How do I get help for my elderly mom?

Time to level with her. She's an old nurse. So am I. Time to sit with her and say "Look Mom, I was wrong to go behind your back; but something is wrong. You are believing things that are not so. We need to stick together now like Hansel and Gretel in the Forest; I will be here for you, but we need to know what is happening, and what might be causing it. It could be anything from Chronic bladder infection to the beginning of some memory issues. To deny it won't work. We have to get papers together so I can act for you and help you if things get worse. You are a nurse. You know this can happen".
That's step one. It may go well. It probably will not. When there IS dementia, the kick back on it being mentioned is HARD. My partner and I are 78 and 80. We can FEEL our brains going. We can acknowledge the forgetfulness. We speak of it together. But when it is bad there is almost always a sort of paranoia that sets in and reality is a thing of the past.
NOW, you know this is happening. Time for a diary. Of what you are seeing. Time for all the paperwork to get done WHILE SHE CAN. She doens't have to be perfect to do Health Care POA and Financial DPOA, but she DOES have to understand what she is doing. May already be too late; a lawyer will let you know after he speaks with her after YOU speak with her and agree this is the best step.
Be reassuring. Let her know you will guard her dignity and independence like a Lioness at the Gate, and if, Heaven forbid, things get bad, you will see to it that she is safe and cared for.
In your heart, more importantly in your HEAD you know what is happening. This bull has to be taken by the horns. If you cannot, then guardianship and conservatorship will be the only answer.
Her fear and her paranoia already sound a bit acute. Worried for you; thinking about you. Hugs to you and hope you will update us. When my brother was diagnosed over a year ago with probably Lewy's Body Dementia he called me and asked me to help him, to get the POA , pay his bills, be Trustee of his Trust. He talked to me about ALL his symptoms. He died, at 85, last May of cellulitis. He was the best man I ever knew, but he was one of the brightest, and rare as hens teeth was his ability to know what he had, to say he wished he DIDN'T know what it was, what it meant, and what losses he would sustain, but found it "interesting" given he did have to know. Moved himself to Senior Living. Quite honestly I never heard a story like his. Most of us do NOT go gently into this dark night.

Sorry the docs office outed you. Gee, thanks for that. Like things weren't already difficult enough. If you have time/energy, I would give someone an earful about that! Very unprofessional. They should know that people do decline and are often in denial and doing their best to cover it up. They should have taken your concerns more seriously and tried to find out if your mom was OK or not. Given your description, it does not sound like she is OK and now getting her evaluated will by much more difficult.

Take this thought for what it’s worth- her “behavior” and what she “says” are not in sync with each other. That in turn means that you may have to begin rethink how “very sharp and alert” she actually is.

Approaching her fears logically may be reinforcing them instead of reducing them, but then, what to do next? She’s no doubt SO FRIGHTENED. She’s been invaded in her own space, and now someone she dearly loved has betrayed her.

I think maybe you were looking too hard for assurances that she’s fine, and out of love for her, were not seeing where she’s really coming from. That she had basic medical training might have made “the A word” even more horrifying in that you “knew her secret” while she was assuming that she was coping with it on her own terms.

When things between you calm down (hopefully soon) could you arrange lunch or tea with your “friend”, or would that be another source of suspicion for her. Our most helpful ally during this horrifyingly painful process, was a quiet, gentle, compassionate geriatric psychiatric physician’s assistant, who joined me in a conversation with LO that revealed several deficits in her thinking, memory, and judgement, and finally led to a helpful and descriptive diagnosis.

The “friend” described many examples of cognitive failure in LO’S otherwise carefully crafted conversation, and explained to me that her efforts to act and sound “normal” were causing her intense stress.

I am not at all comfortable in confronting people with cognitive failure head on. If they were bright and capable in earlier times, it’s unimaginable to me that the pain of experiencing cognitive loss would go unnoticed by them.

To me, acquiring a sense of where she is cognitively at present, and then developing a set of strategies to help her move along with as much peace and safety as possible, is better in the long run than causing her any more distress.

Tough, frustrating, painful job, some tears, and no good solutions. If your plans and solutions are made with love and kindness, there is no one on earth, including your mom, who can expect more.

My FIL had vascular dementia. As it developed, his judgment, reasoning and problem solving ability declined. He become very paranoid. His brain turned normal encounters into frightening events. Staff making rounds turned into policemen in his room. His job in WWII was a submarine hunter and that turned into submarines under the bed in MC trying to kill him. He was fearful and had auditory and visual hallucinations when he was alone. Seemed fine in discussion. They put him on an anti-psychotic med that really helped. Your mother may understand an explanation that her brain chemistry is altered and she needs to see doctor. She might think someone is doing that to her so that explanation may not help. She needs help and probably medication. Getting her there may be hard.

