Senior with BPD

[dogstevens]

Hi  everyone,

First time posting here. My 70 year old mother has all of the symptoms of BPD and my siblings and I are currently struggling with managing her recent decline in mental health. She has went off of her anti-anxiety medication due to obsessively looking up the worse possible scenario and side effects that medication can have. She is extremely anxious about her health and is now going to the hospital by ambulance multiple times a week due to various "health problems" that are very obviously panic attacks. My siblings and I have all calmly and kindly explained to her that help with her anxiety is essential and that she is experiencing health phobia and panic attacks, but she very dramatically claims it is physical-health related.
While I was recently visiting, she had an "allergic reaction" to medication and had me drive her to the emergency department at 1am, telling me she was dying the whole way there (20 minute drive), telling me to drive through red lights (there was no other traffic, thankfully) and I feared that she would grab the steering wheel and create more of a danger to us if I didn't drive through them. She said she didn't know where she was and said that her lungs and heart were shutting down as I was driving there, and made me carry her into the hospital, refusing to sit in a wheelchair. I hurt my back while doing so and was essentially traumatized from the drive there. When we got to the hospital, she was stable and even told me she didn't want to wait the 10 hours to see a doctor and we could go home.
She apologized for "keeping me awake" that night and then proceeded to act as if it was a normal day the next day without mention of the night before.

She has since been to the hospital twice by ambulance for "dizziness and weakness" which have been determined to not be a health risk and required no further treatment.

I am at a loss on what to do, how to even have a day-to-day relationship with her, and what to take "seriously" as a health concern. For 70, she is in great physical health, is active when she is not in a BPD episode, but seems to crave and also fear physical health issues.

Has anyone experienced this? Does anyone have any advice?

Thanks so much for reading.

[Notwendy]

Yes, my BPD mother (now deceased) had many health anxieties and visits to Emergency. She had a medical alert button to push and go by ambulance. This got complicated as she got older and had age related health issues as well. 

Her anti anxiety medicine did help her but as she got older, she became more sensitive to it and her usual dose made her act delirious. If she was taken off it- she was so anxious she was miserable. It took some time to get her on the right dose which was smaller than her usual one. 

Like you describe your mother- her physical needs were not high for most of her elder years- she was in good health for most of her elder years but her emotional needs were very high. She was living in her own home until she needed assisted living and it was hard to match the level of care to her emotional needs as the levels are done according to how much physical assistance a person needs.

There are emotional changes as people age, and so a pwBPD will have them too- but having BPD makes managing this more of a challenge.

My BPD mother was afraid to be alone- but she didn't say this outright. By having "medical emergencies" this also had the secondary gain of getting attention and people to be with her. The problem though, is that it was hard to know if something was real or not. As she got older, she also had age related health concerns so and some emergency visits were for them.

I lived at too far a distance to be there all the time for the ER visits. I decided that- if she went to emergency- I'd call and ask to speak to a nurse, so I'd know if it was serious or not before considering coming.

Does your mother have a medical provider that she trusts? We were fortunate as my mother's doctor had been her doctor for a while and he knew her well. She did trust him and would do what he says. Since a part of your mother's needs are emotional support too- if she has a doctor who she can trust, he or she may be able to get her on an anxiety medicine that works for her and at the right dose and convince her it's safe for her. It took some time trying different medicines and doses to get to where it was helping my mother. You may find this seeking medical care behavior increases- as she gets older and so having a medical provider who knows her and she trusts can be helpful.

Is your mother lonely? Does she have a community? If she can be involved in activities it may help.

[TelHill]

Hi dogstevens,

I’m really sorry you have to deal with you mother’s increased anxiety about her health.

My dBPD elderly mother (90+) was on a heavy-duty benzo for her depression and anxiety. It may be totally different from what your mom stopped taking. If so, no need to read further.

Her psychiatrist told us there was a study linking long-term benzo use with an increased probability for dementia, vertigo and falls. Her bpd symptoms decreased while on it and I didn’t want her to stop.  He stopped prescribing it to her and she went off of it cold turkey. I tried to get her to wean off it to soften withdrawl symptoms. But she wouldn’t do it. She was mad at the doctor and this is how she expressed it.

She was in agony for a few months. The irony is she started falling down more at home and developed dementia a few years later. She’s handicapped from all her falls. I wish she never went off of it.

Some doctors will encourage elderly patients to stop using the ER in favor of 8-5, M-F Urgent Care. If you’re in the US, Medicare won’t cover Ambulance Service for non emergency trips to the ER. It’s almost $1k to use an ambulance. The bill for her latest 911 calls to the ER might stop these visits.

My mom craves medical attentions but fears bad news. She’s also extremely impatient and long waits to get help in ER were a deterrent with not too important complaints.

Does she see a psychiatrist or therapist for help? My mom was always “smarter”  than her psychiatrist so that never helped. There might be support groups or senior clubs in your community or church she can join. I agree with notwendy that it might help bring some perspective and calm her down.

[dogstevens]

Thanks so much for your replies TelHill and Notwendy - I appreciate it a lot.

My mom doesn't trust her healthcare providers and also feels as though she is smarter than them or that they are withholding information from her - she also tells us (me and my two siblings) that the healthcare providers "didn't tell her the full story" about new diagnoses/health issues so she doesn't know how serious they are. Which, so far, has meant that they are not serious and that she is mostly attention-seeking with the new health issues. With her aging, it is anxiety-inducing as we do worry if they are real health issues that need attention or for us to assist her with attending appointments.
We are in Canada so the ambulance rides and all health care have no cost. She also shows absolutely no empathy or care towards the healthcare workers or services for taking up time and care, which is also hard to witness, as our health system is strained - particularly where she lives as it is somewhat rural.
She does have community when she is "well enough", she attends an exercise class twice weekly, dinners with friends, the local library, and has been asked to visit her sisters' homes for various activities and assistance with her health. She limits these activities due to her "health issues" or anxieties about the air quality (her current obsession that is affecting her health and breathing according to her). It just feels like a never-ending battle that she consistently introduces new road blocks into.

I wish she would attend more groups and such to have perspective about how lucky she is to be rather physically healthy, although even when she encounters folks who have it harder than she does, she still centres her thoughts and mindset around her own issues and thinks they are worse or more important.

Thanks again for replying!

[Notwendy]

My BPD mother was also relatively physically well for her age. Her emotional needs though were greater and this made it difficult to match her care needs. Senior care takes into account how physically able someone is. So while BPD mother didn't need assistance with dressing, feeding, getting around for most of her elder years, her emotional needs were more in align with someone who needed a higher level of care. There aren't any resources in the US that I know of that meet this need- and so I think this is what led to her using the medical system more.

This was confusing for us as we didn't know what was a serious issue and what wasn't when she went to emergency.  I called the nurses to see what was going on.

BPD mother was socially active before Covid and during Covid, was isolated a lot. We hoped that once the risks were decreased, she'd be active again. When she needed assisted living soon after that, we hoped she'd enjoy the social activities there. Instead, she mostly stayed in her room, even refusing to go to the dining hall for meals and choosing to eat them in her room. She did want company but only if the person was attending to her- one on one care -which she didn't qualify for on the basis of physical need.

I also think my BPD mother's "refusal" of social contact was due to her need for control in a relationship and inability to have relationships with people. She'd also come up with a health related excuse, perhaps to avoid any shame involved in the actual reason.

Aging is difficult and managing the care needs for an elderly person can be a challenge, even without BPD. Perhaps recognizing the "mismatch" between physical needs and your mother's increasing emotional needs will help you to navigate the situation. Are there additonal resources available- social work, home health, that can possibly address your mother's emotional needs?