Q: My loving, Jewish mother is 92 and has turned into a rude, abusive foul-mouthed woman who I no longer recognize.
She’s in relatively good health and amazingly lives in the same house I grew up in. She has an aide during the day. She won’t leave the house,treats the aide poorly and last weekend cursed out my very patient spouse. We’ve been getting 5 calls a day such as ” I”m having a heart attack; no one will tell me whether recycling comes today”!
I know she has early signs of dementia. Her cardiologist tells me not to take it to heart and this is not the same women who raised me. She won’t go to the JCC adult programs, complains about being lonely at night, yet hangs up on me when I tell her we can get an aide at night or sell the home and let her live in a facility with women her age, etc. She threatens to call the Police if someone comes to her home at night. I have a POA but don’t want to rob her of her independence at 92. I try to tell her to speak nicely to the aides, myself, my spouse, but she says ” I don’t remember or I must have reacted to something someone did or said.”
I feel guilty as I’m not spending as much time with her as I would like, but it’s a matter of survival. Jewish guilt is thrown about with impunity and I can’t tell whether she’s being manipulative and obsessing over bullshit ( “oh my God the outside light may burn out tonight” ) or she really can’t control herself. Her aide is a lovely human being but my mom orders her around like a slave. Who is this woman? I’m torn, anguishing over what to do and am doing nothing but try to correct her inappropriate behavior and language. I wanted to take her to a geriatric psychiatrist but she refused to go. Medication to calm her down is dangerous per the MD as she could fall, etc.
What should I do? I’m at my wits end.
Dr. K’s answer:
Wow, difficult situation but unfortunately not uncommon.
You say your mother has early signs of dementia, and it is true that “personality changes” can be due to an underlying dementia, such as fronto-temporal dementia or Alzheimer’s, especially if a family notices other changes in memory or thinking abilities.
But it doesn’t sound like your mother’s been clinically evaluated for dementia, and you don’t say whether this has been brought up with her primary care doctor.
How to Get Memory & Thinking (or Personality Changes) Evaluated
To get help with this situation, I would recommend you find a way to get a least a preliminary medical assessment done for dementia.
If you are wondering what is the difference between dementia and Alzheimer’s disease, or want to know more about how they are diagnosed, I explain that in this video:
In principle, this can be done at a primary care provider’s (PCP’s) office, and it might be easier to arrange that visit than it is to get her to see a geriatric psychiatrist.
In practice, primary care doctors – and cardiologists, for that matter – routinely wave off dementia assessments in people your mother’s age, saying things like “it’s not necessary” “there’ll be nothing to do” “don’t make her upset” and “don’t take it personally, it’s the disease and not your fault.” (This last statement is generally true, but that doesn’t mean we should skip the assessment!) Also, many primary care doctors may not be quite sure just what to do, in order to complete a preliminary assessment.
Fortunately, you can improve your chances of getting a helpful assessment by familiarizing yourself with how dementia is diagnosed, and then coming prepared with good information regarding your mother’s abilities and challenges. For instance, you can make note of how your mother is doing regarding these 8 behaviors that may correspond with Alzheimer’s.
This article I wrote can also help: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
You can also review this article about dementia diagnosis which I wrote for family caregivers. Do bear in mind that HIPAA does not prevent you from contacting her doctor ahead of time and relaying your concerns and your observations. I generally think it’s good to do this in writing, as it can be put in her chart.
You may, of course, be wondering why you should bother getting her checked for dementia, such as Alzheimer’s disease. You may also be worried that a diagnosis will distress or upset her. In truth, it might upset her in the short term. Still, in the long run, getting her assessed for dementia is likely to bring you both a lot of benefits.
The Many Benefits of Pursuing a Dementia Diagnosis
For your mother, an assessment for cognitive changes means she’ll be checked for other health problems that might cause personality or thinking changes. After all, it’s possible that the problems you’re observing are not due to dementia.
