Sis says Mom has dementia, but I’m not so sure.

Dear Grassflower: My mom is in her 80s. Dad died two years ago. Ever since then, she’s been listless and sits around the house doing nothing. She stares out the window or watches TV all day while the dishes and laundry go undone. She doesn’t eat regularly, and when she does, she often leaves food in the microwave for hours after it’s done cooking. Food rots on the kitchen counter and attracts flies. There’s clutter everywhere, mostly from the accumulated projects Mom never finished once Dad started getting sick. Mom has been in a deep funk since Dad died and has lost interest in everything. She doesn’t change clothes and bills are going unpaid.

I know Mom needs some kind of help. Maybe a maid for starters. Maybe a grief counselor. But my sister, “Beth”, who lives closer than I do, says Mom has dementia and that this isn’t just depression. Now Beth is pushing to have Mom moved out of the house and into eldercare.

Here’s the problem. “Beth” is a control freak. Everything has to be neat and organized. Mom was never that way on a GOOD day. It doesn’t surprise me that Mom is “lost” after Dad’s passing. Dad was always the one who paid the bills, organized the garage, and so on. Mom’s areas in the house were cluttered for ten years before Dad died.

I’m concerned that Beth’s a little too anxious to impose order and control over Mom’s life instead of just letting her live out her years how she wants. I don’t want Mom to lose her independence until it’s absolutely necessary, and I’m not sure it’s necessary yet.

Disagreement with Beth has already caused friction, and I think it will only get worse.

My question is: does Mom have dementia, or not? How do we tell? Which one of us is right, and what is there for either of us to do about it?

—Sharlene in Peoria, IL

Consider other reasonable explanations for Mom’s behavior.

Let’s take your perspective first, and look at things as objectively as we can.

Based on your description of the situation (and I don’t know your sister’s take on it), it is indeed possible that Mom is still depressed about losing Dad. Grief can take anywhere from six months to a year or longer depending on how long people have known each other, and adjusting isn’t easy.

It takes a LONG time to sort through 60 years of memories, bills, insurance policies, house paperwork, Dad’s personal effects, PLUS laundry, dishes, and what’s in the refrigerator. Sometimes things like housework just have to fall off the table so that other things can get done.

But there’s a limit. If Mom’s piles of unsorted bric-a-brac present a trip-and-fall hazard, that’s not good. The uneaten, rotten and expired food are health hazards. And her not accepting Dad’s death or failing to deal meaningfully with next steps like bill-paying isn’t going to end well.

Clearly Mom’s overwhelmed. If she’s just depressed, she needs help NOW. If she’s got dementia, she needs help NOW. Either way, it doesn’t matter who’s right. It’s not a contest.

You’re on the same side. You both love Mom and want the best for her. And right now, that’s probably a visit to her doctor and a referral to a psychologist to evaluate her mental state. You’ll both feel better knowing what’s really going on and dealing with facts instead of opinions.

Is Mom’s behavior endangering her safety?

Let’s say you’re right–that there’s no evidence your mom’s anything other than depressed. You’ve got the psychiatrist’s appointment set up, so you don’t know yet if the answer is going to be antidepressants, psychiatric meds, or custodial care.

In the meantime, look around the house.

Does the clutter present a trip-and-fall hazard? Does the rotting, expired food endanger her health? Start with helping clean and tidy the house, getting rid of the rotten food and trip hazards. Offer to “help” her with bill paying so you can learn whether Mom was just overwhelmed or can no longer handle her own finances.

Helping Mom sort things out might be appreciated, or she might get angry. Either way, you did something that needed doing, and that helps YOUR mental health.

Now that the house is clean and bills are paid, how does Mom appear to be getting on? Does she seem a little more normal? Or does she forget immediately that you helped her organize, claim you stole her treasures, and have difficulty finding the silverware drawer in the kitchen?

In my Mom’s case, the house was so full of unfinished projects and unsorted papers that they were piled on the living room floor; and even though we had healthcare workers checking in on her,Mamma did in fact trip, fall, and break a bone. She couldn’t find the silverware drawer, so she asked for a saw to cut off the fronts of all the kitchen drawers so she could see what was in them. She imagined rooms in the house that weren’t there. And it was obvious to me from the months-expired, molded food in the fridge and the fact that she was overdosing on her meds that continuing to live in her own house was actually a danger.

I knew I’d have to move her to custodial care. Whether it was because of dementia wasn’t really relevant any more.

Deciding that Mamma couldn’t live in her house any more was a tough decision. She had raised me and my brothers there since the 1960s. I didn’t decide it lightly, but it still came as a surprise to nearly everyone who lived farther away and couldn’t see her decline.

