Senior Citizen BPD mum showing signs of dementia - advice for family please

[spotlight]

I have recently returned home to Canada from living in the UK for 7 years. I saw my family sporadically during that time but not for 2 1/2 years until I moved home.  It has become apparent my mum (uBPD) is having memory issues since before I returned.  Some days are worse than others for sure, and she seems to bring it up often -- saying that we must think she has Alzheimer's, but only in a way to try and banish us for thinking such.  Almost as if there is so much shame if she was having memory slips... trying to deflect blame as she does everything else.  For something which doesn't come with blame as it isn't anyone's fault.  She comes from an era when any mental challenges are still taboo, and from BPD which makes her reject any idea she has faults.  She has plainly said to me (on a lucid day) that she refuses to admit she has [dementia] because that would mean she would be wrong, and she refuses to be wrong.  She prides herself on arguing... ah, topics for another discussion.

As she has other cardiovascular issues and COPD I think it is likely the onset of vascular dementia.  It isn't just normal forgetfulness for a 72 year old.

My main concern is of course care in the long term (my mum and dad still live together, my dad is pretty fit and well but also 3 1/2 years older than my mum at 75 and I hate to see her abusing him constantly) but also that her BPD is being compounded by memory problems -- her obsession with running the windshield wipers for example, even when she is not driving (she rarely drives any more), and her forgetfulness of the correct settings and gripping the lever with both hands for a long time while I was overtaking, nearly caused us a car accident a couple of months ago.  My fear is that it is only a matter of time until she does something even more dangerous than she has done in the past and it causes serious injury or damage.  My dad is unwilling to try to broach the subject -- either with the doctor let alone my mum -- to try and get her help, until something serious happens.  (He hopes if something serious happens she will see sense, I think.  But it may be too late to save my dad, or my mum, by that point.)  My mum keeps us all between a rock and a hard place.  My sister and I are trying to develop a plan, a way to help, a sort of gentle intervention.  A way to gently approach this without having to constantly avoid the elephant in the room until it blows up.

Any advice, people who have had a BPD parent start suffering with dementia etc, support for my dad, gentle interventions & help suggestions (for a very sensitive and restrictive BPD), would be so very appreciated.  TIA

[Methuen]

Hi Spotlight
Where to start?  It sounds like you have recently returned from overseas, and it is easy for you to see the changes in cognitive functioning in your mom, but sometimes it can be difficult to separate the dementia like symtoms from the BPD symptoms.  She also has other health issues, and you worry about the implications of all this in the long term for both herself and your dad, and you hate to see her abusing him.  It that somewhat accurate?  If it is, I can relate to a lot of this.  My mom is uBPD 84 and living independently on paper, but in practice couldn't survive on her own for a few days.

My dad passed away from a lengthy illness 15 years ago, which was a huge trigger for her (he "abandoned" her by dying).  She abused him badly during his illness (for eg. calling him a "retard" because he had dementia).  Fast forward to today, and my mom has a laundry list of complex health issues (including vascular dementia).  The most recent crisis was another fall before Christmas, resulting in 4 days in hospital.  Sadly, she has fallen a number of times, but thankfully, because of this, she was already in the "home care" system for receiving services, which were put in place the day she arrived home from hospital.  It sounds to me like you can see the path ahead for your mom, and would dearly love to put some things in place to avoid the  challenges and crises you can see on the road ahead.  Does that sound somewhat accurate, or am I off base there?

