I need help learning what to do for a 90 year old man (my Dad) with delusions who refuses all treatment. Any advice?

Help to move them to the same facility...Dad in memory care & Mom in Assisted living. They can be together that way. Start helping to get house ready for sale to help pay for facility. Also see a Lawyer experienced in asset protection. Make sure their wills, or trust up to date & who has poa & health proxy.
Hugs 🤗

I’ve posted on Discussions over the last week about the effects of my recent eye surgery. I’ve had unusually vivid dreams that make it clear to me that we ‘see’ with the brain, not with the eyes. If your father’s brain is making him ‘see’ your mother on the couch etc, it will be absolutely real to him. He won’t accept logic or ‘it’s a delusion’. It’s all true, he’s seen it himself.

If your mother could accept this, it might make this situation more bearable for her – and for you.

Mom's Doctor SHOULD have given her the phone number of the Senior Mental Health group that facilitates the area she lives in. Your father obviously HAS mental problems and your elderly mother should NOT be given anti-depressants to "help her cope"! She CAN'T "cope" with a man who has mental issues. He could have Alzheimers, or for SURE dementia and should be either in a home, or, have In-Home care with help for your mother. All is available if you contact the Senior Citizens Health Group in your area. Medicare and Medicaid can help. Her DOCTOR SHOULD have directed her to help!

Elder abuse is elder abuse. You can not always save the other person. I would seek professional counseling and find a doctor that works for you and your parents. Your mom does not need to be psychologically a whipping post for your dad. Medication to make her oblivious to the abuse sounds unfair and awful, not to mention heartbreaking. I would get mom out of that situation you are in. Arguing with your dad will get you nowhere. I have a mom with Alzeheimer's dementia that goes on a rant everyday. Prayers for you and your family. I think there is hope on the way.

Prayers sent.

Twooffiveminus2, has your father discussed his very specific delusion with you yourself? You say it doesn't seem to trouble him (although of course it's almost as if it's designed to be as offensive and hurtful to your mother as it might well be), but have you had a chance to talk it through with him and see what its roots might conceivably be?

Has your father always been disrespectful to your mother? Or is the behavior more recent? Either way, the doctor's decision to medicate your mother, as if the problem is that SHE'S not enduring your father's verbal abuse properly, is appalling.

So far, it sounds like there have been no consequences for your father's abusive behavior, so why would he stop? Another poster suggested geriatric psychiatric counseling with both parents in the room. I would urge your mother, with your support, to make it a condition that if he doesn't agree to counseling, she will leave temporarily (or forever) .

Please don't force anything upon your father. Forcing things upon even unreasonable people always leads to even worse problems. He might then see you as a threat, and this will hurt mom even more. I'm guessing he has dementia? If so, then there really isn't anything you can do, unfortunately. You cannot reason with anyone who has dementia, but by having late-stage dementia, you can sometimes maintain at least a bit of control over them to protect them. People with dementia can be found to be unfit to act on their own, but only if they are refusing to take important medication that they were already on. Take, for example, high blood pressure medication. Have him checked for any STDs. I know it sounds ridiculous, but my grandpa was 92 when we found out he had Syphilis. Fortunately, we had caught it on the second stage, and he still had a visible rash that the doctor found. The doctor had informed us, that he had to of just recently been sexually active to get it, which is really his own business. His wife had died young, and he never got another wife after that. Whatever you chose to do, don't try to talk reason into your dad if he has dementia, since it won't work.

I am only responding regarding medication. Dad refuses any testing or medication. OK. So, time for tricks of the trade and mom will need to be very sneaky with this. Find a hiding place that dad will not every find. Get medication from the Dr. and hide the bottle. Mom may need to go to someone else's home to talk to the Dr. to do this if Dad is delusional and listens in on phone conversations. Start by cutting tablets (be sure tablets, not capsules) into quarters, then each day for maybe 4 days crush the tablet and mix it into food. Be sure it is finely crushed so dad cannot figure it out. Then go with half a tablet for a week or so. Then three fourths, and finally an entire tablet. Be sure Dr. prescribes a medication that can be administered this way.

Also, check for local support networks - hospital, insurance plans, community centers. Mom needs to know that others are dealing with similar situations.