WELL, WELCOME TO AGING CARE !!! How fun is this..

check with her doctor about her meds. check if she has UTI.
you can't tell her, but tell her.. you are concerned.
My spouse just said that to me today.. ARE YOU OK? well.... as far as you will know.. .perhaps...
sure, I think I am ok... COVID etc.. is driving up the depression level way too much.... the News. etc........so baby steps with mom... maybe she is feeling a bit of this ...
do check up on the blood and urine tests, if it doesn't take too much out of both of you.
perhaps you can ask her doctor if she can be evaluated for for IN HOME CHECK UPS AND /OR VIDEO appointments.

Oh dear.

So, apart from unhelpfully disclosing your concerns to your mother out of context, what did the doctors' office say in response to your attempt to get her examined? What did they say to you or (from what you can gather) to her?

Are you able to visit her at the moment or are you having to do everything over the phone?

I totally sympathise with how difficult it is to explain to a generally mentally well older person that certain aspects of her thinking and/or behaviour are... I think nuts is the technical term. Not long ago I was visiting a lovely lady, who had had a nasty fall and broken her upper arm but otherwise seemed fine if a little anxious. She then disclosed to me that local youths had been tormenting her and the police had been no help at all. Oh dear, I said, what have they been up to?

One morning it seemed that they had been using a gadget to twist the cord on her kitchen blind without actually breaking into the house. The next day, they had poured liquid into the sun to make it look odd. Without really thinking, I mused aloud: "the sun is several million miles away..." They could send machines up there, though, she said. Again without thinking too hard about my response I said "um. They really *can't*, you know."

But I was afraid of challenging her beliefs outright because I didn't want to alienate her or stop her from telling me what was frightening her, so I quickly said that it didn't matter *what* was making her feel so afraid, it only mattered *that* she felt so afraid, and that was what we needed to think more about. Where is the fear coming from, and what can we do to get rid of it?

Happily, this lady had a very switched-on and level-headed family supporting her; and with our encouragement of her and their practical arrangements she was persuaded to see her doctors and be open about how she was feeling. The last time I saw her she seemed much more relaxed and positive, had just had her hair done (never underestimate the morale boost of a new hair-do), and presumably had stopped calling the police to insist they arrest all males under twenty in her street.

You've begun very well by listening to your mother's anxieties and taking them seriously. I think you might have skipped ahead a bit too fast by trying to get the mental exam done surreptitiously, as it were. Once the dust has settled and you're on sympathetic speaking terms again, go back a step and encourage her again to talk about what she's noticed that is worrying her. Then using questions, rather than making suggestions, ask her what she, as a nurse of long standing, thinks might be going on and help her to examine her theories.

When you say the paranoia has been going on for years, how many years? Any other symptoms, or changes in her? Any past history of mental ill health?

This happened with my mother-in-law. Does she have a primary care physician? If so you can make an “annual physical” appointment for her and yes, tell him or her behind your Mom’s back that he needs to refer her to a neurologist who can give her the required tests (neurotrax) to determine if it is dementia. You can sort of stay out of it if the doctor’s office would call her to remind her of her “annual physical.”He can say she needs a check up because of aging. A neurologist can prescribe aricept and namenda and see if that helps with memory but she may actually need a psychiatric medication with the paranoia and what amounts to delusional thinking. Best of luck.

She may have dementia, but she definitely has mental health issues. I would suggest she see the doctor for a physical to rule out causes: blood chemistry imbalances, infections, brain tumors, stroke... which may be responsible for her altered reality. If those do not work, her doctor can place consults to neurology for dementia evaluation and psychiatry for mental health evaluation. No matter the cause, your mom deserves to get treatment so she can live with less anxiety and you can understand better the cause of her problems.

first has she been checked for an underlying infection (UTI), if not, get that done. if IT is early dementia, she won't believe you because its a brain thing.  I was going to say you could tell her there is medication to slow the process but IF she thinks you are after her, she might not take it.  that's another issue in itself.  All you can do is keep reminding her that with all the security measures in place that no one is trying to hurt her. that maybe she did some things that she just don't remember.  I know my mother told me that IF she ever starts getting like that to let her know.  I do tell her that she does repeat some things sometimes but then I figure why bother cause she doesn't remember.  Old age does a lot to our brains.........is she drinking enough water, she might be getting dehydrated a little.  I already know that my mother said if she gets bad she wants to go into the NH where my father was (he just passed this May). he also had dementia.  Now when the time comes for her to go might be another story and I might be on here myself asking for guidance but with already going thru it with one person, I know what to look for.  I wish you luck that your mom with some gentle assurance that she will calm herself and realize that she does need some help.  But be prepared for different reactions/outbursts,etc as the different stages present themselves in different ways.

Delusions are a symptom of dementia. My mother, also a nurse, would call me, usually at night, saying she had seen a lizard or a mouse or something in her room. She would say "I’m not nuts!" I would reassure her that I was sure she thought she saw something, maybe it was a shadow, etc.

Mom would hide her "valuables" and later tell me someone had stolen the item. A search would always turn it up, with her claiming she didn’t know how it got there. "Someone is playing games with me!" she would say. Sigh.

I would try to explain that her brain was causing the problem, which she knew was true but so hard to accept. She was so fearful of losing her mind. Sadly she is now in Memory Care with little comprehension of anything.