keeps it up and is relatively lucid in her mind and I feel she is just trying to get my goat or assert herself...BUT I no longer argue with her or try to set her straight, I just calmly take a breath and say "hey mom, we disagree on this and let's just drop it". I then redirect her to something more pleasant. If she is agitated or can't drop up, I leave so as not to agitate her more or lose my temper. As far as being in public, I carefully time where and what we do by assessing her state of mind and trying to do activities when she is most coherent, rested and in a good mood. If she is tired or moody, we postpone the outings or I get carry out, etc so we can still have fun but she isn't put in a stressful situation and I'm not stressed either.

My mom lives independently and has dementia. I've learned a lot over the last year and it has made our relationship much better and I understand her better. This disease is ugly. The person loses their filter, especially if they are more isolated or have limited outside activity and stimulation. Even though they are driving or getting out and about, their mind isn't as sharpe very minute and they say things that are rude or inappropriate. With some things, I may roll my eyes to the other party or mouth, I'm sorry she has dementia" and hope they understand.

Memory meds can help, but they don't cure and you have to remember they won't overcome someone who is worked up, tired and /or agitated...so these outbursts can still occur, you just have to remove person from the agitating situation and arrest the argument and more or less return them to a calm home, etc. until it passes.

They won't get locked up per se, but I can say this happened to my mom where I wasn't there and a concerned neighbor was worried about her confusion one winter night outside. They called police and my tiny mom got belligerent with police and scared and struck the officer, they took her to hospital and felt she was having psychotic episode which can happen even with dementia. They stabilized her but then transferred her to behavioral center for 10 days. She was 90 and IMO didn't benefit from it; however, mom remembers this vividly and she works very hard to be sane and fight the dementia whenever she feels like she is slipping. My point is, it can happen, and you can't worry about it nor prevent it but do your best to understand the disease, understand these loved ones hate it as much as you do and don't intentionally set out to be "rude and crazy"...it is very scary for them and they are very aware in the beginning that something is wrong and are fearful of losing control over their life.

Its a good time to have talks and understand what they want going forward and their wishes for future care and assistance, and what auxiliary services are available to them.
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