I wish this could make the evening news. Your problem is real and you are not the only one going through it.
I really liked some of the advice listed below.
1. Do you have POA and Health Proxy?
2. Do you have a "Letter of Competency" on your father, the physician can provide it?
3. But more importantly are you venting, which is really healthy (your gotta be able to have a release) or are you wanting answers and direction?
4. The answers are to protect your parents mentality and physically as best you can and unfortunately let the aging process take place. Which is not easy to say or watch.
5. You will need assistance in VA with a trusted friend and/or social worker and/or senior service counselor, who understands the services and process available in the state of Virginia.
6. If you need more information feel free to email me back.
Stay Inspired,
This is no easy task for the faint at heart

The sad part is, the more your mom gets frustrated with dad, the more sedated doctor may make her with meds. Doctor is treating the wrong person. (A kind of comical situation to explain my thoughts)- A relative when took her spouse to doctor because he was becoming increasingly meaner in things he said, aggravated all the time, etc. Dr talked to both of them. He handed an Rx to the woman. When she went to the drug store, it was a medication for her. Things got worse. They went back to the doctor and he talked to both of them again. Again, he gave her a prescription for an additional medicine. Husband continued to act like an a$$. She did say that the meds were relaxing her and his outbursts didn't bother her as much, but she was going to go one more time because husband was getting even more explosive. My reply: Well I think I'd find another doctor before he has you in a comatose state and husband gets more out of control. He's getting angrier because you don't react anymore because you're drugged. In fact, if they keep medicating you, husband will eventually become physically and you won't have the wherewithal to fight for your life. Her: I never thought about that. Hmm

The worse thing you can do is to argue with someone who is delusional. To them, it's real and you're not going to convince them different. Instead of medicating mom why not medicate dad? Get his doctor to prescribe a mild sedative. Like Valium. which can mellow him out. He's 90 yrs old so at this stage there isn't anything that will really hurt him. There are other sedatives that work fine! My stepmom at 94 had dementia and very delusional. My dad ,90 yrs old would constantly argue with her that what she was seeing and saying was not real. All it did is cause extreme outbursts. I told my dad if she says the school kids are there in the living room. Just say OK and it took him a long time to understand that. But when he finally did it was very peaceful. I don't know how long your dad has been like this but I'm sorry that your mom has to be medicated to withstand everything! If he wont take medication then smash it up and put it in his food. There are so many medications out here to help your dad. Something calming I would say is the best. Do not give up hope this is NOT a hopeless situation! Talk to his doctor. Everyone around him should not be medicated the source should be medicated. You're in my prayers. I know it can be tough until something gives. I was at my dads house almost 5 days per week because of the arguing. So I do know what you are going through. If he wont take medication tell the doctor it has to be hidden in his food so it cant taste real bad. And always start off low and add as needed. God Speed and may He help your family find the right solution.

From my experience, there is only one option:

1. POA for healthcare.
2. MD diagnosis - incapacitated = cannot make own health care decisions.

This is quite common (I'm going through it now).
You need to talk to attorney in elder law / health care issues and MD.

I see only two options here. If you are so far away, you cannot do anything. Perhaps a doctor can give medication to make him more compliant but I doubt it will work. So you lay the law down to him - either he does what he is supposed to do or something will have to give. You can get caretaker, a tough one, or you can place him into facility. The other alternative is to just simply accept he is a stubborn fool who will not cooperate and just leave him be to an earlier demise than if he was cared for. It makes me sick that these people get away with things.

Twooffiveminus2 - if it's any consolation I recently had similar experiences on this forum. Like you, I probably mostly needed to vent and get some validation. I got a couple, what felt to me, harsh responses along with good advice.

You're not being overly sensitive. You need support and kindness right now. Having done the Cali to the east coast thing before going (granted, being there was way worse - but this isn't a competition on what's more stressful), I also know it can be very stressful having to deal with things from a distance.

Last thing probably answered already: APS is Adult Protective Services.

Sending you strength and validation.

This is my personal advice. Ur parents made it thus far. Dad knows what’s best for him. To me taking pills for anxiety only makes matters worse. Mom and dad should take up hobbies like go for a walk, exercise, dance listen to music and most of all pray together.

The antidepressant will only help the very tip of the iceberg.

Unless your mom is decades younger than your dad, she may be developing physical manifestations.

Can you hire help? Even if she is physically strong, to keep her emotional bearings and protect her health, she needs mental breaks.

Can you arrange for someone for her to talk with? Support groups, friends or family, in person or via zoom will be her lifeline.

Before Covid, Mom’s church paired her with a young family for support. She would take the mother to lunch and they became wonderful friends.

If your mom is isolated and/or has few of these options available, consider moving her close to you.

Your time together is precious and irreplaceable.

Two of Five;

Have you considered getting mom and dad to go TOGETHER to see a geriatric psychiatrist? Under the heading "therapeutic fib", they go together to see if there is help for mom's problem.

