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Caregiving Questions

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My mother is 72 years old and has glaring signs of dementia and mental illness (paranoia, for example). Her primary care doctor has referred her to geriatric psychologist. She went once but refused to go back again because they recommended a cognitive function evaluation and medications. She is paranoid, forgetful, aggressive, confused at times, and clearly suffering, but she won't accept any help. Most of her aggression is at my father and he had to move out after being married for 51 years. Our family is suffering greatly and don't know what to do. It's like watching a crash that you know is going to happen, but you no ability to stop it. What shall we do with her, especially under the circumstance that she is in complete denial of her situation? [ 06/16/10 ]

Get together with your family to discuss your mother's situation. If she is currently living alone, then her confusion and forgetfulness could pose a danger if she, for example, forgets that a pot has been left on a hot stove, confuses the amount or type of medication she is supposed to take, or goes wandering on her own outside of her home and becomes lost. Therefore, your family's most pressing concern should be your mother's safety and welfare. Your family needs to come to a consensus about the best course of action for your mother, even if this means you all decide, for instance, that a care facility would be the best option for her now or at some point in the future.

Once your family has reached an agreement about a plan, you all need to sit down together and calmly talk about your concerns with your mother while she still may be able to have such a conversation. Do not expect that your mother will understand or accept everything you have to tell her, particularly since she is suffering from paranoia and confusion. Denial is quite a normal response considering everything, as is the potential for becoming depressed. It is important that you all try to remain calm even if she becomes agitated and starts yelling. Try to address her underlying emotions when you speak to her. For example, she may be scared, lonely, or feeling a loss of control over her life. So continually reassure her that she is loved and that you all only want what is best for her. Work with her in devising a plan that is acceptable to everyone, but be realistic in your (and her) expectations and demands. It is clear that she should not be living alone, though she may be able to remain in her home for some time with appropriate care and providing she takes her medications and visits the doctor regularly.

You and your family should consider consulting an attorney who specializes in elder issues. If nothing else, you can prepare and organize your mother's financial and legal documents, such as a Living Will and a Durable Power of Attorney. In your mother's case, the attorney may recommend that a Power of Attorney for health care also be drawn up. This way, your father, you or another trusted family member can make decisions affecting her health on her behalf. You can identify such attorneys in your area with the help of the following sources:

  • ElderLawAnswers.com: This organization supports seniors, their families and their attorneys in achieving their goals by providing information concerning crucial legal issues facing seniors and a network of highly qualified elder law attorneys nationwide. You can access their website at: www.ElderLawAnswers.com.
  • Administration on Aging: This agency, part of the U.S. Department of Health and Human Services, is one of the nation's largest providers of home- and community-based care for older persons and their caregivers. AoA also provides some legal assistance. Their phone number is (202) 619-0724. You can access their website at: www.aoa.gov/. The AoA website can also lead you to state agencies.

Additionally, you should contact your mother's primary care doctor and/or the psychologist she was referred to and explain the situation to them. The medications that were prescribed to her may help in controlling her paranoia and other symptoms, but they are useless if she will not accept them. Her doctors may have some suggestions for getting her to take her medications.


My mother will be 84 years old in August and was diagnosed nearly 3 years ago with dementia. She is currently taking Aricept and Namenda, and it seems to have helped her. My dad is her primary caregiver and I have noticed that he sometimes appears confused; I am concerned about his ability to take care of mom. He says that he is aware of mom's condition, but is still partly in denial because he expects her to be able to do the things that she used to handle easily, such as paying bills. I do not live close by and am concerned because they live on their own. Also, neither mom nor dad has given my brother or me permission to legally speak with their doctor. My dad said that they have told us everything and there is no need to contact the doctor. I tried to explain that it would be in their best interest, if they were unable to communicate with the doctor on their own or on behalf of each other. Do you have any suggestions on how this situation can be handled without alienating my parent? [ 06/08/10 ]

There seems to be three pertinent issues here: 1) the immediate care of your mother, 2) the mental fitness of your father, and 3) the ability to discuss medical issues with your parents' physicians.

Regarding the first issue, it sounds as though your father could use a little help with the day-to-day care of your mother. Because it is not practical for you check on your parents on a regular basis, a respite caregiver or a home health aide—particularly one that is experienced with caring for dementia patients —would be beneficial in this situation. Your father may argue that he does not need help, or he may feel offended by the idea and resist attempts for you to arrange an aide for such visits. This is not an uncommon response of a primary caregiver, particularly if he is the type of person who rarely asks for help. Tell your father that caring for someone with dementia is a very challenging job, and that it is not a sign of weakness or incompetence to receive some help with that care. In fact, some respite aide will only help to make him a better caregiver, as it will give your father a chance for some “down time” so that he can rest and recharge. This is absolutely necessary for both of your parents' health and well-being.

