BPD and the elderly

[Depression = 72% of members]

Does anyone have experience with an elderly parent who has BPD but is now slowly adding dementia to the suite of issues?

My mother has become very cruel in her outbursts and I could use advice on how to handle the new level of pain that she inflicts.

Her psychiatrist has doubled her Cymbalta dose.

(She refuses any behavioral or cognitive therapy)

Thanks for any suggestions.

[Adri]

Does anyone have experience with an elderly parent who has BPD but is now slowly adding dementia to the suite of issues?

My mother has become very cruel in her outbursts and I could use advice on how to handle the new level of pain that she inflicts.

Her psychiatrist has doubled her Cymbalta dose.

(She refuses any behavioral or cognitive therapy)

Thanks for any suggestions.

[clljhns]

  Adri,

While I do not have experience with this situation, my heart goes out to you. 

When was your mom diagnosed with BPD? When did the dementia start and in what ways did the behaviors change as a result?

If mom is in the beginning stages of dementia, would it be beneficial to attempt therapy? I have had some contact with the elderly and dementia, and I have not seen a level of cognition that would respond to therapy. One thing that I was told about dementia in the elderly, is that behaviors can change dramatically. It seems to be an unfortunate effect of the dementia. Have you read any literature on dementia to help you understand the changes in the brain functioning? Has mom's doctor given you any ideas of what is happening with the dementia?

I know this must be so very painful to watch your mother slip into a place where you can no longer reach her. Please keep posting and letting us know how you are doing. Many here have gone through what you are.

Wishing you peace and blessings. 

[Adri]

Thanks for the kind words. We have been through a revolving door with psychiatry. We haven't had one yet (6 and counting) that would give us a firm diagnosis. Each Dr has said something else; she has major clinical depression, anxiety, hysterical conversion disorder, BPD. I've read about all of these disorders and the one my mother absolutely fits perfectly is BPD. No doubt in my mind. She started taking Cymbalta 3 years ago and it didn't really help. Her outbursts, rages and "attempted" suicides (never truly attempted); berating and cruel rants have escalated. We saw her Dr today and I feel like I am hitting a wall with this behavior. I used to be able to better set boundaries, but her dementia has made that exceptionally difficult because things can become unsafe. This board has helped-- just reading other situations makes me realize I'm not alone. Thanks!

[milesperhour]

Hello Adri,

I have many years' experience working with elderly people with dementia.  So here is some of what I have learned about elderly dementia patients:

Dealing with them takes a lot of practiced patience (counting in your head "one-thousand, two-thousand" instead of reacting to their behavior or comments, deep breathing, going to your happy place, etc.) and a certain amount of detatching yourself (just let them talk or rant without taking anything they say seriously or personally).  Just tell yourself over and over that she is not in her right mind, and therefore not responsible for her behavior.  You can have some pity on her because she does recognize that she is loosing her memory and/or judgement and is suffering the loss of being in control of her own life.  She will act out the entire grieving process (denial, anger, barganing, depression, and (sometimes) acceptance. 

I also know that therapy would just frustrate her and be a waste of time.  Dementia patients are beyond the point of being able to learn.  They just don't have the memory or judgement skills anymore to change their way of thinking.  "You can't teach an old dog new tricks".  Remind yourself of this when you feel like reasoning with her to get her to change her behavior.  You can't.  Dementia is a lack of reasoning ability.

As far as pwBPD and dementia together, I did have a gentleman this past year in my assisted living home that I felt had very strong BPD traits.  I was warned before he came to us that he had alienated all of his wives (3), neighbors, and the Hospice staff with his abusive language and rages.  Of course, when I first met him he was so sweet and charming, but he soon showed his mean side.  He was extremely sensitive to audio and touch stimulus and would rage widly at any sudden sound (like a door closing) or unplanned touch (like bumping his wheelchair).  He was extremely selfish and needy, but also very effected by the emotions of others, almost coming to tears when he saw another man in pain.  He was very good at manipulating the staff and his one co-dependent friend with the sweetest voice and thank yous one moment and belittling sarcasm the next.  He had short term memory loss, and this aggrevated him into more rants with screaming, cursing, and blaming others for moving things that he had misplaced himself.  He hated having to have help paying his bills.  He greatly grieved over the loss of his own home and his independence, which was sad to watch.

I felt I could be his caregiver due to my three decades of dealing with my uBPDh.  (As a matter of fact, my uBPDh shocked me by saying, "That's where I am heading.  I'll just like that when I get old."   And I did deal with him quite well, using the skills I outlined above.  He was very attached to me.  But the other residents in my home, including my husband, became very angry about his tongue lashings and got tired of "walking on eggshells".   So, to return peace to the house, I had to send him to a mental hospital.  I heard later that he had made such a menance of himself that he was shifted from facility to facility.  Nobody wanted to be around him.  I heard last week that he had died, miserable and alone. 

Anyway, I recommend that you try to change your relationship with your mother from adult-child/parent to one of detatched caregiver.  If not, you may need to find a professional that do the daily stuff and you just drop in for short visits.  Good luck and take care of yourself first! 



