Need advice about my aging grandmother

[Magsulfate]

I'm not sure what thread to put this in, but here goes. (sorry its so long)

My grandmother is 82 years old, she lives by herself, near my parents. And up until this year, she was mowing her lawn and taking care of herself just fine. She is a very clean and neat person with a very clean and nice home.

Now, in September after hurricane Ike, she stayed with my parents for a week or two because the power was out and my parents have a HUGE generator. It was like there was no power outage at all at their house!! It was great, and I was there too. I started noticing how different she was acting. Most of the time, she sat in the corner of the livingroom with a flat affect look . She was 'lost'. And when I asked her something, I had to repeat it several times for her before she understood what I was asking. This went on everyday.

Also, my mother mentioned that she hadn't had a shower since she was there. I tried to get her to take one, she said she would, I even showed her how the handle worked in the bathtub. We also have a shower chair in there. Well... she came out of the bathroom a few minutes later saying she took a shower,, etc. And then I went in there and the tub was completely dry, no dirty towels. She did not bathe.

Anyway, come to find out, she never took a bath the whole time. My mother mentioned to her doctor all of these and told him that she is getting forgetful. All the doctor did was turn to my grandmother and ask her "are you forgetful?" and grandmother said "no." and that was the end of it. I have to add here that Home health is seeing her a few times a week and will wash and roll her hair for her. But that is all.. she refuses a shower then too.

Well, Grandmother went in the hospital for vomiting and stayed a week. My cousin stayed with her a week and she did not shower the whole time she was in the hospital. She made excuses each time the nurse came in to ask her.

Now,,,,,,, my cousin is staying with her. The other night she told grandmother that she needs a bath, she is starting to smell bad. Anyway, this prim and proper grandmother of mine starts yelling at the top of her lungs that she won't take a shower and if you don't like it you can go home!

I just don't know what to do about all of this. I don't know what to tell my mom. Some time my grandmother can seem perfect. But then when she's not, its BAD! So, I guess my question is,,, at what point do we determine that she needs someone to take care of her? At what point can she no longer make her own decisions? I mean, if she's refusing to take a bath, for months, then is she able to make her own decisions?????? Need a little help here,,, thanks everyone :)

[Magsulfate, BSN, RN]

i wonder how she would respond if her dtr or someone else close to her, discussed their concerns with grandma before discussing with anyone else?

maybe there's a perfectly valid reason/fear why she's avoiding hygiene?

it sounds a tad early to suspect dementia, imo...

leslie

Well, I didn't put everything in the original post. But, we cannot even begin to discuss this with her because she will not understand. There are things that she should know, that are daily things... that she forgets what they are, and you can't hold a conversation with her half the time. When you do get to have a conversation, it's me, repeating myself over and over, and her saying "okay". and thats about it. So, I don't think its too early for her daughters to be discussing this with family and trying to get the doctor to do something...

Anyway, I have told my mother about everyone's advice. She is a very good daughter who has health problems of her own, but she's writing everything down and hopefully will either phone the dr, or go with grandmother to the next appointment. Also, mother got her a case manager and they will be hiring my cousin to stay with her indefinatly.. which is the one thing I was worried about,,, my grandmother staying at home alone. Now I do not have to worry about that.

Thank you all very very much for the advice, and I am always open to any more advice on how to deal with all of this.

[Magsulfate, BSN, RN]

Okay, UPDATE....

Grandmother has been at home by herself now because she ran off my cousin after only a few weeks. She would yell and throw fits and accuse her of talking behind her back. Then what made my cousin leave finally is my grandmother started punching her in the face!!! My cousin was trying to call her mom (grandmother's daughter) to pick her up because she was screaming and yelling and calling her names, being REALLY hateful to her for no reason, (other than the made up reason in my GM HEAD) Then Grandmother started punching her! My little niece had to step in between them to get her to stop!! Oh my goodness, I can't believe this is happening!

So , from what I can think of, it will take a terrible fall or accidental overdose on my grandmother's part before she will be hospitalized and then eventually into a nursing home because she is so demented that no one will take care of her!

I don't know of any other way to do it. She already proved that she doesn't EVER take a bath/shower, she takes pills when she's not suppose to and gets them screwed up, she doesn't listen to ANYONE, including her home health nurses, and she falls everyday.

Any advice or experience in this?

Edit: one more thing I forgot to add is that we talked to her doctor, he put her on Aricept. Thats all he did. Didn't explain anything to my mom and aunt.....

[Straydandelion]

Not to give any advise or diagnosis, but aricept is mainly given for Alzheimers...early stage though a family member would need to call the doctor and talk with him/her to be sure. There is tons of information on the web and even support groups for someone with dementia if that is what her doctor is thinking.

But some steps need to be taken for her well-being whatever the diagnosis is. The first sounds to me like making sure she stays safe and takes her medicine.

Here is one link, but there are more also with just searching...

http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=569

[teadrinkr]

This sounds like it could be dementia to me. It may be necessary to bypass her MD and get her to a neurologist. Try to fax a letter with your concerns and her behaviors to the neurologist prior to the appt.

The Alzheimers Association has a very good discussion board that is very helpful to caregivers/family members that are concerned about their loved ones. There is also a health professionals board for those that work in the field.

I have learned much more about dementia by reading the alz.org board than I ever did working in geriatrics. Good luck.

http://alz.org/index.asp