Your local Area Agency on Aging (AAA) Eldercare Locator can connect you to helpful services in your parents' area, including respite care options. Click on the above link to find the phone number of your local AAA or call 1-800-677-1116.

This leads us to the second issue: your father's mental fitness. It is possible that the stress of caring for your mother has made your father more absent-minded and confused. He may, for example, be suffering from a lack of sleep or he may be depressed about your mother's diagnosis. If you suspect that there may be a problem, then it is essential that your father be examined by his primary care physician. How to get him to see the doctor may be another problem altogether. You or your brother may have to go with him to his appointment. You may run the risk of upsetting your father by doing this, but just remember that both of your parents' well-being could be compromised if your father is not capable of caring for your mother and in fact needs some assistance of his own. Their health and well-being is what is your primary concern, so remind your father that any help you offer is ultimately for their benefit.

And as for the legal issues involving access to medical information, it may help for you and your brother to discuss your situation with an attorney who specializes in elder issues. For example, you might consider the following sources:

  • ElderLawAnswers.com: This organization supports seniors, their families and their attorneys in achieving their goals by providing information concerning crucial legal issues facing seniors and a network of highly qualified elder law attorneys nationwide. You can access their website at: www.ElderLawAnswers.com.

  • Administration on Aging: This agency, part of the U.S. Department of Health and Human Services, is one of the nation's largest providers of home- and community-based care for older persons and their caregivers. AoA also provides some legal assistance. Their phone number is (202) 619-0724. You can access their website at: www.aoa.gov/. The AoA website can also lead you to state agencies.

My husband has had Alzheimer’s disease at least since early 2006. I had to put him in a home specializing in Alzheimer's disease patients in late 2007 because I could not handle him anymore. He cannot go to the bathroom by himself, always has tremors and now has problems feeding himself or recognizing food. The facility will not feed him; they try to let him feed himself and he is not doing well. He was a very big man (over 200 pounds) and now he only weighs between 148 and 150 pounds. He just keeps his head down and eyes closed all the time; however, he is not asleep. Even though he can talk, he rarely speaks at all. I visit him every day and he is declining. What stage of Alzheimer's disease do you suppose he is in? Sometimes I try to help him, but he is not interested. Thank you! [ 06/07/10 ]

Based on the details you have provided, your husband would appear to be in late stage 2 or early stage 3 of Alzheimer's disease. Your husband's physician can provide you with a definitive answer. Detailed information about the symptoms and stages of Alzheimer's disease is available. You can read more about the different symptoms and stages of Alzheimer's disease in the 'About Alzheimer's Disease' section of our website.


Is it typical for a person with early-stage Alzheimer's to "see" and yet "not see"? For example, my husband will often ask where his razor is, even when it is right in front of him on the bathroom counter. How can he not see it? Similar scenarios could apply to his eyeglasses or wallet. I would like to be more patient with him if I understood that, indeed, this is a symptom of Alzheimer's disease. [ 06/04/10 ]

Alzheimer's disease affects short term memory, so it is not uncommon for persons with this disease to completely forget, for example, why they walked into a particular room or what they were about to do with the checkbook they just retrieved. Similarly, Alzheimer's patients can experience a disconnect between the name of an object and the actual physical object, or what the object is supposed to be used for. For instance, your husband may recognize that he needs to do something in the bathroom involving the razor, but he can't remember what it is. Sometimes patients get “stuck” in the middle of performing a task (or have difficulty starting the task altogether), and need a little help to remind them what to do or how to do it. In these cases, a simple prompt such as “your razor and your shaving cream for shaving your face are on the bathroom sink” could be used to aide your husband. If he still seems “stuck,” then break the task into smaller steps such as: “Lather up a small amount of shaving cream to put on your face, and use the razor to shave the stubble.” Then tell him that you'll be in the next room if he needs any further assistance. Some gentle reminders such as these can greatly help your husband in his daily activities.


I read some time ago that one of the early signs of Alzheimer's disease is an out-of-control temper. My 68-year-old husband definitely has this behavior, but his dad also behaved like this until he died at age 87. Do you think that Alzheimer's disease is causing the temper issues, or is it just related to genetics? My husband’s 70-year-old brother has been diagnosed with some form of dementia and is taking medications daily. Please help! [ 06/03/10 ]

A sudden change in behavior along with memory lapses, confusion, and difficulty with decision making can be early indicators of dementia, but there are many other conditions that cause similar problems. For example, head injuries, infections of the brain or central nervous system, thyroid hormone imbalances, depression, drug interactions, alcoholism, and even certain vitamin deficiencies can all cause symptoms similar to the early stages of dementia. Also, if your husband's angry temper is something that has always been present instead of something that has started recently, then his temper may not be a symptom per se, but rather just his “normal” behavior. Only a thorough examination by his doctor will be able to determine if this behavior is the result of a medical condition such as dementia.

