Psychological problems, plus dementia?

[Beth1000]

My 85 yrs old mum has dementia, around 5 years in, and is cared 24hrs by her elderly husband who is also showing much signs of confusion and some safeguarding issues have been reported (on both sides). We have involvement from social services, Admiral Nurses, Alz UK and basically anyone else we can think of for support or intervention. Husband wont accept any help, nobody seems to understand the crisis and because family live a considerable distance away we can't be there all the time. Care home option is now the only option and although her husband has reluctantly agreed this is the way forward we are still struggling with some issues.
1) Financially mum can fund her own care for a while but because SS are involved they are talking about assessments/capacity etc. Are these completely necessary as she wont be relying on their funding plus they are very slow to respond to our calls with questions?
2) Mum lost both her parents at 6 yrs of age. She has the most pressing of separation/abandonment issues and is stuck like glue to her husband 24/7. She can be kept distracted for 1 hour only and then wails/tugs at her hair/can become aggressive. Dr has put her on Sertraline some months ago but the issues haven't subsided.
With this generation of elderly people (WW2) surely mum can't be the only one with deep psychological/trauma problems and suffering dementia? Is this ever flagged up or discussed in regards to elderly care dementia?
When mum does go into residential care (we have visited a few and made a decision based on the care PWD are given) we are quite confident in our choice but wondered if they would likely sedate her if they couldn't manage? Would we be told (we have LPOA) and what medication would likely to be given? She is not necessarily frequently aggressive but can't seem to live without her husband by her side all the time. As much as she has doted on us, her daughters, we simply cannot placate and reassure her.
Apologies if I have rambled, first time poster.

 

[canary]

Hello @Beth1000 and welcome to DTP

Your mum has reached the "velcro" stage of dementia (otherwise known as shadowing), which is where someone with dementia has so little short-term memory that they develop a fear of being on their own and like to keep their main carer within line of sight all the time. There are many members on here who can testify about how they cant even go for a wee without their person with dementia hammering on the door and getting distressed. It is not necessarily due to past psychological trauma.

Most decent care homes would be aware of this phenomenon, although it will take time to transfer her focus to other staff members. Most care homes do not go in for the "chemical cosh" of sedating people just to make it easier for them to be cared for, but there is a place for judicious medication. If something is prescribed for her (perhaps anti-anxiety medication), then, yes, you should be told.

When you visit a care home be brutally honest with the manager about your mum and ask them how they would deal with it. Woolly answers probably mean that they dont have much/any experience of it.

 

[Beth1000]

Thank you canary, yes you have explained everything as it is.
I was under the impression that Sertraline was an anti-anxiety/anti-depression med so perhaps her GP needs to look at that (or dosage) again?
We will get her into respite care for perhaps two weeks and then they will be able to assess her needs and whether they can manage her. And if they can then she would be able to stay there. We did discuss her needs and behaviour on our last visit to the care home and we were quite confident with their answers.
This will be a very difficult time for all of us but the only option we can see. Thank you again for responding, this forum is full of lovely and intelligent people.

 

[Mydarlingdaughter]

If the PWD lived through WW2 and was an evacuee the trauma lingers on.
Yes I think the financial assessment and capacity assesment will be what SS want, if she is a vulnerable adult they have to tick all the boxes. The PWD may lack capacity one day and have capacity the next. Having dementia doesnt mean you lack capacity.

The SW may be able to get anindependent mental health advocate for her, to ensure her veiws are represented.

 

[Sirena]

1) Financially mum can fund her own care for a while but because SS are involved they are talking about assessments/capacity etc. Are these completely necessary as she wont be relying on their funding plus they are very slow to respond to our calls with questions?

No, you do not need to involve SS at all. My mother (who's 84) moved to a care home nearly two years ago and I did not involve them. SS have been informed subsequently that she's in the CH and there have been no issues. The care home you choose will do the assessment to check they can meet her needs.

