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I have detailed my mom's craziness many time so will not go over that.


Botton line, her anxiety is through the roof. When my dad was going down from ALZ a few years ago and health professionals came over, they said they are not worried about my dad, but my mom. They would use terms like her anxiety is through the roof, off the charts. You name it, they said it.


It's getting worse and driving everyone crazy, especially me as I am the primary caregiver . Every issue is anxiety producing for her, the smallest unanswered question causes her huge anxiety and she calls me to help


I can of course can not answer the phone all the time, but in the meanwhile she is driving fellow residents at her independent living facility crazy. The staff there tells me I must be a saint to put up with her.


One time when she was in rehab after breaking a pelvis, the RN who was primarily responsible for her (and coordinated others like PTs, OTs, etc.) gingerly approached me and asked if it was OK if she had a psychiatric nurse visit my mom. I suppose some might find that offensive. I said OK, please, please send one! The psychiatric nurse visited and spent time with my mom and asked me if she was on any anxiety meds. I said a small dose of prozac. The psych nurse sort of snorted and said prozac for my mom was like giving an aspirin to someone with a brain tumor.


She listed some high power drugs to bring to my mom's doctor. My mom's doctor was a bit miffed by being told what to do by a nurse, but second said they are high powered drugs that she, as a GP should not really be prescribing. Third, she said my mom would never take them as my mom reads all the warnings that come with any drug and gets scared.


My moms GP has basically had it with my mom and given up. I don't blame her. She tells me that she is in an exam room with my mom for ten minutes and is worn out.


Anyway, I did not mean to ramble this long. Any ideas of what to do? I think my mom's next stop is not assisted living, but rather some mental health facility.

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Karsten, When you have a relative with mental illness who won't take meds, there is really only one solution that works. Court ordered medication and it has to be a long lasting injection shot. Depending upon the person, some of the shots last 30 days and are often the only way to keep our family members on their meds.

Getting court ordered meds is difficult in some areas and easy in others, just depends on how enlightened your area's judicial system is in regards to mental illnesses.

My MIL had schizophrenia and her biggest issue was anxiety. Same problem for my son who inherited her illness. When MIL was diagnosed late in her life, she had been taken to a geriatric psych unit of a hospital where she was diagnosed with vascular dementia and schizophrenia.

For my MIL, she didn't need the other psych meds, she just needed her Xanax and a lot of it. They upped her Xanax and everyone's life got easier. As her systems failed due to vascular dementia we really had to watch how much Xanax she was given in the nursing home. As often occurs with many meds and the elderly, the amounts had to be reduced as she aged.
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Your second to last paragraph 😆. Good for mom.
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Karsten: As you've mentioned below, a geriatric psychiatrist is needed.
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Beatty Jul 2023
Yes. Is needed but doesn't sound available unfortunatly.

Karsten said below "I have been told geriatric psychiatrists are few and far between in this area, and almost impossible to find one".

Even a regular psychiatrist, being in IL it would require Mom to concent to going to the appointment.

Sometimes it is easier to gain concent to 'talk to a Doctor' when 'captive' so to speak in hospital, rehab or even an AL facility. People are already out of their comfort zone, already having to trust in the system they find themself in, are willing to say yes to get home.

If already home eg in their own IL room, they have all the control.
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*You have to be able to reach sometome to teach them*

But how?

Anxious +++. Too anxious to take any meds.

Confession; I have read the warning pamphlet & decided against. But I have also read the pamphlet, had concerns, discussed these with my Doctor, weighed up the pros & cons, decided my life may well be better with a little help & accepted 'medication to help' for 6 months. I'm glad I did. It got me partially out of a hole. Then with my head out I could access other forms of help.

Mental health care is here where I live but seems incrediably hard to get into also - services not Govt funded, long wait lists or Psych Drs so busy they can't take on new patients.

There is an emergency mental health crises team, for immediate self-harm or harm to others. As others said, this may lead to a short hold then release. May lead to 2 week inpatient stay to find the right approach, talk therapy & medication mix.

It really is crazy that it takes a crises to get help when prevention would be so much better.

One huge barrier is that lack of insight. Another is having clear judgement.

Being able to clearly weighing up the choice: #1. Anxiety making life so very hard VS #2. Anxiety regarding medication side effects but possible reducuction of anxiety overall.

Karsten, your Mom is making her choice & sticking going with #1.

I totally get that if you could get to the right professional she could feel safe to try option #2.

As VetCareGiver said well "Your mom is an adult, and responsible for her actions".

If the IL management find her behaviour too hard to manage, can they have her Primary Doctor refer her for Psych eval? Does that pathway lead anywhere?
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Never had any luck trying to get Mom into see a psychiatrist---so all 6 of us kids went instead.

Would have been cheaper to have helped her, rather than let 6 kids get messed up.
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Karsten, if there is no Geri Psych, then a "regular" psychiatrist is going to have to do.

