I feel like she cannot process grief, that she will have to hear it over and over and it will be devastating each time. This is her only sibling, they were close over the years, but not in close contact for the last 10 years. I am concerned on how it will affect her health (both mentally and physically). I am considering not telling her when her sister dies. She would have found this appalling before her illness. Now, I feel like she can only live in the moment and even if we have a week of telling her over and over and drag her through a funeral, that she will not remember it for long. So what is the point? She has been robbed of so much, doesn't she deserve to be spared what she is not capable of handling?

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Ksuz, you are absolutely right! I did the same sort of. My mom's parents passed. Grandad in 1963, grandma in 2001. I made the mistake of trying to explain they were dead a few times (in my early days of caregiving) and it was either profound grief or anger because nobody had told her. She lost a sister in 1952, even sometimes wondered about her. I finally decided to go along with her delusions and would tell her that grands were on vacation and would be back the following day. We do what needs to be done to keep them as comfortable as possible and sometimes that means therapeutic lies.
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I think not telling her is the merciful thing to do. You said they haven't been in contact in 10 years so it's not likely your mom will start asking about her sister. And even if she does you can divert her.
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I agree - spare her the pain. My mom's best friend passed away (in the town my mom lived in for 35 years). I never told her. She didn't ask about her friend and I didn't think it would help her in any way to know her friend had passed. It's a small mercy in my opinion to spare our loved ones of these hurts.
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