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 woman 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 type of 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 Signs of Dementia (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:
- Join a support group, either in-person or online. The Alzheimer’s Association and local memory clinics can be good sources of support groups.
- 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.
- 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.
You can also learn more about my approach to dementia care through my free online workshop below.
This article was last updated in August 2024.
Ben says
Appreciate your replies… she is one who is fighting extremely hard to hold on to indendence, apologies for the lengthy details… in short… that point which you removed, when believes she being poisoned when they give her food “added detail”or her loved ones in her mind have overtaken her life and deemed enemies … again the long list of the deterioration of her mental state and behaviors make critical decisions that would harm herself physically and financially … “ courts in session “ next case … hold on judge she is being picked up from the memory care center for dementia patients… she will be right in…. while her lawyer and new friends informs she is having a brief moment of clarity to appear in this hearing… but no worries she will not remember any of this when she leaves…. I just cannot relate to the idea of this being “ capable of critical decision” ability… But Im old fashioned and not a lawyer… again,thanks for replies… you’ve been great..
Lisa Hartle says
I would be very careful with this situation. There are many unethical lawyers out there who will take advantage of your mother. They easily convince elderly parents with dementia that the children are just after the assets or money. Then the lawyer takes control and empties the bank account and isolates the elderly person and files a law suit against you for elder abuse. You then end up spending money trying to defend yourself from false allegations. All the while, your mother controlled be isolated and loses all connections with the family. It happens a lot and lawyers are making a fortune either filing suits full of false allegations or helping the children accused to defend against them. It happened to us and to others. Very ugly.
Nicole Didyk, MD says
I’m sorry to hear that you’ve had this experience and I think Dr Kernisan’s advice about getting a medical evaluation would be especially important if allegations of abuse and lawsuits are involved. A dementia diagnosis doesn’t automatically mean that a person can’t hire and direct a lawyer, but I would hope that it would be helpful in a court case that was trying to protect the person’s assets or was making a serious charge of abuse.
Ben says
how can a person that cannot distinguish day from night … believe there being held hostage by loving caring family…”direct a lawyer”… and cannot remember they told someone the same thing or asked the same question repetitively through out the day and all through the night…. Im confused now…….
Nicole Didyk, MD says
Thanks for the opportunity to clarify.
Just because a person has a dementia diagnosis doesn’t automatically mean they are completely incapable. Dementia involves a spectrum of symptoms – beginning in a mild stage and can progress to a more advanced one, where there could be much more cognitive difficulty and limitations.
The symptoms you’re describing sound like the person would be in a more severe stage of dementia, and might not be capable of making legal decisions, but that has to be assessed on an individual basis, and not just because of a specific diagnosis.
Ben says
I have a loved one who is 94… reads the paper everyday can cook, however when she cooks she leaves the stove on the water running after washing dishes remembers events of 50 yrs ago but cannot remember to take her medicine believes adamantly she has lived within carehome only a few weeks in reality 3 years… if someone mentions that it triggers and she goes off with anger… along with the same questions frequently not knowing day from night, remembers not going to the beauty shop every Friday.
After eating… from within an hour or 2 she is forgotten her meal and says she has not had anything to eat …this is throughout the day and night and she does not sleep at night and is not aware of time and request food and coffee etc.. things from the store… at face one would be impressed with her … but after few hours especially in the evening… it would be neglect for someone to say let her go home when she gets the urge …. she wants to live by herself at her own home… because she is capable of deciding that’s where she wants to live… she can do a lot and make decisions…. but living by herself is a wrong poor decision… “Doctor said cannot live alone” this is why I question how can one make critical decisions when there reality is distorted… she is not capable of making safe and logical decisions upon critical matters.. but she will hold on to the banisters when using steps…
Nicole Didyk, MD says
Thanks again for your detailed story (which I had to edit a little due to its length). The behaviours that you describe could well be in keeping with an advanced dementia with significant short-term memory difficulties. It can be frustrating that a person with dementia seems to use excellent judgement in some cases (like holding on to a bannister) but not in others(like deciding about where to live).