I would contact the best teaching hospital in your metro area and talk to both their Geriatrics unit and their Psychiatry/Neurology unit.

You might also check if they do comprehensive neuropsych workups. Often a psychiatrist or Advanced Practice Psychiatric Nurse (who can prescribe) is part of that team.
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“Our” psychiatrist was part of the referral service at the very good AL my LO had entered when we found that it was impossible for her to continue living safely in the old homestead where she’d been born almost 90 years before.

A gentle, soft spoken lady entered our lives as she entered my LO’s room, and she was able to interpret for us, as no one ever had, the crime and cruelty of the illness that had invaded my LO’s fragile life.

She and her coworkers were with my LO until we lost her in December 2022.

I will never forget the Blessing they were to her last years.
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Beatty Jul 2023
How beautifully described. I thank you so much for this.
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Karsten,

Your update prompted me to see if we have geriatric psychiatry in our area. We have Ochsner Health Care in our area and it turns out that we do have psychiatric care for the elderly.

I am sorry that this isn’t available in your area. I would do more research in your area.

All I did just now, was to google Geriatric psychiatry in New Orleans and it popped right up.

Best wishes to you.
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a little follow up. I tried talking to my moms primary MD and a couple other mental health professionals I have talked to in past about there

Apparently, even though we lived in moderately large metro area (about four millions) I have been told geriatric psychiatrists are few and far between in this area, and almost impossible to find one

I dont get that
\
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ventingisback Jul 2023
Then just talk to a normal psychiatrist, they’ll tell you what to do. As you know, if a danger to self/other, you can call 911.
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Speak to a psychiatrist. They’ll tell you what steps to take.
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Karsten,

I really feel for you! I watched my MIL deal with a mentally ill mother. I use the word mother very loosely because she was anything but a mother to my MIL growing up!

My MIL would pray that her father would divorce her mom when she was a young child so that her dad, a very kind man would be happy.

Unfortunately, some people never find the help they need and live their entire lives in complete misery and they try to take everyone else down with them. It’s horribly sad.

I don’t believe these people are capable of feeling love for anyone, not their spouses or their children. They have no friends because they don’t know how to be a friend to anyone.

I found that extremely kind nurses were able to speak to my mother about her anxiety and depression. My mom hid her depression and anxiety at times because she saw it as being a failure. She was the rock in our family that held it together when my brother went off the rails.

Our parents were part of the ‘Pull yourself up by your bootstraps generation!’ They didn’t feel comfortable speaking about anything that was bothering them. For the most part they had to grin and bear it.

You shouldn’t grin and bear it. You should do whatever you need to do to find peace in your life.

Wishing you all the best, Karsten and I truly hope that this will all be behind you one day. Take care.
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With my mother-in- we called 911 for psychiatric emergency and had her admitted until they found the right medication cocktail. Also sometimes you can get an excellent psychiatric nurse practitioner.
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It is never easy dealing with a parent with mental illness. I finally got my mom into a Geriatric Psychologist. That initial appointment there isn’t enough time to get all the issues out there. Also they get very defensive when you bring up their issues. They feel nothing is wrong with them. I told my mother she had the choice to seek treatment or she had to find other living arrangements. I wrote up a brief history of past, and present including relationships with others. I sent it to the Dr before our appointment so he was aware of what was going on. She thought she was at the Cardiologist office I didn’t tell her where we were going. Needless to say she was pissed. The Dr was so so compassionate and kind, she accepted help. She has been in rehab after a hospital stay. It has been a nightmare the constant calls complaining about food choices, but not saying anything about why they aren’t taking her to the bathroom. It’s just been a wild ride. Finding the right medication is key!

Be firm, set boundaries. Your mom is an adult, and responsible for her actions.
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With my mother-in- we called 911 for psychiatric emergency and had her admitted until they found the right medication cocktail.
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I feel for you. I am in a similar situation with my 93 year old Father. ALL PSYCHIATRISTS I can find are either not taking new patients, or won’t accept Medicare or older patients, His Geriatric GP who is part of the large teaching hospital in my city said she can’t even get him a referral with the Geriatric Psychiatrists because they are booked and have waiting lists. The local psych inpatient hospital will only see patients if are threatening suicide, or have substance abuse issues. GP has tried Lexapro) no help) Effexor ( no help so far) Buspar for anxiety - a tiny help- Xanax - hard to tell- Clonipen - no help. He calls me and says he’s going to die and wants me to sit with him because he doesn’t want to die alone. He calls every day and tells me how bad he feels. He has COPD but there is NOTHING else wrong with him. He has GI issues due to anxiety and has had colonoscopy, endoscopy, CT scans - all normal. Bloodwork normal, BPnormal, no heart disease, no cancer or arthritis. He is on oxygen for COPD and I know COPD can cause anxiety but this is more than that. I think he’s having a “ nervous breakdown “ but the hospital just sends you home if you call 911 and they can’t find anything physically wrong with you. I’m at my wits end. My depression is worse thing over this. I live in a medium sized metropolitan area with a medical school and 8 other hospitals so there should be plenty of services available.
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It’s so hard. That generation tends to be fearful of meds.