It’s also common for dementia to be exacerbated by additional problems – like electrolyte imbalances, medication side-effects, untreated pain, or even constipation — which can be treated, even though a disease such as Alzheimer’s can’t be cured. So you really want at least a preliminary clinical dementia evaluation to be completed.
If your mother ultimately is deemed to have dementia, you want that to be in her medical chart. That’s because this diagnosis has implications for how to manage the care of any other health problems she has. (For example, the doctors should not simply provide verbal instructions to her for her healthcare, as they usually do to patients. And they should do things like simplify her medications if possible.)
A dementia diagnosis will also make it easier for you to get help as a family caregiver. Difficult behaviors are often managed with medications, but it’s true that these generally increase fall risk, so they should be avoided. If you are concerned about her behavior, this article will explain the pros and cons of the available medication options: 5 Types of Medication Used to Treat Difficult Dementia Behaviors.
What is best is for family caregivers – and paid home caregivers – to learn better dementia behavior management techniques, and dementia caregiving coping strategies. I’m afraid it’s pointless to try to reason with her and “correct” her behavior, that just doesn’t work with people who are cognitively impaired. But there are other approaches that can help, most of which start off by accepting the impaired person’s reality.
Plus, learning better ways to handle your mother’s behaviors can have a big effect on her wellbeing, and on yours. For you, learning better approaches will help you with the stress, anxiety, and guilt. This will make it more feasible for you to be present for your mother when you can, and that in turn will improve her wellbeing (even though she may not often sound as appreciative as you’d like). A 2013 study actually found that dementia caregiver coping strategies were associated with slower dementia progression.
Last but not least, a dementia diagnosis often helps a family focus on planning for further declines in decision-making and independence. This is obviously not easy, but trust me, things tend to go better later if families have done some planning earlier.
In other words, there is a lot to learn and do if you are, in fact, the son of an older woman who is changing due to dementia. A preliminary diagnosis is an important medical first step, and will make it easier for you to get help coping, and get help learning skills to make the experience more manageable.
How to Get Help Coping with Dementia Symptoms
For help coping with the experience – whether it’s how to get your mom in to see the doctor, how to deal with the doctors, how to cope with your stress, how to manage her outbursts, how to plan ahead – I would recommend you try the following resources:
- Talk to a professional trained to help people struggling with aging parents, such as a geriatric care manager (now known as an aging life care professional) or a senior care adviser.
- Visit online support forums. There’s a quite active forum at AgingCare.com. The Alzheimer’s Association is another good source of support groups.
- Read a few good books, as it’s hard to learn a lot by skimming web pages. For dementia, the 36 Hour Day is well respected, and I like Surviving Alzheimer’s a lot too. Or consider a course offered by your local Alzheimer’s Association. Another option would be dementia management videos, such as those by Teepa Snow. Pick whatever method of education works best for your style of learning.
- Remember to take deep breaths, and to take care of yourself. Dementia or no, helping an aging parent is usually a long journey. Building some daily walking and daily mindfulness practice into your day can make a big difference.
Good luck! Do get that dementia assessment and then get help learning to deal with her behaviors. It’s an effort but it will pay off in the long run.
This article was first published in 2015, and was last updated by Dr. K in June 2022.
M says
My mother has Alzimer . she dosnt belive that my older Sister skrunder Her Mother s money. My older Sister steels mother s money by bieing big House Big Cars . my Mother belives her also i gave the best of her life with my other sister who i love . those things Ona had bully me for along time . dhe never was a great Doughter tord my mother. Whrn Ona left tucson wgere was she uh. We had too take care our mother not her. Now our mother sticks up for Ona thrn us.
