Elderly uBPD mom, driver's medical, and subsequent dysregulation

[GaGrl]

I agree that getting help with transportation would take a huge portion of carrying off you, Methuen.

We lived 360 miles away when my mom quit driving. She already had a caregiver coming in for light housekeeping and other household tasks, so she upped the visits to three mornings per week, and Mom made her doctor appointments so that her caregiver could drive her. Sometimes, a caregiver visit would be nothing but baking a cake or cookies.

When we retired and moved to our retirement house, where Mom had been living for three years, she asked if she should cut back on the caregiver visits, now that I was "home." The voice inside )…was screaming, " Oh my God, NO! " But I managed to quietly say that she was so helpful in so many ways, we should keep the 3x week schedule. By the time Mom was in hospice, she was coming 5 mornings a week plus coming over every evening for nighttime prep.

Now might be the time to find someone who can be a companion/caregiver for the long haul.

[Methuen]

One reason I spoke to the nurse first, is that my mother often lies to me…I guess she was upset that I didn't call her to show concern, but I would not be able to rely on what she tells me.

I get this.  It is the same with my mom.  Sometimes she is truly unwell from any number of things.  But sometimes like you say, she tells me something is wrong - like the earlier post where she texted her heart was making her unwell again.  This demands a response,  but as soon as I asked if she needed to see her doctor, she replied it was fine 15 min later.  So what was rhe point of telling me?  We think it’s all about a high need for attention. Speaking to the hospital nurse was what any reasonable person would do if they found out a parent went to the hospital.  The thing about BPD is that they always respond in whichever way necessary to create chaos, because chaos is their normal (my mom’s FOO was 24/7 chaos).  The difficulty for us is in that chaos they say things to control our feelings and take us down there with them.  Misery loves company.  I am sorry your mother said that to you, because words like that do permanent damage.  But you did nothing wrong.  

About the car and chauffeuring to appts:

This might be an opportunity to introduce the idea of someone else helping your mother by looking into resources for transportation for her.

You are right.  I have to look into this now.  We have something called a handi dart.  Boy is she going to push back hard on that.  I’m already dreading it.

[Methuen]

Now might be the time to find someone who can be a companion/caregiver for the long haul.

I am going to have to think on this.  There is no one that comes immediately to mind.  But it would be good for me to start thinking on this.

[Methuen]

What she has told me in the past (eg. after a fall when her needs including nursing care are higher) is that "she has friends who will help her if I won't do it".  She is even resistant to home care after a fall, and usually cancels it before she is ready.  

I can foresee that finding the right person to be a home companion would be a challenge.  Her friends are all in their 80's and 90's, so that isn't an option, and they would refuse to be paid anyways.  Even they might be uncomfortable with the "obligation" element as well.

She's also cheap.  

This will be tricky.  I will have to start making enquiries for info.

[Notwendy]

I think it would help you if  your mother used her resources to help herself ( which also helps you) if she has them. It's good to be frugal, but up to a point.

I guess I am fortunate in a way that my mother loves to spend money for her own needs and she loves to have people do things for her. I do wish she was a bit more careful to use it wisely, but hopefully she will continue to have enough for what she needs.

[GaGrl]

What she has told me in the past (eg. after a fall when her needs including nursing care are higher) is that "she has friends who will help her if I won't do it".  She is even resistant to home care after a fall, and usually cancels it before she is ready.  

I can foresee that finding the right person to be a home companion would be a challenge.  Her friends are all in their 80's and 90's, so that isn't an option, and they would refuse to be paid anyways.  Even they might be uncomfortable with the "obligation" element as well.

She's also cheap.  

This will be tricky.  I will have to start making enquiries for info.

It's not an easy task to find the right person.

Mom's caregiver is a member of the church Mom belonged to for almost 70 years -- she is my younger sister's age, and been in youth group and played league softball with her. CG is a CNA and had worked in a rehab facility, so we were confident of her abilities. The trust factor is huge -- this is someone you need to trust in your household, with personal and valuable items. I can imagine that, with a BPD, that level of trust would be difficult to achieve.

[Turkish]

My mom didn't trust anybody. More accurately, she trusted the wrong people. So many "friends" stole from her, including her shotgun. Which she bought at a garage sale illegally (California) so I didn't pursue it.