People with Alzheimer’s disease will often overestimate their ability to manage their day to day lives and for that reason, decisions about where to live usually have to include a capacity assessment, and a substitute decision maker with power of attorney may need to step in.
nunya says
yah coddle them some more till your own sanity goes and you become room mates in the same psych ward
Nicole Didyk, MD says
Well, I understand that it can be very frustrating to be in a situation with a parent who is having a change in behaviour, but I would reiterate Dr. Kernisan’s suggestions in her answer to a similar comment. It is usually more helpful to make an emotional connection rather than trying a “tough love” approach.
Rebecca Johnston says
This article and the responses are incredibly helpful. Our situation is that my sisters and I (and everyone else) has noticed that my mother cannot seem to retain new information. Always asking the same question, not remembering where she went or what she had for lunch, etc… We have made an appointment for her to see a neurologist and have had long, compassionate conversations with her on why we should be proactive and not ‘wait’ which is what she wants to do. After the conversations she seems somewhat ok with the idea, but then the next day we get mean texts and voicemails from her saying she refuses to go, threatening to not let us in the house, threatening to cut us out of her will (which of course we could care less about), telling us that we are the ones that should see a neurologist. We don’t want to force her to go (we do have a power of attorney) but we are just not sure what to do. Any suggestions?
Leslie Kernisan, MD MPH says
Sigh. This situation is so common that I am actually working on a short practical ebook to address the options!
The short answer is that what you describe is concerning and ideally she should be medically evaluated. If you think she’s impaired, it’s considered ethically justifiable to do some fibbing to get her to cooperate. Don’t spend too much time on explanations, they tend not to work. What is more helpful is validating her feelings and also framing the visit as something relevant to her own goals or priorities (such as continuing to live at home).
If you are really feeling stuck, a good geriatric care manager (also known as an aging life care professional) will know lots of tips and strategies that can be used to get a reluctant older person evaluated.
It does usually take a lot of work and finagling to get the person in for that eval. And even after that, she will often resist the changes you try to implement to compensate for her changing mental state. So the medical eval is needed, but the challenges will go on after that!
We do have a Helping Older Parents membership to help people navigate this in an ongoing fashion, and we have geriatric care managers (and me) answering questions in more detail. You can learn more here.
Good luck!
Rose says
What can I do when my husband (an only child) refuses to accept his mother is showing signs of dementia? She has AFIB, and has experienced three strokes. She is in independent living (I think it needs to be assisted living) and insists she’s able to drive. She’s 89 and cannot remember a vast majority of things although she is crafty in covering up her memory loss.
Last week the police called my husband (we live 1000 miles from her) because she was downtown and couldn’t remember where she parked her car. She also could not give the police officer her name, address or even a contact person. They found his number by going through her purse.
I am at my wits end. She should have been prohibited from driving a year ago but everyone is afraid that Lil will throw a temper tantrum. She’s a princess who has clearly stated “no one is going to tell me what to do”.
Well, what should I do? My husband is worried yet thinks it will all iron itself out. You can tell that he non-confrontational because he kowtows to her at her every whim.
I am seriously worried that she’s either going to kill herself, kill someone else or drive off looking for her hometown (800 miles away) because she still thinks she’s living there. The police eventually found her car five city blocks away. When confronted that night she laughed it off that “she and the officer” couldn’t find her car.
Please give me advice. I am a nervous wreck. Thank you.
Leslie Kernisan, MD MPH says
Oh wow, this does indeed sound super stressful. Well…your situation is difficult but unfortunately not uncommon. Your mother-in-law’s symptoms and issues are certainly very concerning, and sound like they could be dementia. What to do is harder.
If the issue is especially around getting your husband to accept that your family needs to intervene, I would recommend trying to hire a geriatric care manager (now known as Aging Life Care professionals) to help. Even if the GCM can’t meet your mother-in-law, he or she should be able to provide your husband with some coaching on why it’s necessary to do something and what can be tried.
We also now offer a special Helping Older Parents Membership program, which allows members to ask questions of me and of some very experienced geriatric care managers that I have recruited to the program. (Plus it includes my course, connecting with others in similar situations, etc). You can learn more here: Helping Older Parents Membership.
Last but not least: if you’re a nervous wreck, you could also consider joining a free online support group…there will be less expert support than in our membership, but you will still get some good advice and lots of emotional support. Good luck!
Lisa Hartle says
I would say she is a danger to others on the road. You can file an anonymous report with DMV that you believe she isn’t safe to drive . It might save someone’s life or even her own. Think how you will feel if she hurts or kills someone in an accident, especially a child. It isn’t about her, it’s about the sac of everybody else on the road.