This allows the doc to examine the extent of dad's delusional thinking and give advice (to wife and child) about how to manage this awful situation.

On a side note, I hope that mom IS taking advantage of the antidepressants AND talk therapy. Living with an insane person takes a toll on one's mental health and mom needs all the support she can get.

Those of us who have been in this sort of situation can tell you that is usually NOT the impaired person who goes to therapy/gets meds; it's the "healthy" one.

At least in cases in which the healthy partner is not willing or able to leave the toxic situation.

I haven’t dealt with this with dementia (yet) but we did when my MIL’s cancer metastasized to her brain. It was awful! I was even slapped a few times trying to help her.

They got a live in caregiver who helped tremendously. She ran interference for my FIL who already had dementia and didn’t understand what was happening. She dealt with my MIL firmly and gave her a sedative at times. She did not let my MIL near my FIL when she flew into her rages and delusions and this helped him I believe.

in your parent’s case, if they choose a live in, I think I would ask for a man caregiver who is strong in case things get physical.

I'm going through a very similar thing with my 78 year old mother! She is 110% certain that my father is having multiple affairs, and every single night she goes into a tirade calling him a f***er - over and over and over again - it is horrible!! Then, the next day she denys the behaviour, denies the profanity, and doesn't remember anything! She would also typically call me every night this happens and the first thing she says is "things are really bad here....dad is cheating" as if its the first time I'm hearing it...this has been going on for about 2 years now. Finally, I wrote a long letter to her dr., my father wrote a letter to her dr, her dr called me and thanked me for keeping her informed, I told her to stop prescribing Ambien, she agreed...and next thing you know, my mother goes to the dr and comes out with a refill of Ambien, and NO additional testing to be done to address this behaviour. My father and I are at our wits end, sometimes these calls are 5/night - until my therapist said as painful as it is, I have to turn off my phone. They live near me so I see them often. But my poor dad just doesn't know what to do, she also sometimes tries to hit him in the face - she's consumed with anger that he is cheating (HE IS NOT) - she tells anyone who will listen, I think half of it is to get sympathy and attention as an "abused woman who's husband cheats on her"...its insane, just awful. My father takes care of everything for her - medication, cleaning the house, taking care of the home, paying bills (she also thinks he is hiding money) - and she has zero gratitude.

I am becoming very angry at her and sometimes I just have to keep my distance, as awful as that sounds....but it really upsets me and I have a full time job and have to take care of myself (divorced living alone no kids)....her horrible language makes me not want to be around her in the evenings at all, and then during the day having to listen to the same story about his cheating is the ONLY thing she talks about...I'm drained.

As long as your parents are safe and healthy and mentally competent, you do not need to intervene. However, if mom or dad is in danger of falls, medication errors... it may be time for them to have another person living with them. You can suggest that they move in with you, move into senior apartment (aka assisted living), or allow others to come into their home to help (family, friends, members of faith community, and/or paid help). At the least, it would be wise to have a few people who take turns checking on them daily to make sure thy are OK. They can let you know if there are problems you need to address. You can also call them daily to check on them.

If you cannot get your Dad to a doctor then you and your Mom may have to wait until an ER event to occur. If he is abusive then call 911 and take him to the ER. Once in the hospital be sure to address this with a geriatric psychiatrist.

One practical suggestion for navigating the forum posts -- You need to start with the "Oldest First" order of replies. I think you started with the "Newest First," replied to those, and then as you got down to the very first reply (which was by AlvaDeer) you thought she hadn't read through the replies you had made to other folks when in reality, she was the first to reply and therefore there were no other replies for her to see. Does this make sense? I do find this forum does not work like others I have used over the years.

Your father sounds a bit like my husband. My dh does not remember later the crazy things he says. His words are very hurtful, and reminding myself that it is the dementia speaking really doesn't take away the sting. I was offered anti-depressants by my doctor and I told her that I was not medicating me because of my husband's problems. Do the meds really do anything to help your mom? It doesn't change her situation in any way so I question why she should be taking them.

Two days ago I repeated back to my husband something he had said to me last week while in the hospital when no one else was around to hear. (He is always "charming and funny, an entertainer, the star of the show" when others are around, they think he is just the greatest guy ever, the nurses said his room was the best room to come into that week because he was such a jokester.) I repeated back to him the name he called me (not suitable to post) when he demanded my presence (he is a very controlling man), I said, "Well, here's your '*** ****-*** South Mountain *****,' " he looked at me with shock and said I should never speak of myself that way. I looked at him and said, "Why not? That's what you called me last week." He denied it of course.