Yet I was the one who would steal her property and kick her into a nursing home, said to me 20 years ago, long before dementia set in. It really triggers me to impugn my character. My uBPDex also did the same thing. It's like they knew some secret about me that no one else in my life who knew me very well had ever suspected.

[Methuen]

It's not an easy task to find the right person...The trust factor is huge -- this is someone you need to trust in your household, with personal and valuable items. I can imagine that, with a BPD, that level of trust would be difficult to achieve.

Yes this is complicated.  Trust is one thing.  Another is the fact that I live in a small town and can't really ask too many questions or attempt to "sniff out" the right person for the right job...'cause in a small town, word would likely get back to mom.  That would be a disaster.

I'm thinking I need to find a way to make this her idea.  All the stars need to line up at just the right moment.

On another note, I'm sorry so that your mom put you through that Turkish.  BPD is truly a horrible disease.  Just horrible.

[Notwendy]

I guess in a way, I am fortunate because my mother loves to hire people to help her, but she's not happy about any of them. Some of them have stolen from her.  Yet, like Turkish's mother, she doesn't trust her own children. She also won't give us anything of value, and instead, people have stolen family valuables from her. She also gives things away to them that she won't give to us.

On the other hand, we are grateful she has people to take care of her.

I hope you are successful with finding help Methuen. You are right, if it's not her idea, it might not go over well. I hope you can convince her.

[zachira]

Methuen,
Don't  underestimate the knowledge of some of these home health care agencies whose staff are well trained and experienced in dealing with people like your mother. Unfortunately, there are many elderly people like your mother and the agencies dealing with the elderly are often quite familiar with them and know how to work with them. It is kind of like hiring a divorce lawyer that gets high conflict personalities.

[GaGrl]

Zachira, I agree. Professional caregivers with a good deal of experience have seen enough to have this amazing combination of empathy and the ability to not take words and behaviors personally -- they just roll with it while continuing to take care of the necessary tasks.

Methuen, what if you found three qualified caregivers and had your mother interview and select one? That could give her a sense of control.

Sooner or later, you'll need to have the conversation with your mother about your limitations in doing things for her. Don't let the FOG deep in on this! I think we all sense you are reaching a limit on your physical, mental, and emotional capacity.

[Methuen]

Methuen, what if you found three qualified caregivers and had your mother interview and select one? That could give her a sense of control.

This is a good idea for me to keep in mind.

Sooner or later, you'll need to have the conversation with your mother about your limitations in doing things for her. Don't let the FOG deep in on this! I think we all sense you are reaching a limit on your physical, mental, and emotional capacity.

Yes, you are right.  The conversation is coming.  I think when the time is right we will seize the opportunity.  The walking on eggshells never ends, because we are aware it is important to pick the right time.  Of course there's never a good time to have this conversation, but with pwBPD, there are better or worser times for sure. When she's dysregulating, I am at or beyond my capacity, because she is completely irrational, impossible, manipulative, relentless, and she strikes out by being vindictive and even hateful.  This becomes a living nightmare.  Failing the driver's medical invoked a trigger - like pouring a huge fuel tank of gas on a smouldering fire.  It's been about a month since that driver's medical, and after bringing her groceries yesterday, I am sensing that she is maybe coming to accept what it means for her (loss of driving independence).  

For me it means more waifiness.

We actually had a "visit" yesterday (an actual exchange of conversation topics), which I can't remember the last time that happened (years?), and talked about a few different things before the conversation somehow segwayed into her home life when she was a kid.  I worked with young adults in my career, and after retiring, I worked for a year in a women's shelter, so I am familiar with trauma.  I have always been able to empathize with her, but I am aware that because she refused to see a counsellor or get help with processing her trauma her whole life, she and her trauma are one, which along with the BPD, also means the same old stories (which I used to hear as a kid when she visited with her far-a-way sisters) keep resurfacing.  She skirts around certain topics, uses euphemisms, and never ever declares what really happened, but just dances around it.  I don't want to come out and ask because it's not my business unless she choses to disclose it.  So I just listen reflectively, but, in another 2 years she'll bring it up again.  I did ask her yesterday if she thought her dad had a mental illness.  She thought about it, and said yes.  She also said he ruled the house with fear and hate, and she said it with emphasis.