 

[Rosettastone57]

My 85 yrs old mum has dementia, around 5 years in, and is cared 24hrs by her elderly husband who is also showing much signs of confusion and some safeguarding issues have been reported (on both sides). We have involvement from social services, Admiral Nurses, Alz UK and basically anyone else we can think of for support or intervention. Husband wont accept any help, nobody seems to understand the crisis and because family live a considerable distance away we can't be there all the time. Care home option is now the only option and although her husband has reluctantly agreed this is the way forward we are still struggling with some issues.
1) Financially mum can fund her own care for a while but because SS are involved they are talking about assessments/capacity etc. Are these completely necessary as she wont be relying on their funding plus they are very slow to respond to our calls with questions?
2) Mum lost both her parents at 6 yrs of age. She has the most pressing of separation/abandonment issues and is stuck like glue to her husband 24/7. She can be kept distracted for 1 hour only and then wails/tugs at her hair/can become aggressive. Dr has put her on Sertraline some months ago but the issues haven't subsided.
With this generation of elderly people (WW2) surely mum can't be the only one with deep psychological/trauma problems and suffering dementia? Is this ever flagged up or discussed in regards to elderly care dementia?
When mum does go into residential care (we have visited a few and made a decision based on the care PWD are given) we are quite confident in our choice but wondered if they would likely sedate her if they couldn't manage? Would we be told (we have LPOA) and what medication would likely to be given? She is not necessarily frequently aggressive but can't seem to live without her husband by her side all the time. As much as she has doted on us, her daughters, we simply cannot placate and reassure her.
Apologies if I have rambled, first time poster.

Although other posters have said that your mum is displaying dementia symptoms, which is actually right, I do empathize with the situation you're in.

My mother-in-law was like this and had mental health problems all her adult life. She had a personality disorder, OCD, generalised anxiety disorder and was needy and demanding , attention seeking all her adult life. She lived on her own for many years after being widowed relatively young . She was constantly seeking the physical presence of someone usually my husband with her most of the time. In fact due to this continuing behaviour family members didn't twig for some time that she actually had developed dementia as well. As her symptoms worsened she became even more anxious and needy. From what she recounted about her early life it was possible that she was physically and sexually abused by family.

She had carers in three times a day but eventually it got to the point where she was unsafe in her own home and we arranged for her to go into a care home. She was completely self funding and we never involved social services at all . She went into hospital after becoming ill last year and we arranged a care home from there . Both my husband and I had lasting power of attorney for health and welfare but to be honest we were never involved in the medication that she was prescribed. In spite of her high levels of anxiety she was never as far as I'm aware prescribed any particular medication for that. The care home dealt with her very well and seemed to be able to cope with her aggressive outbursts.

 

[ShrinkingViolet]

My mum developed BPSD (behavioural and psychological symptoms of dementia) and her care home admitted they were struggling to cope so we had to move her. We found her a specialist dementia care home which practices the 'Eden Alternative' (http://www.eden-alternative.co.uk/eden_register/) and they have worked us and a geriatric psychiatrist to modify her drug regime which includes pain management as well as antidepressants. She still has her moments but on the whole she's better and we haven't seen any self harming since she arrived at the new home.
I wish you well in your endeavours.

 

[Beth1000]

Thank you all for your considered and honest responses.

I hadn't considered an independent MH advocate or knew about Eden Alternative. I will look into those asap.

I was also reading elsewhere that someone who has had a traumatic head injury is 4-6 times more likely to suffer from dementia. My mum did suffer head injury during WW2. Also some sexual abuse. These circumstances, would today, be a signifier for counselling which my mum never had.

I'm not a fan of blanket prescribing of anti-psychotics for dementia but admittedly I've not seen these in practise for pwd only for those suffering from schizophrenia/psychosis which I wouldn't considerer the same at all.

Please could someone inform me whether there is a difference between a care home that 'specialises' in pwd and a specialist dementia care home. Are these the same (in general)?

Thank you all once again for your responses and always open to learning more and discussion.

 

[canary]

Please could someone inform me whether there is a difference between a care home that 'specialises' in pwd and a specialist dementia care home. Are these the same (in general)?

They could be the same, but unfortunately care/nursing/dementia homes can all stipulate their own criteria of what they will (and wont) accept. There are many dedicated dementia units and care homes which say that they specialise in dementia who only want the early, easy, stages of dementia. Then when the dementia progresses and they start wandering into other peoples rooms, getting up at night, resisting personal care, becoming incontinent, showing a bit of aggression, or other normal displays of advancing dementia, then the care home cant cope and will give notice, or make the families life so difficult that they move that person themselves. So if you are considering residential care it is always worth asking what behaviour they would not accept and go and look at the place yourself. If there are residents in all stages of dementia this is a good sign that they can cope with the more advanced stages - if they are all at about the same level of the person who could be moving there, it probably means that they would be moved on fairly soon. Also, when talking to the manager, be brutally honest about the problems and ask how they would deal with it. Hesitations and woolly answers probably means they have little experience.