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Situation: 96 y/o mother-in-law won't take her meds. When the caregiver tries as tactfully as possible to encourage her to take them, she gets angry and her OCD/narcissistic/paranoid behavior kicks into overdrive. Then, when by herself, she starts talking to "her voices," so there's probably some schizophrenia in there with the dementia. When she doesn't take her meds, she is totally "off the rails," so we're desperate for a suggestion or two. Taking her to the doc is a useless exercise because for 30 minutes to an hour, she can amp up enough adrenaline to put on a false front, but by the time she gets home, it's back to moans and groans and helplessness. The caregiver (an incredibly kind and giving lady, by the way) is at her wits' end and threatening to quit if M-I-L doesn't take the meds, and we're fearful that no one else would take the job! Thanks in advance for the feedback!

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It sounds as though your MIL needs a higher level of care than home care.

Has she ever been admitted to a psychiatric facility to get her on a regimen of meds that keeps her on a more even keel?

Can any of her meds be crushed and put intobpudding or applesauce?
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Agree to eliminating as many meds as possible (supplements) & give her the most important prescribed meds.
I am not sure you can employ or direct "two strong guys" to hold her down while they inject her with her meds. They can be charged with battery.
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M-I-L is ready for facility care. You know this.

Not sure how spouse feels, but your home life is quite compromised by M-I-L's presence and her needs.

MIL's irrationality, acting out and inability to reason will only get worse. By the time MIL is out of your home (via placement or passing away), you might not have much of a marriage left. Are you OK with that?

Commonly, the default thinking is that the elder takes center stage -- and the elder's needs are a higher priority than quality of life for the caregiver generation. Not judging. We've all been there. That's why we're on this forum!

Now allow me to appeal to your logic: MIL doesn't have any more vacations to look forward to; no more goals to achieve; little to no ability to connect with grandkids. It is sad with a capital S-A-D, but it's a core truth here. 

You and spouse still have all those potential joys and life-affirming experiences on the horizon. And you still have your health (I hope!). Are you both truly in agreement that it's OK to forfeit your future for a lost cause? If you keep taking this day by day and hoping for fill-in-the-blank, that's exactly what's going to happen.

You would do well to consider an alternative that allows your spouse to simply be a caring and involved adult child. And not the shadow-self of a declining parent.

Residential facilities have 3 shifts for 24-7 coverage. Every 8 hours, fresh talent takes over.

How fresh do you and spouse feel after 8 hours of MIL's physical needs, inability to reason and draining behavior? Then it's you 2 all over again.... indefinitely? Not healthy. Please consider alternatives.

((((HUGS)))) Yes, this is difficult.  
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I know its hard. My dad also got angry about his meds. I wished I had thought of more options for him. I think Barb's idea of crushing the meds and putting them into applesauce or pudding is a great idea.

But given her age, maybe assisted living or a nursing home might be a better option.
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Your MIL is showing typical behaviors for a person with demensia. Yes, even the fact that she can hold it together for the doctor is one of the signs. My mom was like that in the earlier stages. I suggest you and the caregiver learn about techniques for dealing with a person with demensia, it helped me tremendously. Check out Teepa Snow and Naomi Feil. They both have great ways of dealing with the challenging behaviors associated with demensia. There are books, google, and YouTube resources on this topic as well.

As for the medicine, at a certain point (when mom started spitting her pill in my face and I was crawling around trying to find it before the dog did ;-), I found I could put her Seroquel pill (a small pill used for agitation) in a half of a bite-size milky way, I used the dark chocolate ones. I just said, "Mom, here is a chocolate treat!" And popped it in her mouth. She has progressed to stage 7 Alzheimer's now and I still give it to her in a piece of chocolate, I just use a peppermint Patty...less chewing. Works for us, you could try it!

I am with the others who posted before me...see what you can safely cut out, with the doctor's input. My mom no longer takes anything except the Seroquel twice a day. You might also have her checked for a UTI...that can cause abstinent behaviors in a PWD (person with demensia). 