If only she could make the connection between her  trauma and her rage and her relationships, but she can't.  There is zero awareness for self-improvement.   She also often has zero social skills around me (selfish, demanding, lists of jobs for me when I show up downright mean-ness etc).  It feels a bit bizarre to have had a "visit" yesterday.  It feels strange, uncomfortable really, like I'm not sure what to make of it.  One in a million interactions.  The others can be a form of torture.  So unpredictable.  Jekyll or Hyde?

She is lonely.  She also told me yesterday she can't go more than 2 hours without taking a "nap".  Sometimes her "naps" go from 2pm to 6pm.  Then she's awake all night.  Honestly, she's never been able to regulate much of anything throughout her life, be it sleeping, eating (eating disorder), emotions, interactions, what comes out of her mouth when she's talking...even her driving.

H and I are convinced that she could actually thrive in assisted living, because she would be around people.  Probably be the life of the party, except for the ones she didn't like, where she would become the needle in their arse.  She's always loved being around people, who feed her need for attention.  When she had a dizzy spell, or got another attack of nausea, or her heart gave her trouble, or she fell, help would be down the hallway.  The down side is she would give up autonomy, and her house.  Nothing trumps the latter, not even loneliness or personal safety.  Yesterday she expressed how relieved she was that her gardener told her she would look after her yard again next year (the gardener is currently recovering from a hip surgery and couldn't do it this summer, although she still managed the spring cleaning that goes with landscaping and flower beds).  I think that solved a huge worry for her, because it equates to being able to stay in her house (and she knows we won't do the gardening).

The conversation I foresee having with her is pointing out the benefits of assisted living, which she can't do on her own, and balancing those with the costs.  And doing the same benefit/cost analysis for staying at her house.  Help her compare them.  You can lead a horse to water, but you can't make it drink.  She isn't going to drink.  But at least we can know we did our best.  She has to live with her own decisions, whatever that means.  But,  , everybody's quality of life (including hers) would be better if she decided on moving to the assisted living facility here.

Her decisions are driven by her emotions, and fear of losing her house, fear of change, fear of abandonment, fear of the unknown will trump any benefits to moving in the cost/benefit analysis.

My H thinks her window for assisted living is closing, especially since there is such a waiting list and she refuses to go on it.  It will be a catastrophic event that puts her into complex care. She will hate everyone (doctor's, nurses, us, her friends), and trash everyone.  When she's angry, the poison and vindictiveness comes out.   The binswangers are also making things progress faster (vascular dementia).

Meanwhile, I just got a text that tells me she needs another $600 cash from the bank to pay for all the people who come to help her.  I don't want her to give her bank card PIN to a non-family member, so it's another job.  

I don't want to think about which jobs I can do, and which ones I will tell her I can't do any more.  But I guess I will have to.  Hopefully it doesn't  trigger another dysregulation.  Eggshells again.  Then I have to find my way through another tunnel of fire.

there are many elderly people like your mother and the agencies dealing with the elderly are often quite familiar with them and know how to work with them. It is kind of like hiring a divorce lawyer that gets high conflict personalities.

. Yes thank you for the reminder.

I will get through this.

[GaGrl]

Include the cost of paying for what you can no longer do in the cost-benefit analysis, and just make it sound as much like a financial aspect as possible.

On the "conversation"...I had a similar conversation one day before my mom had her call and went into the downward health spiral. We were talking about her stepmother, who was uBPD/NP D and was o e of the meanest, self-centered, jealous, nasty persons O have ever known. She did my mother immeasurable damage from the time she married my mother (mom was 6 and had already been traumatized by the death of her mother two years earlier). Mom was talking about forgiveness -- people do that at age 94. But it was the first time she said, " Sometimes I wonder if the way SM treated me is the reason I am the way I am. " I was floored but validated that everyone close to her knee what the situation with SM was like. My mom had never before gotten close to admitting that some of her behaviors were "off" -- a few BPD traits like the inability to handle anger, giving people the silent treatment, etc. It was a strange conversation .