 

[Turkish]

What milesperhour said is good advice to me, too.

It's frustrating enough to deal with BPD behaviors, but the diminishing of cogniive abilities can add a layer of frustration. My mom has/had a near genius IQ. She used to be able do do long division in her head, for example. Those days were over 20 years ago. Now, I order for her at restaurants because she has trouble making a decision from even a simple menu. It's hard to be patient, and I constantly remind myself, "BPD or not,.I'll be at this point someday. Will my kids be as frustrated as I am now?" Most likely. It's ok to be frustrated because it is frustrating.

[milesperhour]

Excuse me, goof advice or good advice?   

[Turkish]

Excuse me, goof advice or good advice?   

My bad. I fixed it 

[Adri]

Thanks for the information. My Mom does sound like the gentleman who ended up going from facility to facility. Just this month she fell and required sub-acute rehab.  In two weeks we burned up 3 facilities, until I checked her out of the last one against medical advice because she was creating such a scene (threatening suicide, threatening patients) I knew if she stayed,she would end up in restraints or in the Psych ER.  After driving around a couple of hours in the car she calmed down.  I often wondered if I had let it play out--i.e. let her end up in the Psych ER if that would have been better. I just couldn't stand to see her tied down, so I took her out of the facility.  The manipulation is tough to take, and the irrational thinking on top of it makes it hard to know what is BPD and what is dementia. For me, the line is blurred.  I think I just have to keep saying "it's the disease" which is how I currently cope.  The hardest part is when she decides she wants to inflict emotional pain, and there doesn't seem to be any trace of dementia. She speaks clearly, in a menacing tone, with no difficulty word-finding or expressing herself. Tough to chalk it up to "dementia" when she has a very clear agenda.  Thanks for sharing your experiences--they help more than you realize.

[milesperhour]

It must be heartbreaking to have your own mother be mean to you.  You have my highest respect for being so involved in her care.  

I understand that you probably feel obligated and maybe feel that you are the best one to care for her, because you know her best.  However, maybe you should back away a bit.  Her manipulation and bitter words will only hurt those who love her.  The professional staff of a skilled nursing facilty (nursing home) are trained to respect a patient's basic human rights while keeping up their own personal boundries and taking their patients' behaviors in stride.  She can't hurt them.  And as she loses more and more of her ability to care for herself, her behaviors will become worse and more often due to her frustrastion.  Maybe you should consider a home.  Or if she is still too independent (in other words, refuses to move), you could hire someone to care for her at her own home.  Just a thought.  

BTW, it is illeagal for a sub-acute rehab or long term care facility like a nursing home to use physical restraints.  Things like tie-down straps, bed rails, or even wheelchair seat belts are only used in hospitals now because hospital stays are short term, usually only three days, thus the patient is less likely to experience trauma from their use.  I remember when they took physical restraints away from nursing homes and the staff was saying, "Well, I guess they have the 'right' to fall now!" 

Sedatives (like lorazepam and valium) used solely to restrain the movement of the patient are also illegal in nursing homes.  However, the nurses will use these meds at times (if prescribed for that patient) to calm a wild patient and prevent them from hurting themselves or others.  They then have to document exactly what the behaviors were that necesitated the sedatives and what the results were.  The overuse of chemical restraints is very much looked down on by the state health departments.  So I don't think your mother would have been or will be harmed in a nursing home.  

I have to believe her behavior is "just the disease", whether that is BPD or dementia. To be mean to your own children is "without natural affection", as the Bible says, and I just can't imagine a mother doing that unless she really is out of her mind.  Sorry if I am being too harsh.  

[sammy1212]

I have a great aunt who is exactly the scenario of the man in the nursing home.  And Adri, that perfect clarity when inflicting pain.  Yes that is my aunt, she seems so sharp and clear much of the time.  This has been one of the pains of our small family.  I cannot imagine dealing with all this with a mother. I really feel for you. 

My aunt has pushed us all away.  If we happened to talk to her, some kind of argument will always happen.  Or even if we do things "perfectly", she will find a way to be upset.  The last time I talked to her, I had made plans to see her on Christmas Eve. We talked about it at length and then when the day came, she was mid chaos. Had decided to switch herself from an assistant living facility to a studio apartment and, in her mind, had changed the date of my visit.  But decided that I was the one who had the date wrong and screamed at me for it. 

We know from managers at other apartment buildings that she has had the police called on her multiple times, but she has never told us about it.  My family has stopped trying to reach out, but I think about her every day and have a sinking feeling in my stomach.  I talked to someone about having her "committed" but it is a long, painful process and perhaps unattainable since she does seem so clear.  But I am waiting for that phone call, that she has fallen, that she is dead.  She will die miserable and along, and this makes me so sad.  I was very close with her when I was younger. 

I think the suggestion of detached caregiver is a good one.  I didn't realize when the switch was happening with my aunt, from borderline to possible dementia and borderline.  I tried to reason with her about what was going on and she didn't talk to me for a year.  Do you have any support?  Therapy? Family?  I hope you are getting some support because you are really taking on a lot.  I wish you the best.