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My mom has been living independently & was diagnosed with Afib a week ago & spent several days in the hospital. She has always had a strong personality…based on things I’ve read over the years I think she has AADHD, possibly bipolar, some OCD characteristics added with a touch of NPD and a hoarder lifestyle. She’s a night person & is highly critical of everything, especially today’s America, immigrants; her glass is always half empty. She’s surprised she’s still living & has wanted to be in heaven for the past 20 years but is not suicidal. We live on opposite coasts. She has no friends. She has only taken meds for HBP & glaucoma until last week. She has never wanted to take anything, wants no invasive procedures, distrusts most people. When unhappy, has outbursts of not so nice comments & is usually unapologetic about anything she says.



Last week she was feeling unwell, had been off & on for a few weeks. She went in to see her Dr. last week who had her transported to the hospital ER due to her heart rate. She was diagnosed with Afib & stayed in the hospital for several days. Since she lives alone they wanted to send her to rehab for 1-2 weeks. I had already scheduled trip to see her as I hadn’t seen her since Nov/2019 due to the pandemic. She didn’t want to go to rehab & was agitated. I bumped up my trip & went directly to the hospital from the airport where she was then discharged since I would be here for a couple of weeks. She left with 9 prescriptions (digoxin, cardizem, lasix, lisinopril, lopressor, xarelto, protonix, flonase, and latanoprost. They also prescribed Ambien but she refused to take it in the hospital so it wasn’t filled when she left. She didn’t like feeling dopey.) She takes 1 of each pill in the AM.



For years, I have been calling her twice a day, once in my morning & once in my evening to make sure she’s ok & to remind her about her eye drops at night. Over the past year, she has noticeably been more forgetful. She’ll ask the same question 2-3 times during our calls not recalling she already had done so but is pretty much able to carry on a conversation. Since I arrived & have been staying with her, other things are more noticeable. She has always wanted to go shopping, one of her favorite things, but now has no interest in going. Not new…She watches TV with the sound loud in the middle of the night, during the day and falls asleep having an abnormal wake/sleep schedule. She’s put off getting lab work done for over a year, so I don’t know if there are other medical issues. She lost her sense of smell/taste before Covid. Eating no longer brings her pleasure unless it’s sugary.



Yesterday she said she thinks she should go into a nursing home as ADLs? are too much for her. This from someone who doesn’t like to be touched along with her OCD traits (a lot of hand washing, any clothing that touches the floor must be rewashed, checking to make sure doors are locked, will only drink spring water and doesn’t want to consume anything in the last inch of a container due to heavy metals, etc. BUT isn’t too concerned with having piles of newspapers, magazines, mail (half unopened), plastic containers, tissue boxes, etc. gathering dust all around her space.)



Her remark about the nursing home surprised me since I thought she’d have to have more advanced senility in order for me to get her to go into one (her willingness). I don’t know if this is the best place for her, if there are other considerations I should consider that I don’t know about or how I should go about next steps. Given her personality, I fear she could be kicked out. She always rented rooms in other homes but the landlords have had to pretend they were selling their home so she’d move due to hoarding. She’s been in her own apartment home since Sep 2019 so I wouldn’t have to deal with the complaints. I do not have any signed authority but do make sure she has what she needs and insure rent, insurance, etc. are paid timely.



Any advice is appreciated.