My mom read all of the pamphlets that came in meds too.

For us, it took something drastic for mom to consider going on meds. She was trying to walk out of the front door in the middle of the night. Then she agreed to trying Ativan and Seroquel. Both of those meds helped her tremendously.

Since meds affect everyone differently, it really is trial and error until you find what works.

I hope that you will eventually become successful in getting your mom on the correct meds. Best wishes to you and your mother.
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Karsten, I would not engage with the IL and I certainly wouldn't pick her up. She is not your responsibility unless you are her guardian.

I know this sounds cruel, but there is simply no good way to care for a mentally ill person who won't take their meds if you have no authority.

Tell them to send her to a psychiatric hospital.

And if you haven't already, read Liz Scheier's Never Simple.
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Thanks all. Yes, even before reading comments I sent a MyChart message to her primary doctor to request a referral to a geriatric psychiatrist. In the past she (the primary doc) said its hard to get into those, though we live in a fairly large metro area and have the Mayo Clinic down the road an hour in Rochester (which maybe I should talk to)

Her primary docs also issue is that my mom will often not take her BP meds as her OCD compels her to read every word of the instructions/disclaimers that come with it and is afraid of potential side effects. Her primary doc said if she is afraid to take BP meds, can you imagine what she would do when reading disclaimers for high end psychiatric meds.

Anyway, thanks all, and I do have a request for her primary doc to get her to a geriatric psych doctor.

As Alva alluded to, their own anxious condition makes it difficult for them to accept treatment, sort of a catch 25 or whatever it is

Even if I walked away, she is driving fellow residents in her senior living facility nuts at times and I expect at some point they will tell me she has to leave, and I am not sure the next step is assisted living, but rather some mental health facility.
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fluffy1966 Jul 2023
A one page (yet detailed) account of all your Mom's most disturbing, frantic, and annoying (to others!) behaviors can be written up by you, her caregiver. Sadly, what you refer to as a 'mental health facility': pretty much does not exist. Without a court order, you are looking at a "72 hour commitment" at most, and then she is discharged into your care. Without some appropriate meds (Ativan and Seroquel are two that have been mentioned already), your Mom may not be tolerated at her Sr. Living Facility much longer. Unfortunately, the same agitated behaviors might make her unsuitable for Assisted Living, also. Please make this clear in your 'one page summary' of serious behavioral concerns due to High Anxiety and perhaps additional 'mental health diagnoses'. The agonizing solution (because she is medication aversive) is a true mental health diagnosis and the psychiatric drugs that might accompany a true diagnosis.. Mental Health services in our country are alarmingly scarce!
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I had a great one that explained everything to me... then medicare took him off the network. Then I started reading about it and found this website. I have learned sooo much. Yes it gets exhausting. Yes trying to get a psychiatrist is like pulling teeth. Need to keep after them and since you already have a nurse visiting then it may be easier. Finding the correct balance of meds will be the hardest but keep with it! Blessings and prayers for you!
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fluffy1966 Jul 2023
A rare person who 'gets it' but is taken Off Network: might be a worthwhile investment to pay Cash# for services. Totally serious about this. The very best Psychiatrists in my city no longer taken any insurance (that includes Medicare) whatsoever.
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In our country the justice system (as well as the medical system) seems to throw their hands up helplessly when it comes to mental health. Except in rare instances where a mental patient represents a threat of violence upon himself or others, little is done legally to force ANY issues of care or housing. This means that families are helpless and conservatorship is very rare and very costly.

I honestly have no idea how you can help a mentally ill parent. We have never seen anyone I know of on Forum have any success, nor have I seen it as a nurse.
Sadly my own advice to families is not to attempt POA or conservatorship/guardianship.

I always recommend Liz Scheier's excellent Memoir, Never Simple. Ms. S. tried for decades to help her mentally ill mom along with the help and auspices of New York City and State. All to no avail.

I wish I had better ideas for you and hope others do, and am so sorry for all you deal with.
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Karsten, I have often said here that the geriatric psychiatrists that my mom saw from the start of her cognitive decline were the smartest, most compassionate docs she had on her team.

Find a good geriatric psychiatrist. Make an appointment. Take mom.

Perhaps you need to say "mom, your anxiety and OCD are making me crazy. If you don't get treatment, I am going to have to step away from helping you to protect my own mental health".

It's her choice to get treatment or not. And YOUR choice to continue grinning and bearing it.
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