[Notwendy]

Methuen,

Our mothers are so similar. While in theory, I thought she'd like assisted living, and I suggested it when my father was ill ( as he needed it), they rejected all my suggestions. She's rejected any suggestions except for the fantasy of one near me. Somehow "that one" is the best of all of them. But she's not ever seen "that one". There are nice ones near her too. This is a common behavior with her- do decide on something based on how she feels about it, not that she's ever seriously visited any assisted living.

But this: She will hate everyone (doctor's, nurses, us, her friends), and trash everyone.  When she's angry, the poison and vindictiveness comes out.  

I see this now with her helpers. She's also lashed out at nurses and others. I realize now, after seeing this, that she'd be like this in assisted living too. Even with nice people to meet and activities, she'd likely have none of that, find something wrong with everything- because this is what she does now, even with her own children.

It would be the same no matter where the facility is.

I agree, she is acting out on her own trauma but I don't know what that is. My guess is that she's disassociated from it. But she sadly plays this out with those closest to her.  It seems she perceives us as disappointing and hurting her no matter how hard we try to do the opposite.

[Methuen]

This is a common behavior with her- do decide on something based on how she feels about it, not that she's ever seriously visited any assisted living.

This (they dcide on something based on a feeling).  Anyone out there ever found the antidote to this?  Please share urgently!

 It would be the same no matter where the facility is.  

…including if the facility is her own independent home near you…

I agree, she is acting out on her own trauma but I don't know what that is. My guess is that she's disassociated from it. But she sadly plays this out with those closest to her.  It seems she perceives us as disappointing and hurting her no matter how hard we try to do the opposite.

Maybe.  But I think its us perceiving that we must be a disappointment because of what they say and how badly they treat us.  In fact what multiple T’s have told me is that we are the people they feel safest around to dump all those toxic bottled up feelings they have, onto.  It’s counter intuitive. Somewhere in this  is a backhanded compliment.  It’s just super messed up.

[zachira]

Methuen,
It sounds to me like you have to be the last person to tell your mother anything because she will use whatever you say as a means to abuse you. I had a cousin who had BPD. Off and on for years, she refused to get her infected leg treated for months at a time. Everybody was after her to get an appointment with her doctor. One day, I took my cousin to do some errands. My cousin told me she wanted to invite me to eat out to reciprocate my taking the time to drive her around to do errands. I told her if she really wanted to repay me, she would go to her doctor to get her leg taken care of. That day she made an appointment with her doctor, and actually went. She told me that she had also been told that same day by the person doing her manicure, she needed to get her leg looked after. I was being recognized by the family as having somehow magically gotten my cousin to get her leg looked after. The truth is she was just ready to do something about her leg. So many fine people who are kind, tactful, and good at influencing others had failed to get my cousin to care for her leg. I suspect you may have somewhat of a similar experience with your mother. When circumstances make it so she can no longer live in her home, than either she will decide to get the help she needs or the circumstances will leave others with the authority to make the choices for her.

[Notwendy]

Zachira- credit to the manicurist! I mean this seriously.

At one point, I did visit some assisted living centers- a while back. I found one I liked that I thought would be a good choice. Well that was flat out rejected. But then, a neighbor mentioned another one was "good" and that one became THE ONE, based only on that comment. While that never happened, the comment from an acquaintance carried more weight than the one her daughter actually visited and checked out. Now, logically, who would be more concerned about finding a good fit than her daughter? But that doesn't come into play.

Often my mother will say " my hairdresser's third cousin's wife say this is the best______________. And that becomes the best______.

Yes, Methuen, maybe they do feel close enough to us to lash out at but it is messed up.

[Methuen]

I did visit some assisted living centers- a while back. I found one I liked that I thought would be a good choice. Well that was flat out rejected. But then, a neighbor mentioned another one was "good" and that one became THE ONE, based only on that comment. While that never happened, the comment from an acquaintance carried more weight than the one her daughter actually visited and checked out. Now, logically, who would be more concerned about finding a good fit than her daughter? But that doesn't come into play.

Often my mother will say " my hairdresser's third cousin's wife say this is the best______________. And that becomes the best______.

All this!  Exactly!  All of it!