I have no doubt that he doesn't remember saying these things, just as he doesn't remember many other things. And he creates memories of things that never happened, which sounds like what your father is doing. Or accuses me of things that I have not done. All said with a quiet voice, seldom is he loud. (Except when preaching [he used to be a pastor], then he could really yell the judgment and condemnation. I was never sure why people liked his messages. I always felt like a bucket of manure had been dumped over me every week.) Verbal abuse can be done in a quiet voice. Your mom is being verbally abused.

Unlike your mom, I would be glad to be separated from my husband. I had my chances over the years and didn't take them.

No one answered your question about what APS is. Adult Protective Services.

Your father won't get any better, he will probably only get worse. I'm so sorry your mother has to bear this burden, it must be horrible for her. And there is not that many antidepressants in the world. I wonder if she would be better or worse without him?

Have mom come out to visit you to give her a break.

Doesn't Dad have a regular Dr's Check up? If so, speak to him before the appointment to let him know what's going on.

It could be Dementia.
Also, if your Dad has a UTI (Urinary Tract Infection) or if he is dehydrated that can be causes of his mood changes

Dementia is a beast. I am sorry this is happening.

Councelling for Mom - so she can learn to understand it, start to grieve, adapt to now & plan for the future. All important things.

To also learn to ignore any hurtful delusional talk & see it for what it is - symptoms of his brain problem. To get a safety net around her, an emergency plan of who & how to get help if needed strait away. This is most important: to be wary of situations of stubbornness escalating into violence. Eg a close neighbour she can run to & call EMS.

It's a big shift in a marriage, going from spouse to carer. That's what my Dad said 😞.

It can also be a big shift in thinking for adult children too. Doing what is NEEDED for Dad, rather than what he wants. He may not WANT a neuro psych eval, medication or in-home helpers - but those things will help him stay in his home, with his wife for much longer. Sadly, he may not grasp this. So make it simple for him "See the Doctor & follow his/her orders. It will help Mom.

If you can't get your dad to a doctor, therefore can't get him any meds to help with delusions (and meds need adjusting and may not initially --or ever -- be a solution) and your mom is sticking closely to him... then the only 2 possible solutions I see are:
1) use an agency to provide in-home care or a companion to your dad so that he is distracted. I use Visiting Angels (a national franchise) and have been very pleased, but it may take more than 1 person to find the right "fit" or schedule.

2) see if your mom is willing to move with your dad into a care community that has a continuum of care levels and on-staff medical team. He will be distracted and she can escape his delusions within their residential wing,

Is your dad "sundowning"? Are his delusions mostly late in the day or early evening? Is your mom on board with solutions of any kind? If she isn't wiling and flexible you'll be banging your head against a wall.

Do you have the contact info for their neighbors so they can give you an honest assessment of what's going on?

Your dad won't level out, he will continue to decline. If you can't get your mom to agree to reasonable solutions then you will need to let the chips fall where they may until there is an "incident" that sets other wheels in motion. I don't say this flippantly -- I totally understand getting an even bigger knot in the stomach over this thought.

I manage care for 2 very senior aunts who are 1000 miles away. After making no headway with getting them to accept much needed care I finally just asked what I could take off their plate to make their life better, rather than trying to force my solution onto them. When they were ready for the type of help they desired, they called me up and I had already done all the research on an agency. But waiting for them to come around was so incredibly frustrating and stressful. I wish you much success in finding solutions, and peace in your heart no matter how things unfold.

Mom might be more willing to sign the Hippa forms than Dad. Getting her to the Doctor might help a lot. Dad may even be willing to go along with Mom

Two,

As Alva asked, do you or someone else have POA? If not, you need to obtain it! Seek an elder care attorney or speak with your parents local Counsel for the Aging. They may be able to point you in the right direction.

Sounds as though Dad and Mom need in home care if not assisted living/memory care!

Do some online research about "Therapeutic Fibbing ". You may have to be creative.

Dad is most certainly not going to get better. He is only going to decline. I imagine you already know this, but I apologize if that sounds harsh!!

I understand that it's a dignity issue with Dad, however, it's also a safety issue for both Mom and Dad.

Wishing you the best!!
(((Hugs)))

It sounds like your dad's condition may be progressing beyond the mild stage. An evaluation doesn't matter that much IMHO but your mom needs help. This is a lot to deal with at any age and she is likely burnt out. Is she open to assisted living? If so, that would be very helpful to her. Or she needs to get help at home. Maybe your dad will say "I don't need help!" but the help can be for HER. Someone to cook and clean and change the beds, etc. etc. Someone to give her a break.

Good luck.