Manjunath Thimmaiah says
Hello doctor.
My father is about 85 year old and he is in good physical health. from last 10 days we noticed very unusual behavior. at night he gets up and says i am dying call all my children, somebody is coming to steal things from me. he started behaving so different that i can’t even imagine. at he pulls off his all cloths and sit hold some knife or stick and say some body is coming. when we went to Neurologist doctor suggested for MRI and in that the impression is as below
“Diffuse Confluent periventricular and sub cortical white matter T2/FLAIR Hyperintensities more marked in frontal & parietal lobes associated with diffuse chronic micro hemorrhages s/o chronic hypertensive encephalopahty + severe small vessel ischemic changes (Fazekas grade 3) + posterior reversible encephalopathy syndrome (PRESS)
Multiple chronic lacunar infarcts in bilateral centrum semiovale, thalami and ganglio capsular regions
”
Kindly help me for understanding the cause and reason for his behavior and how can we cure this.
Thank you so so much for your time for replying this.
Leslie Kernisan, MD MPH says
Sorry for delayed reply, we had a glitch in our system that we have just resolved.
I’m also sorry to hear of this change in your father’s condition. When an older person gets worse over a matter of hours or days, we always want to consider the possibility of delirium. You can learn more about that condition here: 10 Things to Know About Delirium.
Otherwise, I have information on those type of MRI findings here: Cerebral Small Vessel Disease: What to Know & What to Do.
To be helped, he first needs a comprehensive evaluation for cognitive impairment. Treatment would depend on what the evaluation uncovers. I explain what the evaluation should include here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check.
Good luck!
Dianna says
I read your article with the hope of finding ways of coping with my “mean” elderly mother. I certainly mean no offense, and I’m genuinely glad that people have found it to be helpful, but all I got out of it was: get a diagnosis (and the reason for doing so), read a book, go to an online support group , and remember not to be offended.
These are definitely good suggestions, but, even when I remember not to be offended and know that it’s the disease not her, it’s still so very, very difficult to cope. For people who aren’t living with their elderly parent, the situation is hard. For people, like me, who sold their house to move in with their elderly parent knowing they’d do better at home, it’s monumentally difficult.
The elderly woman in this article could be Mom. We’re not Jewish, but the use of guilt described here, the unrelenting demands and the all encompassing selfishness are the same. The difference is that I experience it in-person not over the phone, and I can’t just hang up.
Could you please write another article, but, this time, could you use concrete coping mechanisms to help?
Leslie Kernisan, MD MPH says
Sorry for delayed reply, we had a technical glitch that kept me from seeing many of the pending comments for the past few weeks.
Thanks for your thoughtful and candid comment. Honestly, I think the best way for someone like you to get help with concrete coping mechanisms is to get ongoing support from a group. It can also be very helpful to get ongoing support from someone with expertise in coaching and supporting people in your position, such as a geriatric social worker or geriatric care manager. (Some private therapists are good at this too.)
I could write another article but I don’t think it would be as good as the better books out there. (And, I am spread extremely thin right now and so have limited time to write additional articles.)
For dealing with a “mean” or demanding older parent, I especially recommend “Coping with your difficult older parent” by Grace Lebow and Barbara Kane. It has great advice on setting some boundaries. I also interviewed Barbara Kane on this topic, which you can listen to here.
Because I believe people like you need ongoing support and guidance from people like me, this year I launched a Helping Older Parents membership program. It includes ongoing access not only to me, but to experienced geriatric care managers who are really good at offering our members concrete coping mechanisms, through our private online forum and also through live QA calls in which we coach members. You can learn more here: Helping Older Parents Membership Program.
Sorry, I can’t be more helpful through the free articles. I am in touch with MANY people in your situation and I know it is crazy stressful and difficult. I do think ongoing support can make a difference. I would recommend you at least try the free group at AgingCare.com; it’s quite active and they are very supportive of each other. Good luck and take care!