The day mom learned that two of her friends were on the same antidepressant,  she made an appointment with her Dr to ask for the same one.  I have soo many examples of how she sees the actions and ideas and decisions of other people as gospel!  Then she copies it!  But her daughter?  Things Ive suggested have been dismissed or repudiated or worse, but then later when a friend makes the very same suggestion, it’s a brilliant one, and she has to do it.

What is needed, is for one of her friends to choose to move into our assisted living facility.  Then it would suddenly be the “best ever”.  And she would want to move to.

I have a deep need to have the psychology behind this explained to me.  Please…anybody?

[Notwendy]

I'll give it my best guest. I think it's similar to them projecting their low self worth on to the people closest to them in a similar way they tend to mistreat them. Combined with a poor sense of self, they may tend to be more middle schoolish about looking to their friends for a sense of self. I recall when the middle schoolers all had to have the same style clothes and hair as their friends no matter how it looked.  If Mom liked something, they rejected it. This is the stage where they don't know who they are, but begin with "not Mom". Mom was soo embarrasing...Mom might suggest a hairstyle- well that had to be rejected, but if their friend died their hair green- well that was the best and they wanted green hair too.

[Methuen]

So I am desperately trying to grasp this, because this very thing has been bothering me for a very very very long time.  I don't understand it at all.  I've come to accept the psychology behind why we get all their toxic feelings dumped on us (even though I reject that as an excuse for abuse).  I don't like it, but I can understand it because of the BPD.  But I'm feeling a bit thick in the head, trying to comprehend the incomprehensible...when it comes to why I can suggest something which is viewed as unworthy, but later a friend of hers can suggest the very same thing and it is not only a good idea, but suddenly she has to have (or do) the "friend's" idea.  

a) It's a role reversal; because they see us as caretakers for them, they've reversed roles so we are mom and they are child, and since teens (i.e our mothers) like to rebel and form their independent self, they reject mom's ("us" being mom) ideas as not worthy

b) Since they have a low sense of self and self-worth, they project that onto us and therefore anything we say has no worth.  It's similar to why they rage at us but not their friends, and is related to who they feel safe rejecting.  They want to be like their friends, so they embrace those ideas.  If this is the psychology of  what is going on, why don't they want to embrace the good ideas of their daughters (or sons)? Especially if there is a benefit?  (Since they see the benefit when their friends make the same suggestion).

c) they are emotionally developmentally delayed (probably related to the age at which their trauma occurred) and their choices and emotional capacity to make decisions is about the same age as their emotional developmental delay

d) all of the above

e) none of the above (meaning I'm still not getting it)

  Thanks in advance for being patient with me, as I try to grasp why a BPD mother rejects a loving daughter's ideas, but admires the same ideas if her friend's have them.  This is just so messed.

Or could it be plain and simple but deep insecurity - related to narcissism (we had a good idea, which they didn't think of, so in a narcissistic way if they didn't think of it, it must be a bad idea coming from their daughter), or alternatively, could it be plain and simple jealousy of their daughter (kind of related to "c" above)?

Sigh.

Several years ago, mom was in a serious long term crisis, which meant my life was in crisis (because they are parallel lines on the curve).  I offered the idea of checking in with her doctor, to see if antidepressants would help.  Well, the   hit the fan because somehow suggesting she might need antidepressants was taken as a terrible insult, and life got worse for everyone.

About six months later, two of her good friends told her they were on Mirtazapine.  That very day she called and made a doctor's appointment, and came away from the appt with her script of Mirtazapine.  

Could have done that 6 months earlier when I suggested it mom!  (Thoughts only - I bit my words as we all learn to do.)

Same thing with my suggestions of handrails (rejected).  After a subsequent fall, someone else suggested it and she called and had handrails installed.  Words can't describe what   my life becomes when she has a fall and breaks bones at the age of 85 and can't use her walker or do the things that need to be done for daily life (like eat, bathe, use the toilet etc).  All preventable, if she had just said "handrails! What a good idea!" when I suggested it, instead of rejecting the idea.

Really really really trying to grasp the psychology.

[zachira]

Methuen,
I believe there are many explanations for why a BPD mother would reject the ideas of her daughter while being open to the same ideas from either a friend or even a stranger. Here are a few: People with BPD see their children and other close relatives as extensions of themselves, and not as separate people. People with BPD are terrified of intimacy and only feel comfortable in superficial relationships. People with BPD have poor boundaries and treat relationships with strangers as being more intimate than they are.

