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

A change in mental status needs to be reported to his doctor right away. Could be a UTI, a stroke or some other physical problem. Call now.

Lock up everything he should not be getting into - like laxatives and any other kind of medication!

Sounds to me like it's time for dad to go into care where they can deal with his needs and he can be a phone call away from physician's care, unlike at home.
Saying he'll slit his wrists is suicidal ideation with a plan. That right there can get him a nice stay in a geri-psych unit for evaluation.

I believe there is probably more going on with him than you guys may be aware of and he needs to be seen by a geriatric specialist specifically.

The thing that we're both saying is NOW. This is not a "wait for a family meeting" situation. This is a "call 911" situation, unless his doctor is willing, without seeing him, to say that he's not a risk to himself.

As Sandwich says, suicidal ideation with a plan is not something to be ignored.

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.

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.

He's on hospice? What is his diagnosis? Is he on any psych meds? Does he have a dx of dementia? Your profile says he has "age related decline".

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?

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.

cynergy, I am seeing this in a different light.... how far into dementia is your Dad-in-law?.... otherwise from what you wrote in your title, sounds more like he wants a lot of attention, thus will do or any anything to get that attention. He is making a game out of his illnesses. Time to put him into "time-out" any time he acts up.

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.)