Holly says
I have been taking care of my mom for years, but had to move in with her this past December. She has major heart problems and also has cancer in her thyroid and lungs. They did a MRI of her brain and said that she has had a couple of small strokes and the beginning stages of dementia. They took away her driving privileges and that was the start of her anger. I cannot imagine how scared and angry that she must be, but she directs it all towards me. She hasn’t said a nice thing to or about me! It doesn’t stop, she’s called me every name in the book. That is just a small example of how relentlessly her hate for me has been. My sister, brother and dad are all deceased, so I don’t have any help! I’m not a well person myself and I have had to cancel my appointments so I can take care of her. Recently, she has been refusing to take her meds, won’t shower/bathe or even change clothes. Plus, she’s telling everyone that I’m stealing her blind and stealing her medications….I would never do anything against my mom. I love her with all of my heart, but I honestly don’t know how much more that I can take! Please help me!
Leslie Kernisan, MD MPH says
Sounds like you have been through a lot and maybe you are (understandably) reaching an unsafe limit of stress. You probably need to renegotiate the caregiving situation so that it can be more sustainable. It’s wonderful that you have done so much for your mother but if your health or sanity are starting to feel at risk, it might be time to pull back a bit. You can still love her and actually be very helpful to her, without necessarily living with her or putting yourself in a position you have so much exposure to her unhappiness about her situation.
For help figuring out your options, consider:
– joining an in-person or online support group
– contacting a social worker (try your local Area Agency on Aging to see if they can help you find one. Some medical clinics also have them available.)
– contacting your local Alzheimer’s association
– contacting a geriatric care manager; they have experience coming up with other care plans
Always remember that sometimes it is ok — and even necessary — to choose yourself over your parent. You can’t keep helping her if you fall sick from the stress. You deserve to get what you need too, and it’s often possible to keep loving and helping a parent without doing quite as much. Good luck!
Stephana says
We recently had to decide to put Mom into a nursing home for 2 reasons:(and it was a very difficult decision) Osteoporosis(which has caused 3 major breaks in 5 years,) and moderate Dementia(forgetting what day it is, when to take your pills, . having problems with day to day tasks, denial and anger(she refused any help at her apartment which we were trying to give her to keep her home and safe) The day she went into the nursing home her leg had become numb. Mom had been in physical rehab for 3 months due to a fracture on her lower spine..She had only been home 4 weeks.
I came up to help care for her(post physical rehab)…She wouldn’t do the things to keep herself safe…While caring for her she would refuse to listen to me if I told her not to overdue with chores.
I said “-let me help since you just got out of the hospital.” but she wouldn’t listen…and would get angry.
Mom has been at the nursing home for a month(a really good place) close to where relatives can visit her.They love Mom and do lots of activities and have entertainment regularly.
The sad part for us -Mom refused to move closer to US.(we’re a 1000 miles away) because she is so stubborn.
Last evening she called me very upset because someone told Mom she was at the nursing home permanently . She blames ME(not my brother) for her being there and said she would disown me)
I did not argue with her but said I had to go. You can’t use logical explanations because she refuses to accept it due to the dementia…and to be honest she can really hurt you with words.
I try to let it go but it really hurts . We also had to put Mom on Medicaid because she did not have the financial means to have 24 hour care at home. Even then we couldn’t be assured she would be safe from falling. I’m just expressing my sadness and frustration because it hurts that we couldn’t be closer but she made those decisions very clear to us…
Leslie Kernisan, MD MPH says
Thanks for sharing your story. It sounds like you’ve worked really hard to help her. I’m sorry she’s not able to be more appreciative. What you’re describing is fairly common in dementia, and even making a reasonable and necessary decision can feel very hard.
If you haven’t already done so, I would recommend connecting with a support group, to help you with difficult emotions that come up. We have a special expert-led group for people like you, you can learn more here: Better Health While Aging’s Helping Older Parents Membership Community. Good luck and take care!
M says
My Sister & I had to take care of our elderly alzimer mother when she was in & out of the hospital. My older Sister Ona was in Washington liveing there she never help 1. We had to make things comfertbul . My Sister had to work nights & days witch she was a very hard worker . Then my older Sister was doing. Any way we had too take care of mother more more very way more. Now our mother is taken advanage of us say we where not there for her. When we helped her . Well thats it my older Sister would bully me thrue mail all the time now she said she never did maken harder for me.
Leslie Kernisan, MD MPH says
Sorry to hear of your situation. It is common for there to be very difficult histories and feelings when caregiving issues come up, either between adult children and their parents, or between siblings, or all the above. I would recommend joining an online support group for people caring for older parents. Many have had conflicts with their parents and/or siblings, so they’ll be able to provide you with ideas and support.