Older person with personality disorder (BPD)

[roundaboutthehillsareshining]

Just wondering if anyone else has experience with supporting an older adult with BPD? The mental health team aren't interested now they're over 65 so no therapy or ongoing care available, cognition is OK (except for everything affected by the PD). It's just the rage, the inability to self care, the wild storytelling, self-medication, self-sabotage which is becoming so hard to deal with and is just deteriorating as the older person becomes lonelier and more isolated.

Unfortunately even if MH support was in place you'd find that a person with capacity is deemed to have the right to "make unwise decisions". My SM is under a CMHT but is allowed to instruct solicitors, lie to them, make people's life a misery and is vulnerable but it's out side of official remit.

It might be worth looking at organisations like Age UK or Age Concern for local support, there may be groups for carers that could support you and them.

Best of luck - it's absolutely shit to deal with xxx

It's 💩. Sorry but it is. I have no advice. Just sympathy. When they eventually get to the stage of not being able to keep themselves safe you can raise a safeguarding referral, but I had to raise several before things escalated enough the system stepped in. All you can do is decide what your boundaries are and stick with them.

Mainstream charity offerings like AgeUk etc don't really work at the intersection of MH and old age deterioration in my experience. You may be better speaking to Mind or the individual's GP. But only if you want to get that involved. As soon as a relative or friend pops their head above the parapet social care and health care practitioners keep expecting them to keep stepping in.

I will also say though, in my experience, some of the escalation turned out to be amplified by dementia and I suspect as it often starts out 5 to 10 years before it hits memory clinic stage you may be seeing the start of a longer term change. There is correlation between some types of MH disorder and earlier (not early) onset dementia, so something to keep in the back of your mind.

Is it a close relative? I hope for your sake you can keep some distance. I am still in a messy situation and this is after years of no contact/very low contact with my Mother and still maintaining minimal contact. It has been a horrendous experience all round. I will say though once we hit crisis point, the MH team have been brilliant. But the lead up to that was awful and the non-specialist care unbelievably bad.

Oh gosh. My elderly mum has BPD, when she was left to her own devices, it was awful… she stopped taking her meds and got up to all sorts of trouble.

We then had a daily carer to check she was taking meds, but somehow she still managed to get Lithium Toxicity and was sectioned again.

Now she is in a care home, where she is taking the meds and eating well, is generally stable but has anxiety. Best thing we ever did.

I wonder what the general prognosis is? I’ve often looked up BPD in the elderly and it’s very hard to find any info on it.

Sorry I just realised you were asking about personality disorder, I thought BPD stood for Bipolar Disorder! My Mum has Bipolar.

@roundaboutthehillsareshining are you meaning Bipolar by the acronym BPD? Are you meaning Parkinson’s Disease with PD or Personality Disorder?

Either way I think there is a huge unspoken area in geriatric care regarding personalities - especially the older persons personality and general approach to life prior to hitting ‘old old’ age.

As the next generation we have parents still alive way longer than previous generations - often because we are identifying and heavily medicating health issues which a generation ago we did not.

That aside as an example - my mother has always been a difficult, quite obnoxious know it all. Very prone to hissy fits in her younger days unless she got her own way and everyone danced to her tune. As her kids - well my sister and I anyway - were always on eggshells around her. What people outside the home saw was a very different person to the reality. She would sulk, cry and give ultimatums unless we danced to her tune. When she left the house she would be dolled up to the nines and be the life and soul of any party. She always had a bigger story to tell she always dominated the conversation.

Do I thinks he has a personality disorder. Absolutely.

Now she is in old age and cannot have everything her own way she is unable to cope. She has no coping skills because she never had to develop any - she simply got her own way.

Our brother has been telling anyone who will listen that she is ‘ill’.

The GP prescribed anti depressants 2 years ago. All off the back of a 5 min appointment our brother instigated because he was , rightly so, fed up of silly behaviour. She has refused therapy or counselling. She continues taking the medication, it has not been reassessed.

Frankly trying to medicate a ‘difficult’ personality is madness. She has no diagnosis other than looking sad at a GP appointment almost 2 years ago.

Do let us know if you get any help. People on here are for the main really supportive.

So yeah, I meant Borderline Personality Disorder, AKA Emotionally Unstable Personality Disorder. As EUPD is it's new name, I thought probably for older people, it'd be more likely to have been known as BPD. But I suppose the same kind of issues arise for elderly people with any functional mental illness - it just seems that at 65 they're expected to have magically recovered, as the older adults team just deal with biological mental health symptoms brought on by dementia.

It's the capacity that's the problem, this person wants their life to improve, but the PD "forces" them to sabotage any attempt to make it better.