Caring for our elders can be challenging. Many years ago we cared for my FIL but his was physical and not that much hands on care needed. We also care for my MIL now, but again, it is not much hands on care. My mom's care is 24/7. She can't do any daily living tasks at all anymore. She is double incontinent, can't feed herself so we hand feed her, can't walk or stand, mostly rambles all day. But as my 14 yr old grandson pointed out, "Grandma may not be able to remember much, but she knows all the cuss words." Hahaha, and she was always a proper lady but now she has a sailor's mouth as my nephew says. I couldn't do this without the amazing help from my husband. I am sure your husband appreciate your care for him mom. One thing is for sure, demensia is progressive, it changes, each stage has it's own challenges, but this too shall pass, and the next stage will have different challenges.
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My mom, at times, will refuse to take her meds. My mom is on puree food and so all meds have to be crushed or liquid. Right now all her meds are crushable (the doctor did have to change a couple of her meds that were not crushable, so always check with the pharmacist on whether you can crush a pill or not), so we do not have to go to liquid, yet. Although I wouldn't outwardly encourage people to not tell their person what they are giving them, I do not tell mom when I'm giving her meds, it's just a whole lot easier and no arguments. Often times she takes them for the aides, but there are times she will spit it back out, then, of course, you don't know how much of her meds she actually got. So, the aides have used my tactics as well. Also, 60% of the time my mom doesn't feed herself, so I can get away with this.
One way is by mixing it in with a little pudding (applesauce has never worked with my mom) and then I get the rest of the pudding cup and put this little bit of pudding on top so it looks like the pudding is all the same. I feed her right from the pudding cup. This always works. I have used a separate little plastic cup along side the pudding cup and it doesn't always seem to matter. But you never know and I don't like to take the chance that she will refuse because it's downhill from there. :)
Another way is by mixing it in with ice cream and then chocolate syrup on top. She can never tell when I do this, but I try not to give her too much sugar so this is her night time med treat and she loves it.
Another way is by mixing it in a little pudding, then when I feed her breakfast of oatmeal or cream of wheat, I take a little scoop of the pudding and then I scoop the spoon into the oatmeal or cream of wheat. Now, she can tell the difference here but only if I put too much pudding on the spoon, so the key is small amounts of pudding on the spoon.
Another idea, which I have not used yet, is after you crush the pills, put a little warm water in with the pills so they dissolve and pour that into like Ensure.
By the way, I always crush the pills until it's like powder, no chunks, so mom can't feel the chunks. Sometimes it's all about the texture :) Good luck and make sure you are taking care of yourself.
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Another thing is to find out which meds are really important. At 96, you can ditch vitamins, statins, and a whole lot more, but since I'm not a doctor, I won't say. Generally the mood stabilizers are important or nobody can provide care. Taking medications, or not, is one of the few things your loved one has control over (even with dementia, they seem to know it). While hiding meds is often done, there are states where that is against the law because it is the patients right, dementia or not, to refuse. Good thing this law is often ignored!!
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If someone is in the end stages of dementia and dies of a heart attack because they stopped taking their statin, that may be a blessing.
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Can you crushed them and put them into some applesauce or something
she likes to eat?
This is what the nurses used to do for my mother.
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First, find out what is really needed to be taken. Eliminate all that is not necessary.
Second, find out if there are any medications that can not be crushed. This is very important as some are time released or some are designed to dissolve in a lower part of the gut or they are coated to protect the stomach. These usually can not be crushed.
Begin crushing the ones you can crush and put them in pudding, applesauce, yogurt, ice cream....
If this does not work you may have to ask the doctor if any come in liquid form then you can just add the dose to any food that you are serving.
You might also want to find out if any are available as slow release patches that can be applied to the skin and left for as long as intended. You have to watch these because if one patch is applied and the previous one not removed the person can get a higher dose than intended.

I don't know if telling your MIL that if she refuses to take her medications you may have no other option but to place her in a facility where the medical staff will be able to ensure that she gets the proper medications at the proper time. This may mean an Assisted Living or Memory Care facility or possibly even a Nursing Home. Explain that you really don't want to have to do that but she needs to care for herself and taking the necessary medications is a way she can do this so that she can remain home.
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