[zachira]

Understanding why the disordered persons with BPD in our lives are the way they are does not take away from the frustration and ongoing suffering of having to deal with them. The reality is people with BPD function on how they are feeling inside at the moment. Close intimate relationships are where they seem to be the most triggered and likely to act out as intimacy and closeness seem to trigger the fears they could be abandoned at any moment.

[Methuen]

My H has just reminded me that the elderly services consultant we spoke to after mom's last fall, believes my mom could have another diagnosis called "pathological demand avoidance".  Basically, anything can be a "demand", such as the expectation of needing to get up at a certain time, having to go to an appointment (such as a driver's medical) or even to get her hair cut, or a pedicure.  These have all become "demands" because she has to get herself ready to go to them, or do something, and even going to an appointment she wants (such as a pedicure) is an extremely difficult process for her.  When she comes home from that, she takes a 4 hour nap for example. 

So if H or I indirectly try to steer her towards acknowledging the struggles she is having living independently, and diplomatically lay out alternative options to help her see how she could make her life easier (eg assisted living), for her to even make a decision to move would be a "demand" she can't handle.  Not to mention that her emotions would get triggered along the process, and once that happens, everything is lost.

This "demand avoidance" fits mom perfectly, although the other elements of "pathological demand avoidance" don't line up.  The demand avoidance seems like a solid pysch explanation of why she rejects my ideas or suggestions.  She doesn't like an idea.  It "feels" perhaps like she is losing control.  It triggers her.  She rejects it.

In addition, a CAT scan for a minor stroke back in 2015 also showed binswangers.  The neurologist told us that, but mom didn't hear at the time.  I don't think she even knows.  To my knowledge, her family doctor never followed it up.  Binswangers are essentially vascular dementia I believe. 

So I'm kind of thinking there are other elements in addition to the BPD going on here.  Age-related dementia, and possibly "demand avoidance".  She's definitely struggling.

Earlier in this thread (on page 1), I mentioned a friend of mom's who was over-involved with her, and has on occasion told me "what I need to do for mom".  Yesterday mom accidentally sent a text to me which was intended for this friend.  Since I didn't understand the text, I inquired as to it's meaning.  Turns out the friend diagnosed mom as needing a higher dose of antidepressant. Apparently the friend is a physician now, instead of a retired teacher, and whatever she says is gospel (whereas she hates her doctor now that she failed her driver's medical).  I am pretty sure mom has the friend in a Karpman triangle, with the friend being the rescuer, and me either the persecutor or negligent daughter.  Turns out mom (a retired nurse) was confused about the prescription dose of her current antidepressant.  The dose is on the prescription bottle, along with the instruction to take "half a pill" daily.  Even though mom was only taking half a pill, she thought she was getting the full dose.

I believe this is the dementia.  I know my mom.  There is no way she would have got that confused earlier in her life.  No way. 

[GaGrl]

Is your mom trying to manage her own meds? She could be getting confused, taking the incorrect dosages (I would be concerned about her taking more than prescribed doses), and having increased side effects.

[Methuen]

When the social worker did the most recent Rai Assessment, they determined she was still managing her own drugs well, which she was.  She is very independent on a few things, and demonstrated she could self-manage her drugs to their satisfaction.  As a "nurse", this is something she wanted to maintain control of.  I suspect that until something catastrophic happens, the Rai assessments may keep suggesting she can live independently.  They seem to put a lot of weight on what she reports to them, rather than what the family might say.  May I ask which side effects you are thinking about?  If it's her napping, I've read up and learned that can be associated with cognitive decline dementia.  My 87 yr old FIL was the same the last few years.  He had vascular dementia.  But who knows.  She's far too complicated for me to figure out.

[Notwendy]

I never heard of demand avoidance before- it seems a bit like oppositional defiance disorder, but whatever it is, I thought it was a part of BPD because my mother does this too. Anything can be a "burdensome demand" on her- even asking her to get ready to go to the dinner I planned for her. Predictably, she even refused to be ready- and it was a dinner I planned when we were visiting- all for her. This isn't new behavior. I assumed it was a way to maintain control. I also think it's "victim thinking" as it becomes "how dare you ask your poor mother do to this" as if requesting something is intended to insult or harm her.