Leslie Kernisan, MD MPH says
If you do think there’s the possibility of financial exploitation by a family member, this article might be useful:
Financial Exploitation in Aging: What to Know & What to Do
Sandy says
I am still working at 64 – 30 hours a week. We have arranged caregivers for my mom, but she sends them away because she won’t spend the money! It is only $15/hour, or she changes the schedule at the last minute – repeatedly – and they become so frustrated that they quit. My husband also had double knee replacement surgery 1 month ago — and I told her I would be unavailable during that time — call my other siblings and my niece – but she actually called me while I was at the hospital 1 hour away to stop by on my way home (at 9 pm to take out her trash) – she had one bag of trash. It has become an obsession. Her house is a mess but she sends cleaning people home after an hour. If I take her somewhere socially, I cannot even have a conversation with anyone, however brief, because she constantly finds things for me to do — needs another drink, need more deserts, etc. – the list is endless. She repeats the save conversations endlessly, day after day. They are word for word. Won’t listen, forgets things constantly, refuses to believe her memory is failing and won’t wear her hearing aid. She is always right. Can barely get around with a walker, but insists she doesn’t need more help. She can barely make a meal. I am constantly running over with food and groceries, as is my sister. I am beginning to avoid her because it is so frustrating to be around her. I have become depressed and angry. She has always had a bit of a mean streak – extremely frugal – would not even help out with my prom dress when I was 17 — but took a trip to Spain just a few months later with her friends. Never there for me emotionally until I had children – then she could be the wonderful grandma! I wish I could move back to California, but we can’t afford it.
Leslie Kernisan, MD MPH says
Wow, this does sound like a difficult situation.
If you haven’t done so already, I would suggest looking for an online community of people caring for aging parents. What you are describing is not uncommon. Most people find it helps to connect with others who can commiserate, encourage setting healthy boundaries, and offer practical suggestions on what to try next.
I would also recommend the book Coping With Your Difficult Older Parent, as it addresses setting reasonable limits with a difficult or demanding parent.
It’s good that you are trying to help your mom AND you need to find a way to take care of yourself while you do it. Good luck!
Janet says
I was searching the web and found this site. I see that others are going through some of the same things I and experiencing with my 93 year old mother. This above posting sound just like my situation except for moving back to California. I still work 30 hours and when I come home, mother tells me how terrible I am, how I am rude, and how I am treating her just like other adult children. She says she did not know that I would turn out so horrible. Every day, she tells me I am going to hell and if my dad were alive, I would spark me! (I am 66!)
I am trying to be a Christian daughter and be kind and compassionate. But the daily, hourly, and minute reminders of how I have failed her is more than I can take. Most of the time I leave the room she is in in order not to confront the meanness. Then, she comes after me and tells me how I am treating her horribly. I am in trouble if I do anything and I am in trouble if I don’t. I have no help from my brother and sister-in-law, as they have lost their house and are living with us until they can get on their feet.
I pray every night for guidance and patience. But, I feel so guilty that I am not able to help my mother or even make any one in my family happy. I love my mother,but I can’t seem to get her to respond to me as another human being.
Can someone help?
Leslie Kernisan, MD MPH says
Sorry to hear that your mother is treating you this way, it sounds very stressful and must also be heartbreaking in so many ways.
The main thing I would recommend to you is finding a support group, to get emotional support and also ideas on how to troubleshoot these situations. Many people have gone through similar challenges and will be happy to help you.
I also cover what can be done in these situations in my Helping Older Parents course, which is included in our Helping Older Parents Membership Community. Good luck and take care!
John King says
This is so true.
Midge LeCroy says
We have taken mom neurologist. She passed clock drawing and initiall questions. Has had brain mri waiting results. Went today for psychological assessment. Told doctor upset we (3) suggested these assessments. Then after about an hour she took a break and told my sister and dr I’m leaving. She feels like we ganged up on her and are putting her through hell.
Leslie Kernisan, MD MPH says
Sounds like your mother is angry with you, sorry to hear this. This is actually quite common, but doesn’t make it any easier for the family members who are involved. There is no easy answer. When you are feeling patient enough, keep reaching out to her and try to keep the tone of your exchanges empathetic and non-confrontational. Avoid arguing or trying to reason with her, that almost always makes older adults more frustrated and defensive.