It doesn't help that the demand avoidance side of the PD just makes this person a bit unlikeable. It's difficult to see the person beyond the disorder, especially as they've got older and all their support that enabled them to function has disappeared.

@roundaboutthehillsareshining thanks for updating us. Really interesting and I absolutely agree that as soon as ‘old age’ happens they are treated as having cognitive issues as opposed to looking at their past personality.

I really like the parallel between them saying they want things to improve but their PD making them only able to sabotage everything.

Reference to the fact they had support to enable them to function really hit home. Thanks for this thread - really helpful.

I really feel for you @roundaboutthehillsareshining

So my M was diagnosed with a PD many years ago and completely refused to engage with the diagnosis, refusing any treatment or support. I have been NC / VLC with her for a long time in order to keep boundaries around it all, but found myself being dragged into it all again over the last 6 months.

As others have said that there seems to be little acknowledgement in older people's services (or indeed any of the advice, guidance or charitable support out there) on what ageing with a PD actually means in practice. My experience is that M normal PD cycles got more extreme and more frequent. She became even more difficult and challenging. More recently it became apparent she was also experiencing cognitive decline. In my mind it was clear that Mum's distress at the cognitive decline was exacerbating the PD but no one... not family, not her GP took this seriously. They assumed all her chaotic behaviour was down to rapidly progressing dementia.

M had to reach absolute crisis point before this position started to shift, and even then it wasn't quick. She ended up in hospital in a complete mess. There are people (family) out there that judge me unkindly for not stepping in to care for her at home before it got to the hospital stage, but the reality is M's PD means she can get violent and I didn't want to be dragged into that and as soon as I saw it escalating I knew she needed professional help and I couldn't do this on my own.

However, the hospital were equally as hopeless. She was treated as being old, frail and demented the 8 weeks she was in there. They didn't bother doing much more than keeping her safe and clean. And the reality was for those people who hadn't dealt with the PD side of her (or refused to believe it) all her behaviours were due to extreme dementia, rather than considering there could be comorbid conditions at play. It was dire. Even when I kept saying she had MH issues at play and asking for a proper assessment, it wasn't until the social worker contacted me to discuss discharge did they start to put on her hospital notes there was an MH issue sitting underneath all the phsyical presentations M was displaying at the time.

But. This one conversation made all the difference. It meant when the time came, M was discharged into a high dependency specialist MH nursing home rather than a standard step down pathway. The MH team plus the nursing home have taken it incredibly seriously. For the first time in my life she has been medicated appropriately for the MH conditions she has. It also turns out she likely has PD plus a few other things, all of which mean they are carefully titrating meds to address MH plus Dementia as not all dementia meds can be used effectively with what she has. She is now (sadly) old and confused rather than old and distressed. The MH nurses have described what she was going through for 6 months as mental torture. 6 months of mental torture because not one single person would consider two conditions at play. I don't have a great relationship with M, but that is unforgiveable. No one should have to go through that.

My personal experience of this phase is the whole system is stacked against the older person and their family. Even before her dementia, I had to fight so hard for anyone to take the PD seriously I had to step away. It was as if, because she was an adult, over 65 the whole thing didn't exist. It has been exhausting and traumatic for both her and me. There is literally no service provision or recognition for old age plus MH outside of the MH system.

I really hope you have a better time of it, than I did. But prepare yourself for the worst.

@Lastknownaddress excellent post. I recall a conversation we had with my brother 2 years ago. My sister and I had arranged a private referral for our mother due to her behaviour - Dad was hospitalised and she kept firing off emails trying to get staff sacked because she didn’t think they were doing their jobs properly. Nursing and clinical staff asked us to deal with her and when we explained ‘this is just how she is’ they requested she did not visit. She had accused them of all sorts.

Anyway as our brother continued telling us ‘she is ill’ I arranged a private referral with a consultant specialising in care of the older person.

When I asked my brother what he was hoping for his response was a very terse ‘well obviously a diagnosis and medication’. He had decided she had dementia.

She passed the memory test with flying colours, was her usual rude and dismissive self to the very lovely consultant. He gave her a real talking to about the fact we had our own lives and she needed to step up and realise this. Her anger was palpable.

My sister and I had to sit and laugh frankly that it had taken our brother to this point in his life to see how his mother’s behaviour is awful. Personally I am glad she got no diagnosis. She is now very lonely and I - with the help of many kind people on here have stepped away. Early days but the relief is already amazing.

Remember the old days when the family would look after old people
aka
They would be stuck in a back bedroom and fed and occasionally washed and wouldn't last very long
?
I imagine the "not last very long" bit was multiplied with "difficult personalities". Elder abuse and neglect would be hard to detect - the GP would probably put it down to old and and frailty, or pneumonia.