GaGrl- brought up a good point. BPD mother has insisted on control which is one reason she won't consider assisted living. So far, she's insisted on managing her own medication but it's been discovered that she's non compliant with her medical providers- deciding not to take it, or not taking it as prescribed. Now  they are leaning towards assisted living, but I don't think she's going to go along with this. She can "hold it together" when motivated, so she may cooperate to avoid this.

[GaGrl]

I would be looking for side effects like sleepiness, confusuion, intestinal upsets, dizziness, etc.

The increased sleep is associated also with vascular dementia, which my dad experienced after age  90.

[Methuen]

She can "hold it together" when motivated

Yes yes yes.  And then when that is over, and they need to unload their emotions, guess where they go to do that!

I would be looking for side effects like sleepiness, confusuion, intestinal upsets, dizziness, etc.

Yes, the tricky part is all those things have been typical through mom's life.  The intestinal upsets and dizziness have been there for 40+ years.  The sleepiness has been getting worse for the past 5++ years. The confusion (eg not understanding that taking 1/2 pill was 1/2 dose on the side of the prescription bottle) has been developing over the past 1-2 years.  Sometimes it is super subtle.  Other times, like the script example, are more obvious.  Sometimes it's hard to sort out the problem; is it that she can't see the script properly (macular degeneration)?  Or is it progressing vascular dementia (which she doesn't even know about).

Here's a question:  Should mom be told she has vascular dementia?

She suffers acute anxiety (going to an appointment of any kind eg haircut) stresses her out.  She suffers from fear of everything - of change, of aging, of being abandoned, of being "stuck in a home" (and repeatedly says she would rather die than go into care)...  So,  would asking her family doctor (whom she now hates because he failed her on her driver's medical) to discuss her dementia (binswangers) with her, be helpful because it is her right to know, or harmful because of all her other underlying health and mental health issues?  If she knew she had binswangers, I know that her quality of life as she now knows it, would be over.  She would be terror stricken, and probably permanently become emotionally dysregulated.  I can't even imagine what would happen with that news, knowing that failing her driver's medical was a disaster.

I am already POA, and she has a Will, so that planning has been done.

So what is more humane? Telling her, not telling her, or waiting until it progresses further? I'm inclined to wait until it progresses further, but would be interested to hear what others think.

[Mata]

My mom does the same thing about discounting all advice from family but accepting it from outsiders.  It's maddening.  But I don't know if it's unique to BPD.  My brother does the same exact thing, and he's bipolar.  I think it is a mix of control, trust issues, and just generalized disorganized thinking. 

As to your last question, I would leave it up to her doctor to tell her about her medical condition.  He may well have, and she just ignored it.  Who knows.  My mom has done that before, kind of a conscious disregard for things she doesn't want to hear.  My T says to me, "do you want to own that?" when I'm debating questions about what's best or better for my mom.  Is deciding to tell her something you want to own, or could you leave that to the medical people?

[Methuen]

Oh I would neve take that on to tell her - not my job.  I’m not looking  to put a target on myself.

I think her GP has dropped the ball on the report from the specialist back in 2015.  My mom and I have the same Dr.  I have seen him for mental health appts for myself (related to my mom), and shared info about mom and disclosed how her behavior was making me unwell.  He doesn’t discuss my mom’s health with me because of confidentiality, but he listens and offers support for my appt.  When I brought up at a mental health  appt I had booked for myself (about a year ago) that mom had binswangers, he looked confused and jumped onto his computer to look up the report.  He’s a good doctor, but can be disorganized.  I think he hasn’t brought it up with her because she’s an overwhelming patient, even for an experienced doctor.  She’s always there for some  other health reason, and he’s always running late.  He focuses on whatever she book d the appt for.  I honestly think the binswangers aren’t on his radar.

But I’m living with the consequences of them.

My question is more of a moral or ethical  question.  Considering her personality, would it be more humane for him to tell her, or not tell her, yet?  I realize none of us are doctors or professionals, but I’m curious about perspectives.