Is manipulation and exaggeration about his care needs part of dementia behavior? - AgingCare.com

Is manipulation and exaggeration about his care needs part of dementia behavior?

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Father-in-law is using manipulation and exaggeration about his care needs with his caregivers. Is this behavior part of dementia? Is very demanding and mean and nothing is good enough for him. Has stated that if they don't take care of him he will slit his wrists. Demands that they clean/ wipe him after his BM even though he can most likely do it himself. Sneaks extra laxitives. Doesn't sleep at night and turns tv volumn way up. Treats the female badly when the male isn't present and when confronted on it blames his age (86). Keeps picking at a bed sore that was almost healed to get more nursing attention. Is afraid that he will be removed from home hospice care if he presented as being more able to care for himself.



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My mom was skin picking from anxiety. She swore there were fleas everywhere she went. And I do *not* have fleas in my home thank you. This and her over-demanding, high-need, pretty selfish personality came partly from dementia and partly from her existing mental illness. She also demanded that I wipe her butt - not the staff at the facility, but me. No thank you.

Why did none of her previous doctors catch this? It's regional and cultural. She had lived her entire life in a place where mental illness just doesn't exist. If we don't talk about it, it's not happening. There are few psychiatrists in the first place, and give up on finding a geri-psych. All her issues were treated as a physical ailment. Her "nerves" required nerve pills, tranquilizers, sleeping pills, uppers, downers of all stripes. None of it was ever the right thing for very long.

It wasn't until I got her in a controlled environment with people who knew how to deal with this that things evened out, she was a lot less volatile, and the right meds made a HUGE difference.
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FILCaregiver, you have such a dark tunnel you're having to look through. I hope you can get some relief from his behavior soon. One off-putting thing about reading elder care articles is they are written like the elders have sprouted wings and have halos over their heads. Some of the elders do have evil hearts. Chances are they've always had them.

I used to know this woman. In fact, we were friends. She only had two friends, so I guess I was special. She was one of the most evil women I've ever known. She didn't really do anything, but she was wicked inside like she had sickness in her heart. Her family wanted nothing to do with her. She was blind in one eye and had lost a leg to diabetes. She couldn't walk. She lived by herself and had a wretched life with vomit and food on the floor and walls. But no one better help her. She was a proud woman. That sounds good, but if you knew her, you could just feel the evil will toward everyone.

You've heard that only the good die young? This woman lived to over 102 and spent only the last year in a facility. Family couldn't handle it and I don't blame them at all. She outlived all of her children and the good man who was her friend (not boyfriend!) died young.

As caregivers we can face what seems like evil. It may be because of the disease or it could be that the person was already sick of heart. It can be a hard thing to deal with, whatever is causing it. We do have to protect ourselves either by getting away or building walls so we don't have to wrestle with it every day.
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You're right, Jeanne. I focused on the OPs comments regarding behavior rather than the diagnosis and hospice care. That's my own tunnel vision, as I lie here awake searching for answers as well as kindred spirits! Appreciate the hugs and understanding.
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Regarding picking at the sores to get more medical attention, my MIL did this because the FIL was sent to a wound doctor and she wasn't. She got her wish, and got her referral to the wound doctor and her visiting nurses, but took it too far and ended up in a rehab for LTC after a bout of blood poisoning.
Both are demanding and seek a lot of attention, but I don't think it's dementia as much as it is their personalities. I don't know about your FIL, but my ILs have always thought the world should revolve around them. I've read that getting older magnifies the good or bad personality traits. My grandmother was fiercely independent, so she refused help even when she needed it which wasn't the smart thing to do, and this is where the dementia came into play. Therefore, narcissists and manipulators tend to be more do with age, I suppose. I don't think dementia makes someone something they weren't already, if that's makes sense. Alzheimer's is not the same, as it can make people forget others as well as their own selves.
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FILCaregiver, a narcissist is a whole entire different and strange kettle of fish.