I'm not sure you meant to post that here? If you did, it isn't very helpful, to be honest. I'm talking about someone who refuses all assistance from family or the state (they have no friends left), sometimes violently and abusively driving people away. They've been living in this state of aggressive independence their whole life, but now as they are older and more isolated, it's becoming untenable......

@roundaboutthehillsareshining thanks for posting this. I too was confused as to the relevance of @MysterOfwomanY post. We are all on here to support each other. Sorry if I misunderstood @MysterOfwomanY but I definitely read your post as quite passive aggressive. I am in a similar, or was until stepping away recently, situation to @roundaboutthehillsareshining . A mother for whom nothing is ever or has ever been right. Always has to have the last word. Always has a bigger better story - but now in her old age we are expected to put her horrible nature down to cognitive decline.

Some people are just not nice and there is no magic button to press to change that - even if they appear like a sweet little old lady.

Thanks @BlueLegume And your previous post really resonated. My relative isn't my mother (thankfully) but someone I am close to via family. And yeah, they know all the answers to the cognitive and capacity tests, and pass with flying colours every time! I don't know what the answer is? There's talk in the family of "ultimatums" and "reading the riot act", but I'm not sure that won't just end with us all being told to do one.

There has always been a bit of an issue with different specialist teams in SS being good at what they do and bad at comorbidities. I know because I worked in LDs and took all the people with LDs who had offending and addiction issues because I had some other experience. Older Adults won’t be specialists in MH and PD. And if you don’t ‘fit’ and no one has a special passion and remit for that work, people get missed.

Strong and compassionate boundaries with excellent communication is all I can suggest. The family knowing as much as possible about PD and communicating accordingly. In the longer term advocating for care is great but PDs are so so difficult.

@roundaboutthehillsareshining sympathy. Totally understand that you get to a point where you think you can ‘read the riot act’ etc. but ultimately all our mother does/did is say ‘I don’t want that’/‘I won’t let carers in’/‘I won’t accept a supermarket food delivery’. I won’t is her mantra.

Interestingly though she used to revel in telling stories of my SIL giving her own parents ultimatums such as telling them if they did not move to more suitable accommodation she ‘would put them in a care home’. Thankfully they listened and made good life choices.

Another irony is that my parents invested very little in us quite frankly so expecting the dividends they do again quite frankly - there is nothing o draw on. We have all - in our own way gone over and above in trying to help our parents, now our mother. Nothing any of us do is ever right. Self entitled-yes.

@roundaboutthehillsareshining oh God, I appear to have expressed myself very badly - apologies.
I just meant to say that, although this has always been a problem (difficult people becoming difficult OLD people), paradoxically, the improvements society has made in medicine and safeguarding, housing quality, care of the elderly and so on, means ... It now can be something that seems to go on for ever.

I'm not sure there is an answer. Sometimes all you can do is state your case ("If you carry on like this I'm worried that Blah will happen, that's why I suggested X, but it's up to you in the end, we both know I can't make you do it...") and then walk away and let them mull it over.

It's one of those cases where all the possible choices are grim. Do you want to be the person who runs themselves ragged, wracked with a mix of guilt, resentment and rage, or the stony-faced person who says, "She's refusing all the available solutions and she has capacity, there is nothing more I can do," ?
Neither are much fun, but there's no magic Third Way afaik. The window to make them a more balanced person probably closed before most of us were born.

@MysterOfwomanY thanks. That explanation really helped. We try to be helpful on here as well you know.

I'm following this thread with interest as I've spent most of the day writing a lengthy complaint about the events of the last year around my Step-Mothers "care" which after a hospital stay, followed by sectioning being lifted after two weeks by an infuriatingly dismissive and patronising psychiatrist, culminated in her being released back to my frail 85 year old DFs sole care with next to no support, leading to her physically attacking him three times in her first week home. When he left for his own safety, he became homeless, and every agency involved was frankly useless because "capacity" and alleged delirium.

She'd had an absence seizure and was under the CMHT, with a long history of paranoid schizo-affective disorder and delusions about my Dad being unfaithful. The medical profession put her deterioration after the seizure down to a "possible" UTI. They ignored her observed in hospital aggression towards my Dad, and due to confidentiality wouldn't meaningfully engage with us. She developed extreme hatred of me despite us having had a reasonable relationship for the 40 years they were together.