It may be difficult, but try to persuade your husband to go see his physician, perhaps by scheduling annual physicals for both of you during the same visit. Rather than telling your husband that you want the doctor to assess his behavior (which very well may anger your husband), you can say that with advancing age it is a good idea to get regular medical check-ups, and therefore both of you are going to the doctor. He may feel less threatened if you are having a physical as well. Prior to his examination, you can discuss your concerns with his doctor and/or your doctor.

Regardless, you may also benefit from talking to a counselor about your husband and his angry outbursts. The Alzheimer's Disease Education Referral Center (ADEAR), for example, has professionals who can help with issues such as this, as well as generally providing advice on immediate caregiver questions, referring patients and caregivers to help in their area. ADEAR is available 24 hours a day, 7 days a week, and can be reached at 1-800-272-3900. Other useful agencies can also be found under “Helpful Organizations.”


My mother-in-law is in the moderate stages of Alzheimer’s disease. If she needs to move to an assisted living facility in another state, but closer to her family, should she be told about this change ahead of time or wait until the day before the move takes place? [ 05/28/10 ]

Alzheimer's patients generally do not like surprises or unexpected changes, and may become frightened, stressed or agitated if their routines are suddenly altered without warning. So by all means prepare your mother-in-law for the move to the new facility by describing what will happen before, during and after the move. Mark the date of the move on a calendar that she can see, and be sure to talk about the moving process frequently beforehand.

In order to make her transition less stressful, try to make her feel welcome at the new facility. Have some of her possessions or personal effects already waiting for her in the new facility. Do not leave anything to the last minute for the move – try to have all the necessary paperwork and provisions in place. Also, Alzheimer's disease patients can get stressed if they feel as though they are being rushed, so be sure to leave plenty of extra time for the journey to the new facility. Finally, immediately following the move, try to get your mother-in-law back on her regular schedule as soon as possible.


My father placed my mother in a nursing home because she has Alzheimer’s disease. He no longer wanted the responsibility of taking care of her. Her short-term memory is poor; however; she still knows where her home is and recognizes her family. She has been in the nursing home for 6 months and begs to go home where she is familiar with her surroundings. She is confused and scared because she doesn't understand what is happening to her. What can I do or say to help her? I just tell her everyday that she'll get to go back home in a couple of days. What can I do to make her adjustment less frightening for her? [ 05/27/10 ]

Your mother is still anxious and confused by her new surroundings, but with time she can be aided in accepting them as her new "home." Try to visit your mother frequently, and speak enthusiastically about how nice the new place is. The more things that are "familiar" to her in the facility, the sooner she will come to accept it as home. Perhaps the facility will allow some of her personal effects (pictures, a favorite blanket, etc.) to be used in her room. Be sure that the items are not valuable, in case they should become lost or damaged.

Also, when you speak to her, continually reassure her that you are trying to provide the best possible care you can for her. She may feel as if she was rejected by your father in some way, so you must assure her that no matter what, she is loved by both you and your father and she will be cared for. Finally, try redirecting her attention to a more enjoyable topic or activity.


We have an Alzheimer's patient who is 96 years old. He gets up several times each night and roams with his walker. We get no sleep; however, he can sleep throughout the day. His doctor has changed his medications several times but nothing is helping him. We have tried Ambien CR, Depakote and Benadryl. Do you have any suggestions? [ 05/26/10 ]

For reasons not fully understood, Alzheimer's disease frequently disrupts a patient's circadian rhythm (our internal clock that helps regulate day-night awareness/activity), which then results in patients being awake at night and sleeping during the day. Regular exposure to sunlight can help to improve an Alzheimer's patient's overall mood and – when combined with calming, dim lighting in the evening – can help to keep a patient's circadian clock on track.

Several studies also seem to indicate that the use of bright lighting in the patient's home environment (or care facility) improves sleep quality in dementia patients, presumably by normalizing the day-night cycle. For example, bright lighting improved facility patients' sleep patterns (longer nighttime sleep with fewer nocturnal sleep interruptions), reduced patients' agitation, and lessened the incidence of depression.

Additionally, physical activity during the day can help to improve or regulate nighttime sleep. So try to encourage the patient to participate in some sort of physical exercise every day.


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Disclaimer: The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for the advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product or therapy. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.

Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.

Last Review: 04/29/13


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