How to help Jeckyl/Hyde behavior

[CloudySue]

Hi, I'm a pediatric private duty nurse, and I need advice from geriatric nurses who can help me help my dad and step-mom.

My dad's wife is 92, he is 79. They live independently in their privately owned home. They live 3000 miles away from me. For the last 6 months, my step-mom has been like Jeckyl and Hyde- she can act completely lucid to medical professionals, neighbors, her own children, etc. but she's become increasingly delusional and verbally abusive to my father. She's convinced he has another wife and kids who live down the street, she thinks her own dog is not hers but was swapped with his other wife's dog that looks exactly like hers, she believes people live on her roof and urinate off the side of the house (as evidenced by water on the windows, which really come from the lawn sprinklers), she rants and raves in the night, hits her call bell while she's asleep and hears it and thinks it's dad's "other wife" sending him messages, etc. She's also threatened to set fire to her bed if anyone tries to make her leave her home.

She's seen doctors but she's a perfect angel to them, she's been in the ER, they've had a social worker to the house, but she's given nobody any evidence that she's having problems. Meanwhile, my dad is at wits' end, I'm so worried about his own health. He's too old to be dealing with the stress this sort of life is giving him.

I did visit for a week in December, she was such an angel to me the first two days that I seriously thought my dad was the one who was delusional. But on the third day she let down her guard and let her delusions out. I saw and documented lots of erratic behavior.

Tonight my father asked me to come out again and help me take care of her. I work PRN so I can get away from work for a while. Can any of you point me in the right direction once I'm out there staying with them? Thank you for any advice you can offer.

[jadelpn, LPN, EMT-B]

I would describe said behaviors to the MD. Especially if they are documented. You need to get some services in the home. ESPECIALLY if there's a "I will set fire" tone to things.

Another thought is an assisted living or even LTC for a short stay to see if there are medications that can assist in stabilizing these periods of dementia/psychosis.

To even say to social worker who comes to house "Mother, tell this nice person about the people who urinate off the side of the house. I think that we can help you deal with that." Call her out, ask pointed questions--but in the presence of a care team.

If it becomes apparent that she can not live at home with services, other arrangements need to be made.

Best wishes!

[CrunchRN, ADN, RN]

She needs a neurocognitive evaluation by a neuropsychologist. They will be able to do cognitive tests that will reveal what is going on. Have your dad make her an appointment with the closest one you can find.