How to handle behavioral issues?

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There are two things my mother does: 1) She starts harassing me about food starting at about 5pm, in a very passive-aggressive way. 2) She occasionally has complete melt-downs -- eyes bulging, teeth bared, where she calls me names like "stupid bitch," etc. when I stop her from doing something. Most recent episode was last night, where she began inexplicably cleaning the gunk from under her finger nails in the kitchen sink where I had a pot of pasta that I had just cooked draining. My husband feels like she should be punished, or made to suffer consequences, for her behavior. This would include ostracism for some period of time, a talking to, not being allowed to join us for our next meal, etc. I'm kind of OK with it for a certain period of time (I need a break from her being around for a few hours after being called a stupid bitch), but truthfully, not sure there's much efficacy in it. She claims not to remember her behavior (not always totally sure of that) and she isn't really capable of learning anything new--again, not 100% certain of this, as she has occasionally surprised me here). And I don't really want her to be unhappy in the presumably short period of time she has left with some level of self-awareness. What do you guys think? What is the best for all concerned?

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See the article on geriatric psychiatrists here, on Aging Care

BY DR. HELEN KALES
I am a geriatric psychiatrist. Um, what is that? An older psychiatrist who is ready to be put out to pasture? Nope. A psychiatrist that has an extra comfy couch so that older patients can lie down and tell me about their mother? Also, nope (although I do enjoy comfortable furniture).
A geriatric psychiatrist is a medical doctor (four years of medical school after college) with four years of general psychiatry training (an internship/residency following med school) and an extra one to two years of sub-specialty training (a geriatric psychiatry fellowship).
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A psychologist cannot prescribe medications, but an M.D. psychiatrist does.
In psychiatry, the M.D. furthers the degrees and area of study into specialties.
In neurology, an M. D. can then specialize in psychiatry, adding geriatrics.
A geriatric psychiatrist specializes in elderly, and has accreditations.
Any psychiatrist can then specialize in elderly patients, but it is a matter of furthering their studies, obtaining specialty degrees, associations, and certificates to become accredited in the field of geriatrics, or gerontology.
Neuropsychiatrists specializes in study and treatment of the brain biochemistry.
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What is Neuropsychology?
Clinical neuropsychology is a sub-specialty of clinical psychology that specializes in the assessment and treatment of patients with brain injury or disease. A clinical neuropsychologist usually holds an advanced degree in clinical psychology (Ph.D., Psy.D.), and has completed a clinical internship and specialized post-doctoral training in clinical neuropsychology. What distinguishes a clinical neuropsychologist from other clinical psychologists is knowledge of the brain, including an understanding of areas such as neuroanatomy and neurological disease. The discipline involves the application of standardized measures in the study of brain behavior relationships. They use neuropsychological tests to assess cognitive deficits, and they are involved in the management, treatment and rehabilitation of cognitively impaired patients. Neuropsychology also entails the development of models and methods for understanding normal and abnormal brain function.
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A geriatric psychiatrist precribes medications for the sort of behavioral problems you describe. It sounds as though she is suffering from agitation and possibly depression. There are chemical changes that occur within the brain with dementia that sometimes cause these. Meds can help, and not in a way that cause your loved one to be "drugged".

As Rainmom points out, meds helped her mom become calmer. I saw this with my mom as well.
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My mother has seen a neuropsychologist for testing. I have seen that people are recommending a geriatric psychiatrist, but I'm not sure what for, could someone explain it to me? I appreciate your remarks, Rainmom. My mother is in her late 80s, we are in our mid-fifties. I can tell you that in HER mid-fifties, my mother was having a ball dancing and singing, not taking of anybody. My husband and I are not retired, but we work different shifts (and I work 30 hours a week), so, except for a few hours on a couple of days a week, one or both of us is always here.
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There are many good points made above. I'm including a link for an article on this site about how dementia behavior may seem like manipulation, but it's not.

I think many caregivers struggle with this. It's so tempting to assign some kind of blame. When the stress is too much and it's just very overwhelming, I would look for assistance. Trying to punish or blame is not really appropriate with a dementia patient. It won't get you anywhere and the person will not benefit from it, either. It is likely to just make them feel more confused, agitated and frightened.

Have you explored what options are available for her care? I might read A LOT about dementia and what you can expect down the road, because the behavior and challenges are likely to increase substantially. Having a plan is one thing the article recommends.

https://www.agingcare.com/articles/dementia-behavior-manipulation-154554.htm
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It is really nice that your husband does make time to pay social attention to your mother. That is hugely beneficial to her, and a Good Deed on his part, and takes a little pressure off you.

However. It sounds as if he is still thinking, or maybe just hoping, that normal thinking processes - such as a grasp of logical consequences - apply. You both need to abandon that idea for good. They don't. If they haven't already completely gone, they soon will; and it is certainly futile and potentially cruel to continue to hold your mother to standards of behaviour that she cannot possibly keep in mind.

The rages that first led you to post... Those must be incredibly hard on you, and painful. I'm really sorry you're having to witness them, let alone be the target. Teepa Snow's videos might be helpful and comforting, and offer some guidance about detaching from the emotional hurt. The better behaviour you see at your sister's house, or during activities, I would guess is actually more to do with the pleasant stimulation of those environments rather than a control issue as such - again, I think it's probably attributing too much to your mother's remaining reasoning ability to suppose that her frustration and irrational anger comes from trying to be in control. Although, yes, I'd agree that it would be frustrating to her if domestic routines that should be second nature have become bafflingly difficult. For guidance on helping her to do things without triggering her frustration, there's another thread started by a lady whose husband is beginning to struggle and getting angry about it - can anyone remember the headline, please?

Please don't stop her enjoying anything she is still able to enjoy. Depriving her of these pleasures will not restore her reasoning faculties. It'll just deprive her of her dwindling opportunities to have fun.

I'm sorry to say this, but the real trouble is that it is only going to get worse and whatever you do is not going to arrest your mother's decline or mitigate the challenges of it in anything more than the very short term. So, it is time to consider options, collate information about costs, resources and her likely future care needs, and draw up a plan. Do you have POA? If not, it sounds as if you might have missed the boat there and could need to apply for guardianship, especially if your mother is unlikely to be co-operative. Ask around friends and your mother's GP, and if anyone can reliably recommend an elder care specialist it would be a good idea to take legal advice.
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Army retired makes a good point. The earlier in this disease mom moves to AL, the easier the adjustment will be.
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Have you thought about selling her home and using the proceeds to pay for an assisted living facility? You have only started being 24/7 caregivers and already serious issues have come up. You also need to make time for you and your husband together.
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I believe there is a fine line between enabling behavior and accepting behavior due to a dementia diagnosis. For instance, the person I cared for with mild dementia would throw dinner on the floor because she thought that would entitle her to dessert for dinner....no that wasnt acceptable so she would not be given dessert until she ate a sandwich or leftovers or something healthy. Yes, it was a form of punishment but it worked. I believe it is important to set some sort of boundaries and stick to them. If you get called names, it is okay to eat by yourself, I know I did several times, mostly for my own sanity.

As for the outings, I see nothing wrong with her doing the same activities. You did state that finances were starting to get to you. Is she paying for her activities or are you? If you are paying for them, sometimes we need to cut back for our own financial security rather than to make things normal for the family member. If she is paying, let her enjoy those activities.
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