My heart goes out to anyone dealing with that particular mental illness. Hugs to you.
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My FIL is the same way. He is 88, and won't do anything for himself even though he could. He's a narcissist, and wants everyone to go as he says. His behavior includes refusing to get up to pee at not, and refusing to use a urinal. He doesn't have to clean it up, and has become nose blind to the foul odor. He, too, has threatened suicide--it's all for effect. He has never tried to harm himself in any way. He somehow broke our toilet tank this weekend, and didn't even tell us. He was like a child pretending he didn't know what we were talking about (the entire hallway was flooded) before fessibg up after being caught in a lie (his shoes were wet and he had taken them off,) he then proceeded to sit on his powerlift throne and calmly read while we cleaned up the mess and my husband got the parts to repair the tank. Sometimes I think he does things on purpose, because that same night he was slurping a cup of soup and he didn't know I was watching him from behind. He threw it against the wall and floor, now the wall is stained from the cream of spinach soup. He refuses to wear his dentures or hearing aid, but he's not senile. He can also walk with a walker, and do things he wants to do. He demands three hot, full course meals per day, snacks, minimum of two loads of laundry a day, meds and insulin four times daily, and has a visiting nurse, a PT and OT, a lady to bath him--all two times per week to our home, and now a social worker because the visiting nurses recommended an assessment due to his refusal to do anything for himself (thank goodness!)
My grandparents and great grandparents were exactly opposite of my FIL (and my MIL, who was recently put into rehab.) All were independent except for my grandfather who had cancer, so I was definitely not used to elders not wanting to go anything for themselves, but there are these types of people. You can only do what you can do, and no one deserves to be abused no matter how old the abuser/manipulator! You hear of elder abuse as it pertains to them, but few people address elders who berate and take advantage of their caregivers. Abuse is abuse no matter what! Know when to let go and have someone else take over. Consult with an elder care/estate planning attorney if necessary as well as a social worker. Try to find an agency with social workers besides Adult Protective Services, who seem to be more concerned with elders' assets than their well being and care. It's a great and honorable thing to be a caregiver, but you shouldn't give up your life, your well being and self worth while doing so. ❤️
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I agree with Jeanne about assuming that some dementia exists. There may have been some prior personality issues, too, that are pushing the somatic problems. Wanting someone to wipe him, however, is very unusual if he is flexible enough to do it himself. I would talk to someone to see if they think he may have some vascular dementia. With hypertension, diabetes, and general poor health, it could explain some of the behaviors you are seeing. I live with someone with vascular dementia, so know that the behaviors can be inconsistent and seem purposeful. It can make for a difficult personality, particularly when overlaid on other mental and health problems.
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Jeanne, I caught that, too. I thought maybe she meant ulcerative colitis, which can indeed be serious. Esophageal colitis wouldn't exist, since they are two different body parts. (However, the esophagus can be affected when someone has colitis. That is way beyond the scope of this thread, though.)
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I just did a dementia risk calculation online for FIL. I have no idea how valid the calculator is but, wow, it is interesting.

Just for being over 85 FIL's risk factor is 32%. (I've seem estimates of 50%, so this seems not unreasonable to me.)

The high blood pressure and diabetes multiples the risk by 4. This is over 100%.

Oh my goodness!! Since he is on hospice and may not be eligible for further diagnostics, I would simply assume the poor dying man has dementia. Accepting that instead of trying to guess at the motives for his strange behavior will be easier on everyone, I would think.
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cynergy, he may not have been diagnosed with dementia (yet) but with both high blood pressure and diabetes he is at increased risk. And just being over 80 puts him at high risk to start with.

If he has been manipulative and attention-seeking all his life, well, he still is. But if this is fairly recent behavior, it definitely should be reported to his doctor.

The notion of wanting someone to wipe your butt for attention is a bit off the range of healthy behavior, don't you think? Something is going on here that needs medical attention.

I trust your observations of his behaviors -- he picks at a bedsore, he asks for help you think he doesn't need, he doesn't sleep at night, he threatens suicide, he is unkind. I believe that all those things happen. What is less clear is the reason for these behaviors. You speculate that it is for attention. You assume that he can do things he asks for help with. But if he has dementia you may be VERY wrong in your assumptions about his motives and reasons.

If he is on hospice care I'm not sure what diagnostic services he could get. Why not at least discuss these things with the hospice nurses? Does it seem like dementia to them? Do they have recommendations in how to handle it?

Lavishing a dying man with extra attention seems appropriate to me. He shouldn't have to act out in negative ways to get such attention. Isn't that why he is in in-home care? Whether he has dementia or not, I'd make sure he gets plenty of positive attention without having to do anything for it.

I'd try to prevent activity that is harmful to himself. "Dad, I know how natural it is to want to pick at a scab. I've done it myself many times. But we both know that it isn't healthy and could lead to more painful infections.So when the nurse comes later today I'm going to ask her to show me how to tape some gauze over the area to help you remember not to pick at it."

I'd get him a wireless headset for the tv, so it doesn't disturb everyone. (In fact I did that for my husband -- saved our marriage.)

If he has dementia, it is possible that abilities come and go. Sometimes he can clean himself up in the bathroom, and sometimes that is overwhelming. I'd set things up to make it as easy as possible to to it himself but also let him know that if it is too hard somedays I would come in and help.

If there is no cognitive decline here then perhaps setting some consequences will work. If there is dementia present, that just DOES NOT WORK and only makes you appear cruel or uncaring. So getting the nurses' input on whether this seems to be dementia may be a practical first step. Or just assume he has dementia and treat him accordingly.

I cannot find anything on esophageal colitis. Is that Crohn's disease? Is that the condition that makes him eligible for hospice?
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