THE BLOG
06/07/2013 02:33 pm ET Updated Aug 07, 2013

Recognizing When Your Elderly Parent Has Dementia

The other day this comment appeared on my post "15 Ways to Stay Sane Caring for an Elderly Parent":

We moved my 70-year-old mother in with us two months ago, and it is not working out. She has a compulsive eating problem and we cannot afford to keep up with her overeating and strange eating habits, like picking things up off of the car floor and eating them or stealing food from my children's plates and lying about it.

She has weird issues about authority. We set some limits and boundaries with her from the get-go, and she has continued to ignore them. Simple things like, wear clothing around the house. My husband has seen her naked, eating directly from the fridge in the middle of the night or sitting, naked, in our computer chair looking at stuff online in the middle of the day. She doesn't seem to think she'll get caught. I don't know what this is, or how to handle it.

She sleeps day and night and refuses to shower or brush her teeth. I know that's depression. I'm having a very hard time finding anyone who can see her who takes Medicare and is taking new patients.

Lying seems to come easier to her than telling the truth. She lies about everything, little and big. I'm trying not to diagnose her, but it would help me understand better. I want to know how to handle this stuff. It is really stressful.

She has not set up a good financial situation for herself. She gets $700 a month in social security and has used up most of her retirement already. We would like to put her in an independent/assisted living environment, but how could she afford that? We certainly cannot.

I am sinking. We are only two months in and I can't see this getting any better. Advice???

Everyone's psychology is inextricably combined with the psychology of their parents. For more reasons than we can shake a shrink at, that can of course be profoundly problematic, it's so hard to tell, basically, where we stop and our parents begin. Everyone suffers from the fuzziness of that line. But that phenomenon becomes a whole new category of problem for people who are taking care of their elderly parents, especially if their parents start displaying the kinds of irrational behaviors that your mom has.

In one way or another, your mom's been driving you crazy for your whole life. That means that your crazy (and I'm not saying that you're crazy, I'm saying whatever crazy you have -- and we definitely all have some) is wedded to your mom's crazy. Everyone's like that with their parents. That's just... a rule of being human.

Your big problem is that your mom has become actually crazy. Your problem, in other words, isn't that your mother is depressed. Your problem is that your mother has dementia.

It's hard for us to be sure when our elderly parents have moved from their usual range of weirdly dysfunctional -- which we've known all of our lives, which we've created ourselves around, which to us is basically normal -- to becoming actually, objectively, weirdly dysfunctional.

And the core, primary reason that is so hair-pullingly trying for us is because we're so attuned to the entirety of who our parents are, which is so intertwined with the entirety of who we are, that it is not, to say the least, easy for us to distinguish between our parents' normal, everyday range of crazy, and the whole new range of crazy of the sort that your mom is now evincing.

You know how you can tell when a person has gone from what amounts to normally/habitually dysfunctional to having dementia? When they're virtually incapable of modifying their behavior. That's the test. A person has dementia when they can't change, when they can't stop, when they can't modify or adjust their behavior.

A person has dementia when they're acting in unhealthy, unhelpful, manifestly unbalanced ways and have no choice but to act in those ways. That's how you know that dementia has come upon them. That's how you can be sure that they've gone from being someone you know to someone you'll never know again.

It's tragic. Dementia is awful. It forces you to mourn for someone who's still actively living and breathing.

And the really tough thing about dementia is that it comes and goes. An elderly person with dementia doesn't have a constant reality; their reality -- which they themselves are incapable of tracking -- is ever-shifting. And sometimes it shifts into the place where -- surprise! -- they are again themselves. Suddenly, they're back! They're sane! There they are! And then, just like that, you're back to thinking that they're manageable -- that, just like with people who don't have dementia, they're capable of choosing their behavior.

And then you find them, yet again, naked with their head in the refrigerator. Or wearing their pants backwards. Or licking their dinner plate. Or doing any of a million other things that might be funny if they weren't so terribly real.

The reason it is so important for you to distinguish between the mother you used to know and the person now living in your house who has dementia -- the reason you must make that very difficult emotional and conceptual paradigm change -- is because once you do that, everything related to caring for your mother becomes a whole lot easier for you.

Then it just becomes about the practicalities of the situation you're in. Then you just have a job to do. Once all the emotional baggage has been cleared out of the way -- once you realize that, persistent optical illusion to the contrary, you are no longer dealing with your parent, but rather only their unpredictable doppelgänger -- you're free to worry about the only thing you really have to worry about, which are the practical aspects of physically protecting your mother from herself.

Then it just becomes about finding, allocating, and utilizing whatever resources are available to help you with your mom. Then it's just a puzzle you have to solve, rather than a pit of emotional quicksand you keep having to fall into and then struggle back out of.

I don't know where you live, but surely somewhere around you is an organization that can help you deal with your mother. There's going to be some group, or some non-profit, or some regional or state-funded entity near you that can either help you directly, or point you toward the people who can. A great place to start is by seeing if your area has a 2-1-1 number that you can call.

Work the Internet, basically. Discover what's out there. Assistance for this sort of thing is always first and foremost regional--but it's very rarely not there at all. You just have to locate it, hone in on it, and then get busy using it.

It's true that you cannot fix your mother's dementia. But you certainly can deal with it. Probably not at home; it sounds to me like you're going to have to transition your mom into a place where they can watch and deal with her in a way that you simply cannot. For now, find out where those places are, what they are, and what it takes to get your mother into the best of them.

You're a project manager; physically protecting your mom is your project. And there are people and systems near you who can help you with that project -- whose whole purpose is to help you with it. Find them; talk to them; work with them.

(Oh -- and be prepared, of course, for the grueling truth that, in your quest to protect your mother, the one person upon whom you can count for consistent -- and, alas, freakishly creative -- resistance will be your mother. Common geriatric dementia looks and acts in all kinds of ways. But the one thing it's never not is almost ferociously and counterproductively stubborn. It's a pretty sure bet that your mom will do a whole bunch of random stuff to make your helping her as difficult as possible. Just remember: that's not her purposefully or willfully doing that, at all. That's just her dementia.)

Good luck, friend. Please keep us up on this as you move along with it.

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