What next please with 92 yr old father

[Dogwitjstripes]

Asking for some sage advice from the Elderly Care experts on here please.

DF is 92 next May, living independently and has been widowed for 25 years. Has coped remarkably well for the most part, still cooks for himself, dresses, no carers and drove until relatively recently. Rarely has falls but has been diagnosed with mixed vascular dementia and alzheimers. He doesn't present too badly with it for the most part but he's suddenly become frantic about dying and not coping.

I have a sibling and we get on very well but both live a distance away in two different directions, neither of us get on particular well with DF, I have had a very torturous relationship with him all my life but he's on his own so....

He trialled a care home last year for a month but hated it and came back out again, he's refusing carers and only wants the two of us in the house, it's impossible for us to go very often to visit but he's not bathing for fear of drowning, emailing us every night begging us to go down (can't phone him as always ends in horrific hours long arguments). I know I should probably post this on the Stately Homes thread in a way because the poor relationship clouds what we can or are prepared to do but does anyone have experience of what in general can be done or what is likely to happen next? He has a cleaner and she takes him food shopping occasionally, he refuses to let me organise an on line food shop, refuses to allow a taxi to take him to the shops (he has the financial means).

I've read loads of threads on this board over the years and most seem to say that it won't change until a real emergency occurs, is that the case for the most part do you all think?

TIA

When persuading older people to claim AA I usually name the current prime minister/Chancellor and point out they'll only waste the money if it isn't claimed.

Works 99% of the time.

He's much worse the last week or so, saying he's convinced he's going to die any minute it's awful. This the dementia/Alzheimer's presumably? He's written a great long email (our only way of communicating as relationship is so rubbish) saying we need to drop everything and get down there. Trouble is he would say that every time we went down, he wants us to move in - that is just not going to happen....I need to speak to his local Social Care dept sooner rather than later

He's been put on Mirtazapine but the doctor told him to stop his Zopiclone and Amyltriptaline immediately, he's been on the last 2 for 25 years since our DM died. He said the results have been catastrophic in his words, sounds like he's gone cold turkey almost? Does that sound like bad advice? Sorry @AnnaMagnani to ask but you're a GP aren't you?

meds such as amitryptilline are not good in dementia as they are anticholinergenic and can make it worse

Thank you that's helpful, is stopping it with immediate effect a normal course of action? Does he just have to sit it out until the other meds start to work?

Both medicines I would absolutely be tapering down for someone like your dad, just stopping them is abit wreckless clinically in my opinion. I get the justification for mirtazepine i.e better for anxiety/good for appetite and sleep however can also make older people drowsy and more prone to falls. No wonder he 'feels like he's going to die', I have experienced many older people have extreme rebound anxiety and increased behavioural symptoms of dementia on reduction or cessation of these medicines, anecdotally especially when they have been on them for many years.
I think telling a 92 year old man living alone with dementia to stop these drugs immediately (if that's the advice that was given) and start a new one without very close follow up is not great tbh. It would be reasonable to discuss this with the GP and what plans/support/follow up have been arranged around this. Otherwise I think he might benefit from a referral to the older peoples mental health team.

Thank you very much, my thoughts exactly. It's so worrying.

He's probably having withdrawal symptoms from the drugs

Could he have misunderstood the GPs instructions? My mum has alzheimer's and gets very confused about what she's been told. If you tell her not to do something/ to do something quite often gets it the wrong way round.

It's possible yes but he's quite coherent I'm going to check with the GP today

FIL didn't have dementia and was generally on the ball but often got instructions totally wrong because he panicked and heard blah blah kidney scan blah blah 9am tomorrow at the surgery and sort of filled in the rest. What he thought was he was having a kidney scan 9am at the GP surgery. What the GP actually said was " It's a UTI. I'll check with your urology consultant but you've had a kidney scan very recently so he probably won't want another. But I need to check what antibiotics because of your other meds so the prescription will be available at the surgery 9am tomorrow".

I sympathise, I really do, currently going through this with MIL who admits she is forgetting things but will not allow us to put anything into place to help.

She is 89 and is obviously not doing any cleaning as the kitchen is grubby but refuses a cleaner, lost her key and was locked out as only son with a copy was miles away but will not let other son who live close by have a key.

Will not entertain POA either. She is obviously to us in the early stages of Dementia but will not see a doctor.

I guess we will have to just wait for a crisis, she is also still driving, MOT had run out and insurance and she hadn't realised either!

So frustrating aren't they? Just waiting for the next phone call.

It's so so hard! The driving was the thing that worried me most, thankfully he has stopped now after intervention, I was terrified that he'd kill someone.