Alzheimer's Caregivers?

Former domiciliary carer here (specialised in end of life and final stages of dementia) and current med student.

First off, I have the greatest respect for anyone caring for anyone else. It is hard in so many ways and I understand your very obvious frustration. But, your mother in law is incredibly vulnerable and as such her well-being is absolutely a priority.

I hate to be blunt but if you're not going to maintain her hygiene then you need to get her to someone who will. Neglecting her intimate personal care is not just a case of her smelling bad, (and her dignity and quality of life) it's about her health. Urinary tract infections develop incredibly quickly and could rapidly progress to nephritis, and more often than not in older patients this leads acute renal failure. I mean, I had nephritis as a very healthy 19 year old and it led to acute renal failure. At 89 that will probably be fatal. Alzheimer's greatly weakens the body's immune system and the most frequent cause of death in Alzheimer's patients are from infections like pneumonia. Second is dehydration.

Her behaviour isn't as manipulative or deliberate as you think it is. As cognitive function lessens behaviour reduces to simpler and simpler patterns and often all that is left is fear and aggression. She can't understand your behaviour, your feelings, your body language, your reasoning because at this point she's not even aware of her own. It's so easy to read malice or spite into the behaviour of those with dementia but it truly isn't there. If I had a penny for every time I've been sworn at, spat on, kicked, punched, etc I could buy a house. What you have to consider is that she no longer has the cognitive function to manage simple self-care tasks like washing. If she can't do that then she certainly doesn't have the capacity to be intentionally malicious. Just let it wash over you if you can. If you can't, again I'm afraid I have to urge you to seek outside help.

Bullying her into doing things is only going to make things worse. It leads to a terrible cycle, trust me. Also, I think that you should be aware that within care any form of coercion is considered to be abusive.

Her decreased appetite is probably partially due to her condition and partially due to her medication. The go-to meds for Alzheimer's will decrease her appetite pretty significantly, and can cause fairly constant nausea. Often something like omeprazole will be prescribed with that (because the other medications cause an excess of stomach acid), and it can decrease appetite. If she's on anti-psychotics they have a tendency to decrease appetite also. You can ask for a medication review and explain that she won't eat or drink, but honestly there's only so much you can do in terms of medication. As has been mentioned Ensure, Build-up or Fortsip are good for getting extra nutrition in and they actually taste pretty nice.

If she's still physically able to eat you can try and coax her with her favourite food. She won't understand why she needs to eat no matter how much you try and explain, and she won't feel hungry because of the cocktail of meds she is likely on, but she possibly has enough awareness that a favourite food might pique her interest. Even if she eats cheesecake five times a day it's better than nothing (unless she's got any other medical conditions that would be affected by this). PEG tubes/feeding tubes aren't really an option in Alzheimer's, so you need to try and keep her eating as long as possible.

Sorry this has been an essay but it seems like you've chosen to do something good without being fully aware of the scope of what you're dealing with. Like I said, I sympathise and I know how hard it is, but you need some outside help. And that's for your sake as well as your mother in law's.

I wish you every luck and I hope that you can find the support you both need at this difficult time.

Also, if she has medicare, you may qualify for a home health aide (at a lower cost than private pay) ... they come and do all the "icky" stuff (i.e. the privates) ... though to be honest, I was helping my mom and my nonno with the care ofmy nonna (feeding,bathroom/bathing stuff) as a child, teenage, and young adult ... (changing diapers and bathing, doing the soiled laundry) ... It's really like taking care of a large child .... both physically and mentally (to some extent, but they are usually smarter, but just as awnry, lol) ...

I know it's hard, but have some compasion.

It sounds to me like you need caregiver relief! Talk to her doctor and see if you can get a home health aide in a couple of times a week. It is just wonderful what we can and we are there to spend 100 percent of our energy on her and helping here. I take care of someone that is 90 and she has memory problems but not Alzheimer's. It is hard sometimes but I know I can't make anyone do anything they don't want to do but I change my wording so it is harder to say no. I know this may sound mean but it's not. I will say like would you like to shower before or after breakfast? Because she doesn't enjoy shower she says it's too cold and she did so yesterday when that is not true. And would food sometime she doesn't want to eat so I will say what sounds good for lunch today and name a few things. I would really look in to getting a caregiver if you can. it would make everything a lot better I do believe