What I have learned in the last 15 years, but mostly in the 1 1/2 yrs, is that the best I can do is be resourceful, and reach out to the professionals who can help ME to cope with her.  For example, I take her to her Dr appts when she lets me (like right now when she can't drive with a broken arm).  I have made appts to see her Dr (to share info about her, knowing that he can't share info back because of confidentiality, but hoping that what I share can help him treat her, and thus help both her and me).  This is how I initiated home care services with a previous fall.  I made an appt to see him, disclosed what was going on, and asked for home care help.  He made the necessary referrals.  These disclosures let him see that I had caregiver burnout.  Please understand that I was asking for help for myself.  Had I not done this, the health care system would be happy to let me care for my mom at home 24/7.  I live in a small rural area, so the resources available in my area are different than what is available in a more urban area.  But for me, the key to my mental health, has been reaching out for services to help me.  I also have a T.  There have been a lot of bumps along the way, including emergency room doctors who turn to me to ask if I can care for my mother upon discharge from emerg, while she is in the bed listening.  This has happened more than once.  The first time I was a pushover.  The second time, I was prepared for it, and pulled the doctor aside, briefly explained the situation, which resulted in him admitting her for 4 days before Christmas, while home care was set up to assist, so that I wasn't responsible for her 24/7.  The emerg Dr was then discreet about it, and told mom she needed to be admitted to manage her pain meds, and until home care could be arranged.  Again, none of this would have happened unless I advocated for it by sharing info confidentially.  I strongly believe it is important to have and keep your "voice" to both advocate for her, and for yourself.  If I didn't reach out for help, I can't imagine where I would be.  I really can't.

My mother was one of these who pressured us to have her live with us for years and years.  OMG she never stopped (10 years?).  One day my darling H finally told her that just couldn't happen.  Then she tried to humiliate us in front of visiting family by announcing to them that we had said she could never live with us.  It backfired.  The topic was changed and nobody took the bait.  She hasn't brought it up since.

As for your dad, it sounds like he isn't ready to talk to a doctor about her.  By any chance, do your mom and dad share the same doctor?  About 2 years before my dad died (but after he was diagnosed with the illness), he asked me to drive him to his doctor, and he told his Dr his story about my mom.  That was my dad's idea, not mine.  I wonder if it's possible to gently guide your dad to think of that on his own?

My mom qualified for assisted living, almost two years ago, and refused it.  There is no way she should be living alone right now.  She's a hazard to herself.  With her broken arm she can't even use the walker inside her own home.  If I dared to bring up conversation about assisted living, an epic crisis would ensue, and I could be the one with the mental health breakdown.   So I don't do that.  But I've slowly and patiently been building relationships with the health care professionals and case managers in home care, so perhaps one day the idea will come from them, to her.  

But before that happens, mom may have a catastrophic accident in her home, which results in the hospital transferring her to assisted living or complex care.  

I can see the path.  I can see the solutions, which healthy people would be happy to take to help themselves, but when BPD is involved, the path is not straight, and it is not easy. I think all my mom's falls could have been preventable.  She repeatedly makes bad decisions, and contributes to her own failing health. So again, my best advice is to start by building relationships with people and resources who can help YOU.

There are no easy answers to the problem you have identified with your aging BPD mom and the onset of dementia.  The best I can offer, is to know your own boundaries, stay within them, stay strong, get yourself really good support, and reach out to the professionals including doctors to advocate for her and also for yourself.

My path has felt difficult for me and my H, but I have a lot of gratitude for the support I am receiving.  But I've only got it because I reached out for professional help.  There are plenty of others with BPD loved ones who have it much much worse than me.  I hope your path will be an easier path.  I really don't know if any of this is helpful or not.  Just know that you are not alone.

[Notwendy]

My story is similar to Methuan's. My father passed away several years ago and it was horrible to see how my BPD mother treated him. Yet, he was reluctant to disclose anything to their doctors. What I did not understand at the time was that his role as enabler to my BPD mother was strong and still very much a deciding factor for him.

I was the one who stepped in and disclosed issues about her to his health care team. The reasons were well intentioned. I was concerned for him. But the result was that he got angry at me for disclosing information about her.

I have spoken to social services about the situation and, as long as he was legally competent mentally, there was nothing I could do. Same with my mother, she's still technically legally competent, and so can make her own decisions. I will share what they told me- it has helped me and others here: legally competent to make their own bad decisions. That is- what I thought about the decisions was not ground to intervene. They were competent and not doing anything illegal.

As much as I am concerned, I have realized that it is imperitive to my mother that she remain in control and there isn't much I can do about it. I can be supportive by doing what Methuan has said, maybe running an errand for her if I am visiting. We speak on the phone. I try to avoid conflicts with her.  I don't really have better advice but to take care of yourself and do what you can but understand that your parents will make their own decisions.