The best way to fix that is to be open and abundant with your communications, starting with your sister. Get her full take on Mom’s condition and let her share until she’s done talking. When it’s your turn to ask questions, set aside any opinions you had before the conversation. Consider that it’s probably hard for your sister to be the bearer of news you don’t want to hear, and when you feel drawn to express your opinion, write it down on paper and decide LATER in a more rational moment whether it’s worth sharing.

If Mom’s endangering herself, priority #1 is keeping her safe. Dangerous behavior can sometimes make difficult care decisions easier, because whether or not Mom has dementia, the decisions are often the same.

But I still want to know if Mom has dementia.

Okay.

Let’s say you’ve considered all the angles, decided Mom can’t live at home, and you’re actually talking with your sister productively about Mom’s care. Issues of guardianship and Power of Attorney are getting settled reasonably, and while you and Beth may differ on how to spend Mom’s assets to take care of her, it’s all getting sorted out.

But you’re still at odds with Beth over Mom’s mental health. You feel like Beth’s jumping to conclusions in a desire to get Mom’s life back in order.

The first and best step for BOTH of you is to get Mom evaluated by a psychiatrist. They’ll usually be able to tell clinically and objectively whether Mom actually has dementia, what kind and how far along it is, and brief you on what’s in store for the future.

If Mom doesn’t have dementia, they’ll tell you. In that case, you’ve dodged a bullet.

Until then, here are ten warning signs of dementia that you should be able to recognize.

• Leaving things in strange places. Toilet paper in the fridge, car keys in the microwave, you get the picture. Sure, everyone makes little mistakes like that now and then, but if Mom’s doing this regularly, ESPECIALLY if she’s unaware of it, denies it, or gets upset when you mention it, alarms should be going off in your head.

• Sudden, bad changes in judgment. Mamma once paid a yard worker multiple times for the same job and loaned him $1000. Sure, normal people can live chaotic lives and make crazy money decisions, but if this isn’t normal for your mom, something’s wrong.

• Sudden, uncharacteristic changes in lifestyle. If Mom’s always been a family person and is now gambling, drinking, and hooking up with strangers online, it’s probably NOT just her starting a new life after Dad. Impulsiveness can be a sign of a particular form of dementia, and it’s important to have a qualified doctor check her out.

• Multiple car accidents or getting lost. If Mom’s gotten into three fender-benders in the last week, can’t remember them, denies them, flees them, responds inappropriately to emergencies or makes up stories about what really happened, she’s probably cognitively impaired and shouldn’t be driving.

• Unawareness or forgetfulness about recent events. If Mom doesn’t remember the car accidents or getting lost at all, it’s a sign she shouldn’t be driving.

• Inability to recognize familiar people. It may be as subtle as forgetting the name of a great-grandchild (there can be a lot of them!) or as obvious as forgetting YOUR name; but if Mom’s never been a bad rememberer and suddenly is now, it’s important to act timely to get her on meds to preserve what memory she has, and prepare yourself to deal with the psychological trauma of taking care of someone who confuses you with her sister, aunt, cousin, or doesn’t remember you as anything but a kind stranger.

• Sleep problems, hallucinations, delusions, or bizarre behavior. If Mom’s seeing people or things that aren’t there it’s a strong sign of dementia.

• Frequently skipping or overdosing on meds. By itself, missing a pill is something we all do. Many seniors are on a lot of meds and it’s hard to keep track of them all. If missing or overdosing on meds is a regular habit that Mom didn’t previously have, or if the effects are scary or life-endangering, something’s wrong and you really need to have a medical caregiver dispensing those meds.

• Repetitive, insistent, frustrated behavior. If Mom keeps going to the cupboard to get something even though she doesn’t remember what it is, it’s possible she’s just hoping that looking in the cupboard will remind her. But if she won’t stop looking for something that would never be there in the first place (motor oil in the pantry), gets agitated at your interrupting to help, frustrated at not being able to remember, or greatly upset at not being able to find her favorite cookies–or worse, claiming that you moved or stole them–then it’s time to consider that she’s not functioning as she used to and may need more help to live than she can muster on her own.

• Failure to use familiar tools or carry out daily activities. Nobody likes to bathe, fold laundry or do the dishes. But if Mom hasn’t done any of those in weeks, it’s possible she’s forgotten how to do them, doesn’t remember that those are things you do, or is simply unable to do them any more, and it’s a sign something’s wrong.

If Mom has dementia, the chances are good she’s had at least a few of these episodes. If you or your sister notices even two or three of the above, your mom probably does have some cognitive impairment, and you should think about ways you can help guide her and your sister supportively through the difficult times to come.

It’s a jagged little pill to swallow, I know. And I sympathize. I’ve been there.

We all want things to be different. But don’t let your desire for things to be different make things harder for those forced to deliver bad news and uncomfortable truths. Nobody wants to hear that a parent has dementia, and it’s just as important to face the reality with grace and compassion as it is to look for alternative explanations or creative care arrangements.

Good luck, and remember to breathe. 🙂