I could go on, but long story short after a year of stress and abuse towards my DF, and her being allowed to remain at home alone, my Dad's already poor health deteriorated. He went from 13.5 stone and was 8 stone when he died in April after three weeks in hospital. There are a catalogue of errors and what I see as neglect - despite my advocating for them both all agencies involved and the GP basically played pass the hot potato and " not our problem", and the stress of this basically killed him.

There's enough for a bloody Netflix series but I won't bore you with it. I am so angry, and missing my gentle, loyal, artistic and musical Dad so much.

I know I won't get anywhere but I feel it's the last thing I can do for him.

The relevance to this post is that despite my SMs formal diagnosis, I strongly believe that she would have been diagnosed with BPD under different circumstances, and much of her behaviour has always been self-centred in the extreme with high expectations that my Dad was there to say how high when he said jump. I believe the extreme hatred of me that she finally started to show over the last year was partly jealousy and had always been there, as she effectively isolated and controlled my Dad. He went along with it because he believed she couldn't help it, but I really do wonder.

Essentially he died of a broken heart on top of his other health conditions, and even on his deathbed he was worrying about her and her vulnerabilities.

Sorry to trauma dump, I'm not handling this very well.

Sending love and solidarity to fellow "bad daughters" who have suffered from this sort of situation. It's utter shit.

@MistressoftheDarkSide sending a hand hold and opportunity to keep venting on here.

Thanks for the clarification @MysterOfwomanY and sorry if i jumped on you a bit. I've been on the receiving end of some judgement about this situation from people who don't understand the degree of difficulty this situation poses. And also how personally difficult I find the aggression sometimes. So after having a bit of a crisis, the relative was admitted to hospital where, surprise surprise after being properly fed and looked after for a couple of weeks, they're recovering and well on their way to another discharge. And so we go round again.....

Although not BPD, my DM has had a long running challenge with her mental health for most of her life. She was eventually diagnosed with bipolar in her 70s after being hospitalised and sectioned for mania. She is now under the care of the CMHT, but it took her being sectioned to actually get the help she desperately needed and we had been asking for for so long. Like many of you here, I have found the presumption to be dementia whenever I raised questions or said she needed MH support. Where she lives, they have recently started an “older person’s CMHT” (their name for it) and this has been a game changer as the staff actually seem to understand that it isn’t always dementia at play! She now has support that she needs and they also know me well enough to know that when I phone, it’s because she needs support asap.

You have very likely looked into this given they don’t seem to be giving any support, but could you ask if something similar exists where your relative lives? My DM was referred by the psychiatric hospital when she was discharged and we were told it was basically a service that aimed to keep older people well at home and avoid hospitalisations which could just cause more distress. I do appreciate BPD/EUPH and bipolar are different, but on the MH front thought the above might be worth asking about.

I am so glad to have found this thread as I have never heard of anyone who could possibly relate to what I have been through. My mother has a severe PD and has despised me, her only child, for the last 30 years starting when I was pregnant with my first child. She is insanely jealous of my life and has tried her utmost to destroy it. Over the years she has written horrific letters about me to my family, neighbours and work place. She threatened to tell social services that I abused my children and get them taken away from me and I lived in total fear of her until my children reached adulthood. I remained very low contact throughout as I am her only relative. She has been in and out of hospital, usually after overdosing on prescription medication, and has finally been permanently placed in a care home. She is 75 years old and has been diagnosed with terminal cancer. I have tried to support her though this but, even now, she is sending me the most awful messages about how I have ruined her life and treated her appallingly. It’s affecting me badly. I guess I always hoped that she would mellow in old age and we could have some form of relationship. I even thought that if she were to get dementia she might turn into a nicer person! The type of cancer she has will cause her so much physical distress and she must be terrified of what she is going to have to endure. Even now I feel so sorry for her and I can’t understand why she is still persisting on saying such evil, hurtful things when I would still be willing to support her. I considered using my free counselling service through my employer but I honestly didn’t think anyone would believe the things she has done and would assume I was making it up.
BPD/PD really is a cruel condition

@Maidofdishonour welcome. It is something of a taboo subject - unpleasant old people who were unpleasant young people and them simply being treated as thought hey have cognitive decline or dementia. It is unfair on people experiencing cognitive decline or dementia for whom their lives have changed drastically.

This thread is about addressing the fact some ‘difficult’ people do not miraculously become sweet little old people.

It is most definitely a needed thread.

@navigatingchaos One of my M's most recent assessments is also suspected bipolar. Although I I could say more but I am still processing some of this and we are in a constant stateof flux right now. One of the challenges is that she probably has genuine forgotten how appallingly she has behaved (partly due to the PD) during one of her more manic phases. The CMHT team are taking it all very seriously though.

@Maidofdishonour you are not alone.