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Gma is 86, has Alzheimers, lives with me (granddaughter, 46), my husband (48) and my mother (67, disabled) lives downstairs in her own "apartment" in our home. We're very new to this as gma has been with us for only 6 months, previously living out of state, independently. Gma has anxiety but refuses medication. One thing I notice is when I give her advanced notice, say letting her know yesterday that her home health nurse would be coming today, she sleeps poorly, gets up early, anxious actions, etc. I'm curious how others approach this, should I not tell her in advance and just let her be surprised when the nurse shows up? Not let her know she has a Dr appointment in the afternoon until it's time to go and just say: let's go! She's in a moderate level of decline, can't do many things, loops on subjects, can't come up with words, remember people in pictures, but can still dress herself, toilet, sponge off, eat food that has primarily been prepared for her. She's trying to remain very independent while not being able to recognize the limitations. Thoughts?

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You’ve tried warning her and seen how that works, so try the surprise approach and see if it’s any better. You may find a difference or you may find the anxiety is present no matter what you do. Does she refuse all meds or just those for anxiety? If just those for anxiety, I’d try adding one without her knowing what it is for, or having her doctor take a different approach in having her accept it. The anxiety is what needs calming
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Welcome, MsCorrie!

My mom's anxiety is what landed her in a facility. Anxiety is a treatable condition.

Has gma been seen by a geriatric psychiatrist, who can explain this all to her?

In your shoes, I think I might get a large wall calendar and mark down when various appointments and events will occur. Consider that "informed" and see if it helps her manage.
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If what you're doing is not working, then try something different! Oftentimes, giving an elder with ALZ advance notice about things CAUSES anxiety, so why do it? Nix the wall calendar entirely (since they can't and won't pay attention to it anyway, 99% of the time) and just let gma know shortly before it's time to do something, and get her ready for the event at the last minute. Then there's little time to fret or argue, and off you go.

I agree with Daughterof1930 to slip some anti-anxiety meds into gma's food if she's refusing to take them. My mother with dementia had good results with Ativan to calm her down. There's no point in turning down meds that HELP an elder with chronic anxiety, let's face it. Yet being argumentative goes with the ALZ territory.

I suggest you read this 33 page booklet (a free download) which has THE best information ever about managing dementia and what to expect with an elder who's been diagnosed with it.

Understanding the Dementia Experience, by Jennifer Ghent-Fuller 
https://www.smashwords.com/books/view/210580

Jennifer is a nurse who worked for many years as an educator and counsellor for people with dementia and their families, as well as others in caring roles. She addresses the emotional and grief issues in the contexts in which they arise for families living with dementia. The reviews for her books are phenomenal b/c they are written in plain English & very easy to read/understand. Her writings have been VERY helpful for me.

The full copy of her book is available here:
https://www.amazon.com/Thoughtful-Dementia-Care-Understanding-Experience/dp/B09WN439CC/ref=sr_1_2?crid=2E7WWE9X5UFXR&keywords=jennifer+ghent+fuller+books&qid=1657468364&sprefix=jennifer+ghent%2Caps%2C631&sr=8-2

Best of luck dealing with everything you have on your plate.
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I chose not to tell Mom until we were getting ready to go. Since she was no longer making the appts or driving there, there was no reason to give her a heads up. A calendar would not solve this problem. Its not her asking "when is my next appt" its anxiety because there is an appt she needs to be up and ready for.

I wondered one day why when I picked Mom up for Church she was fully dressed sleeping on the couch. My nephew was living with her and told me she was up at 3am. He told her it was not time to get up yet but she insisted she needed to get ready for Church.

I would just get her up, dressed and maybe some breakfast. I would then tell her "now ur all ready for the nurses visit".
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Speaking from years of homecare experience, I'd say in cases like yours it's better if you don't tell the elder their help is coming or they have an appointment. All this does in give them an opportunity to work themselves up and then everyone has to deal witht he anxiety and panic they've worked themselves up into.
Put reusable calendar on her refridgerator and mark the days of the week her homecare aide comes. She won't pay attention to it, but do it anyway. Then about a half hour or so before their shift tell her so and so will be here in a littlw while, then point it out on the calendar. Chances are she'll probably 'showtime' like she remembered all along and will not work herself up.
The way to break a dementia loop is to answer the question once ot twice and then ignore the subject completely. Let her repeat the same thing over and over, or ask the same question a thousand times. Ignore it. Don't ignore her, but ignore the subject of the dementia loop. This usually breaks it.
Also, it would be a good idea to have her doctor prescribe an anti-anxiety medication that you can give her when needed.
Ativan (lorazepan) is a benzodiazepine class drug and it is like a miracle for anxiety.
I've been in homecare a long time 25 years and have dosed many elderly people with a little liquid lorazepam or even a pill. It calms them down right away without making them a zombie. Ask the doctor.
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I favor the surprise. It’s not actually a surprise, which might be viewed as scary. It’s more of a casual mention that after breakfast we’ll be going to (fill in the blank). It’s usually greeted with acceptance and very little questioning because there’s not enough time for anxiety to build.
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Went through the exact same thing with my mom. When everything was on the wall calendar, she would stress and ask me a million questions every day about the same stupid things. So, to save both of us from the stress of this exercise in futility, I stopped writing ANYTHING on the calendar until the night before or first thing in the morning. She would complain about that but that was 100 times better than answering all the questions! And she would drive herself (or was it just me??) crazy trying to keep everything straight. Which was impossible due to her dementia. I'd give her enough time to get ready and that was about it. Not that she really listened to it but I also told her that she didn't have to worry about any of it any more. I made the appointments, I know the schedule, and I'll always give you plenty of time to get ready.
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