Working through this type of situation often takes a long time…weeks or months or sometimes longer. There are lots of things you could try, too many for me to list here, some are listed in the later part of this article: 6 Causes of Paranoia in Aging & What to Do
I would recommend connecting with a community of people in similar situations if you haven’t already done so. The caregiver forum at AgingCare.com is quite active and many of them have been through this type of thing. They’ll be able to give you moral support and ideas.
Good luck!
Mary B. says
Very helpful article, thank you. My 81-year-old widowed sister lives by herself and, while she’s always had severe emotional issues, aging has caused her to be downright rude. She lives alone and can still mow her lawn, is in good physical health, and does fine with self-care. However, I’d like to stop thinking I have to listen to the complaining, haranguing, and what seems to be lying (although I think that’s the dementia). She would never listen to me, hates all women, especially her sisters, and sometimes even her children, who are professional people in their 50s. I’ve been advised to cut off the relationship completely, for my own sanity. I’m taking this into consideration currently. Her children, who rarely see her, will have to decide. Thank you for this opportunity.
Leslie Kernisan, MD MPH says
Glad you found this article helpful. Also glad you are thoughtful enough to be concerned about your sister.
She does sound quite difficult and if interacting with her feels too toxic, it’s certainly reasonable to set boundaries and limit your contact with her. With the right approach (and sometimes encouragement or coaching from others), it’s often possible to provide some support and caring without letting the other person drain or hurt you too much.
A good book on how to do this is Coping with Your Difficult Older Parent: A guide for stresed-out children. Although it is written for people like your sister’s children, you would probably get some good ideas from it as well.
If you think your sister has dementia and she lives alone, there’s a high chance that she’ll eventually be jeopardizing her safety and health. I have recently recorded a podcast interview on “self-neglect” which may be helpful to you, in terms of what to monitor and when to consider intervenening:
066 – Interview: Addressing Potential Self-Neglect in Older Adults.
Good luck!
Michiko Bozic says
Dear Leslie Kernisan, MD,
Thank you so much for your article!!! I have been studying about Dementia, since I visited my mother last December – January, 2018. She has changed!!! Your article is the most helpful one!!!
Sincerely,
Retired Teacher
Leslie Kernisan, MD MPH says
You are so very welcome. I’m always delighted to hear that an article has helped someone.
ana says
Excellent post. In Serbia I have a grandfather who suffers from dementia. We had to put him in a nursing home because he can not take care of himself. There is surrounded by people who properly care for her.
Leslie Kernisan, MD MPH says
Yes, as dementia progresses, people eventually need someone to be taking care of them all day (and also usually available at night). Placement in a residential facility, such as nursing home, memory care unit, or even a smaller home, is one way to manage this situation.
Margaret Mary says
Here is the best advice. Put your mother in either assisted living or a nursing home. In case she refuses to go you call the police who take her to the emergency room. Once there the doctor can have her sent to a nursing home. All her acting out will be handled by the nursing home.
Leslie Kernisan, MD MPH says
Well, it is true that many people with dementia end up moving (or being moved) to some kind of residential facility. It may or may not be the best way to go, it really depends on the situation and what the available care alternatives are.
I would recommend using the police as a last resort…it’s often possible — and less traumatic — to get a reluctant person with dementia to move by using benign deceptions, such as inviting her to lunch at the facility and then introducing her to her new home. (Some families propose it as a temporary arrangement, or say that the usual home is in need of serious repairs.) And even then, families should only resort to deception after being quite sure there is no other way to address the situation, and also being sure that they have legal and ethical grounds for moving the older person against her will. Legal requirements vary state by state, so it’s best to consult with an elder law attorney before proceeding.
