The intersection of mental illness and dementia. How do you stand on this fine line and do the right thing?


What do you do when you have a parent who has always had some mental illness and then they start to get dementia? My mother's mental illness was never diagnosed because outside of the home she appeared to be high functioning, but inside the home was another matter. Emotional problems and hoarding issues. I think there's always been a personality disorder but also something else which I have no idea what to name. Now as doctors try to determine how much mental function she has lost it is hard to tell them exactly how much she has declined because she was never normal to begin with. And problems like her hoarding that were once not mine to control because she was technically an adult free to make her own bad choices, suddenly are now my business in the eyes of medical professionals. She's still legally competent even now, but she's also not well - how does one stand on this fine line and do the right thing?

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Jeanne thanks as always for your wise advice. I like the idea of putting anyone who insists I force her to do anything on the spot as to whether they would declare her incompetent in writing. That would help make it clear to them too what the bind is. It's not that no one cares about her. Unfortunately I have an inactive DPOA which requires two doctors to declare incompetence to activate. I'm glad to have it at all, but she would not agree to a straight DPOA since clearly she was perfectly fine to manage her affairs!

GladImhere, thanks too - yes I am an only and a GCM would be lovely but she lives in a tiny town where such a creature has never been seen. I might be able to hire a nurse for a customized job in a pinch maybe.

JessieBelle, much sympathy and empathy to you too. With your mother it sounds like even the basic competence questions like what year important events happened were ones she could not have passed so determining precise decline is even trickier. You asked what type of decision I'm facing and it made me stop and think. I realize I've already made it - that right now I have to "let it ride" because I'm not in a position to take action yet though that could change at any time. I guess the real point of this post is just reaching out to vent and ask how to find the patience and strength in myself to let it ride without being eaten up by guilt and anxiety. Last time I posted on this many people gave me great posts about detachment and I am able to do so sometimes, but it is difficult.

Thanks you guys!
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I should have reviewed your profile again, Bermuda. You do have some serious considerations. You have my sympathy and empathy. Any thoughts on what you are going to do when your mother loses more function?
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Bermuda, I know exactly what you're talking about. My mother is very good at word games, but has never learned much in her life. She never learned to do most things, like driving or even riding a bike. Since she didn't have much book learning or executive function, it was hard to say how much she had lost. It is most peculiar. She never paid attention to things like what years her parents were born or died. It seems like she considered these things to be unimportant. She also can't tell you when her children were born or how old they are -- she never could.

Somewhere along the way she decided that she and my father were the only important things and discounted everything else. Her two living sons now don't pay much attention to her. She has decided that it is my fault that they don't come around more. This evening she said she wants me to start driving her out to visit one of them every other week. I personally know that my brother and family wouldn't care for that, and I don't have that kind of time to spend on something that has no meaning. I asked her if she has done that in the last 40 years. She said no and blamed my father. I told her that I could not undo the damage that had been done in the last 60 years -- that it was not my fault. She didn't accept that. I know what you mean about being responsible for a lifetime of bad choices. She didn't want her kids for 60 years. She can't expect me to make them want her now.

I don't think there is a right thing to do. We can try to keep the house safe. We can make sure there is nutritious food and their medicines are in order. We can take care of the yard and run errands. But we cannot undo the damage that was done during their lifetime. Unfortunately, when reasoning is lost it is impossible to convey this message.

It sounds like you and I have the same thing on our minds tonight. What type of decision are you facing at the moment, Bermuda?
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Bermuda, Do you have powers of attorney for mom? If not get them now, if you want them. If not, is there someone else that would take care of things for her? Are you only child? Consider hiring a geriatric care manager to help sort all of this out
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Wow! My heart goes out to you. The doctors want you to step in and help your mother. You probably want to help your mother. But Mother is still competent to make her own bad choices, regardless of what the doctors and you want.

You would be in exactly the same situation if she "only" had dementia and did not have a history of mental illness. The obstacle to helping her is that she is not yet at a point the law would consider unable to make her own decisions. When you talk to the medical professionals, ask each time if they are ready to declare her incompetent and put it in writing. The question (as I see it) is not how much mental function she has lost, but how much mental function she has left.

You can try to help her now, of course. You can provide good advice, and try to influence her decisions. You can offer various services. But unless she agrees, you can't force healthy decisions upon her. Dementia is a progressive condition; it gets worse. If she is still competent now, that can change quickly (or slowly), so it would be prudent to start thinking about what will be best when she reaches that point.

Do you have POA for her finances and medical care? Would she agree to give this to you? Would you consider guardianship when the time comes that she is legally incompetent?
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