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I don’t know that I can offer any advice for your situation, but I believe AFIB may be chiefly responsible for my mom’s dementia. She made it to 95 with her faculties intact, but has declined steeply in the past year and a half. She has had intermittent AFIB in the past, but last year was diagnosed with it as a constant. It may cause tiny blockages or bleeds that damage the brain. I hoped her blood thinners might stop or stabilize her condition, but I can’t say I’ve noted any such effect. But I don’t know if she’d have been worse without them. I live next door to my mom, so I’m still caring for her at home. I know she definitely could not live by herself, but she is kind and appreciative and can still function with my help. I don’t know what I would do if I lived across the country, perhaps move her closer.
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TChamp May 2022
Nobody reaches 95 years of age in perfect health. Medical and brain problems should be considered unavoidable and expected at this age. She was blessed with a very long life, way above the average life expectancy for women in this country. You're a very lucky people.
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Judging by the medications she received at the hospital, your mother seems to have significant medical conditions besides atrial fibrillation. For example, severe hypertension, some degree of heart failure, gastritis or acid reflux, insomnia, allergic rhinitis, and glaucoma. Her psychiatric problems are not life-threatening and as such, so they are less important for now. Atrial fibrillation is a heart arrhythmia that occurs from damage to its electric system. She probably has an enlarged and weak heart that is beginning to fail and she is now accumulating fluids in her body. Her medical problems will get worse and eventually become life-threatening. The medications won't prevent her physical deterioration. The worst problem seems to be the heart failure. The atrial fib. is not dangerous as long as she takes Xarelto, a blood thinner. Nevertheless, anticoagulant medication creates other perils, like internal hemorrhages and bleeding strokes. She does not seem to have dementia at this time, only a severe cognitive decline due to aging. The first thing to do is to accept that from now serious medical emergencies will happen in the near future. You have to be prepared for them. Independent living is out of the question. With so many medicines to take, she will need assistance to avoid serious mistakes. POA is a must because pretty soon she won't be able to manage her own affairs.
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AlvaDeer May 2022
Atrial fib (chronic) is quite common in those of us over a certain age. They used to claim that 15% of us live with it. I have had it for two decades. No pacer, and rate controlled with atenolol. My SO has it for 10 years, has a pacer for low rates, and is med controlled. We are 80 and 82. People can live well with AF but are more prone, I know you know, to stroke. I don't take any of the blood thinners because as an RN saw more disasters for people on blood thinners than not. I take baby aspirin daily as does SO. I agree with you, more going on here because we have not only the electric system, but the pump system involved here, and CHF spelled out to Congestive Heart Failure says it all, a failing pump. Without transplant that can be helped with meds only.
I agree with you also that the ongoing mental issues whatever they are aren't the crucial problem here.
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It sounds as though your mom would be competent enough to assign POA (medical and financial) to you, which should definitely be done as soon as possible if you can persuade her to do so. You should have it worded to go into effect immediately, even if you may not yet have to do a lot. It sounds as though you are already doing some of the POA duties, i.e., make sure bills are paid in a timely way, and your mother is willing to have you do that. It sounds as though AL would be a suitable placement for her right now, finances permitting, but in a facility that has a continuum of care so she could move to NH or memory care if/when needed. And, make sure the facility will accept Medicaid. A more thorough assessment can determine if AL is a good placement for her right now.
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Gosh, it sounds to me you are staring down the face of placement.

I moved my mom cross country from an AL in September. I had not realized dementia had started probably a year earlier… maybe 2 .. but she was good at masking it.. I tried numerous times to get my mom to move. It was pulling teeth to get her to move into an AL the first time.

it was the hardest thing I had to do.. .. I wish I could have done it sooner.. she may have been more physically capable.

I found an AL that had memory care, they said if she they find she didn’t belong there , we would move her to AL .. she belonged there..

I flew out , boxed what she had to have and some that she couldn’t let go of… believe me that was pulling teeth both times I moved her …( rocks from a camping trip ) made it to the AL , sat under the chair side table because the room was wall to wall of stuff…

I sent 13 boxes UPS , booked us airfare, and moved her. Emptied her AL. … It was hard.. my mom had NO stamina, The flight was awful , as our flight with first class arrangements was cancelled just before boarding. No flights available that day, rebooked on another airline for next day, another night in a hotel .. the hotel the airline arranged had no handicap room …that hotel kindly found us a nice hotel to take our voucher.. but meant another Uber trip..
got to the airport to check in, flight was canceled… I could have cried … the agent wasn’t very sympathetic, but got us back to the first airline… with difficulty..

But her new place was nice and she so needed to be moved…

I wish you good fortune if you take on this task…
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Do know that you cannot get any guardianship on Mom with mental issues or hoarding issues (also now a diagnosable mental concern). And you have no workup about dementia, which will be increasingly more difficult to diagnose with the mental issues a co-problem.
If Mom would like to move she can still appoint you as her POA to act for her if she wishes. See an attorney with her. You can then help in placement.
However, if Mom doesn't want to move, her aging heart issues CHF and AF aren't reason to take her rights of choice from her, and no court will do that.
I would offer Mom help in choosing a place. I would likely myself not offer to be POA because that is a difficult duty to do for a rational and well person, let alone for one who is difficult and has mental issues. But up to you on whether to offer to do that for her or not.
Much of this, esp. the heart issues, is self limiting. At some point Mom will end up hospitalized and the social worker will contact you. They can often get you temporary guardianship if you wish to assume that role, and help you with placement if that is necessary.
I sure wish you luck as there is lots on your plate.
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It sounds like some of her personality/ character traits could be signs of alzheimers/ dementia.
Repetition, fear and paranoia are symptoms.
You could ask her doc to have her checked for that.
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She's had a nasty shock and I expect she's tired and frightened.

Is it too late to reconsider her refusal of rehab? If she thinks she ought to go to a Nursing Home, this would at least be a good opportunity for a full and realistic needs assessment; it would also give her a bit longer to see how she feels once her new complete px has had a chance to kick in.

How long since she got home, and how long are you staying?
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SacFol May 2022
I’ll be here until June 3. She has an eye appt on June 2. This had been scheduled before the aging issue. A nurse is coming by tomorrow to see how she’s coping and what Medicare resources may be available I think for home care of some kind. I also want to ask the nurse about taking the 7 pills in the morning after she eats something…which isn’t much these days.
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