I have an article about decision-making capacity here:
Incompetence & Losing Capacity: Answers to 7 FAQs
Plz Halp! says
What do i do if i am in critical medical condition, have a long standing arrangement with my parents for the past 2 years that they have repeatedly texted me, that they are paying for my life saving stem cell treatment, and within the last month they are completely denying that my hips are broken? I planned my life around this treatment ive been promised for almost 1.5 years, she says ok ill go get the money, then it never comes or she picks a fight with me, hangs up on me, then wont answer my calls for 2 weeks. Since its gone on so long,i cannot work, I have had to spend all my savings, and i have advanced lupus due to the torn/broken hips. I even drove over to tell her how urgent this is and she called the police on me. This is full on lupus with sun allergy. Im in san diego, its summer, and now when i go outside i throw up and get blurry vision. The emotional toll after being injured so long and my parents now fully denying i am sick is overwhelming. I have lost everything from her deception, now possibly my life. mThey lead me on this entire year so at this point it has developed to the point i can barely think or move. I feel like they are trying to kill me. I plead for friends to help me get through to them but they play it off and tell lies about me. its to much for anyone to understand. Im not able to heal, now i have to take them to court because i have no voice. with them. I couldhave paid for my own treatment but now ive had to go through my savings. Its a life or death situation now.
I show them the documents from MRI, Xray, Multiple diagnosis from 6 different doctors and nurses. Within this month its never enough. They are so paranoid that they think everything is a hoax. My father was always forceful and abusive but now he doesnt know whats what and hes getting more pushy and controlling to the point its dangerous. For instance when i went to visit last year he would physically move me. like grab my hand. my mother knows i have 2 broken hips but every once in awhile she would tell me to hurry up, while walking. This is so surreal…
Leslie Kernisan, MD MPH says
Hm. It sounds like you are having some significant health concerns and want your parents’ help. But at the same time, they have become challenging with you, as you describe paranoia, not following through, and not listening to you.
Unfortunately, I don’t know that you can force your parents to help you. If they are older, there’s a possibility that there are real medical reasons for their behaviors and conflicts with you. Ideally, they would get evaluated to check for these. While they are in this state, they probably won’t be able to provide you with the amount of help you’re hoping for. It won’t work to argue or reason with them. I would recommend looking for other ways to get your needs met, and then later trying to help your parents, if possible and if it still seems relevant. good luck!
Andrew Schechterman says
Kudos Dr. K, as always. Our mild and moderate AD-type dementia patients and families (as well as some LBD and even a few FTD), are increasingly interested in local clinical trials. Our office is very high touch, we make house calls for established patients, the team answers every question and returns every phone message (some of our patients email, too). This rapport and continuity of care often widens the many options that might be dismissed as scary or inconvenient or offering no guarantee whatsoever. With a clinical trial inclusion, some complementary services are starting to show up as well, Psych, OT, SLP, LCSW. Hard to be 100% grumpy when so many kind folks are paying attention (LoL). = : )
Leslie Kernisan, MD MPH says
That’s a good point: a local clinical trial is often a way that families can get extra support while dealing with Alzheimer’s or other dementias.
Wonderful that your office is able to provide so much help to your patients; I hope some day this will be more the rule than the exception.
Joseph Smith says
That`s a very thoughtful answer. Thanks Leslie for sharing and the evaluation. Most of the people can relate to this situation. You are spot on. She should prevent further cognitive decline in her mother`s health instead of pushing her into home care support. In my opinion a face-to-face conversation with her mother may bring out better outcome and may control her anger issues. Her mother might be acting angry and feel disgusted in order to get her daughter`s attention and time I`d say. I like the article and love the “Serenity prayer” too.
Leslie Kernisan, MD MPH says
Conversations with the mother are a good idea, but they are mainly useful as a way to better understand how the older mother is perceiving the situation. When we understand an older person’s reality, we can better learn to work with it. However it is almost never possible to convince an older person to be less angry or paranoid, especially when the underlying problem is cognitive decline.
Preventing further cognitive decline can be difficult. No medications or medical therapies have been proven to work well for this purpose. Probably the best approach is to minimize risky medications and prevent delirium; both of these have been associated with acceleration of cognitive decline. Other methods that promote brain health (e.g. exercise and social engagement) may also help prevent decline.
How to Promote Brain Health