How best to support elderly mum living alone and losing confidence

[twentyyearsagotoday]

Hello Looking for a bit of a sense check and also a bit of a hand hold. This dealing with elderly parents malarky is not easy!

My DF passed away 2.5 years ago. DM now lives solo (bar elderly cat) in her very old cottage in a village. She is still mobile (had 2 hips done) but suffers from low mood, anxiety and a fairly defeatist attitude. She has been like this her whole life but it is definitely more pronounced with DF going. She's still grieving (as am I really). I think covid also had a massive impact on her confidence doing things too and getting out and about. She's convinced she will get dementia as her brother and sister had it (I'm not actually sure they did, they made it to 90 and so tricky to say whether it was cognitive decline or dementia).

I have noticed she has been repeating conversations to me, sometimes across the same day. She still knows things like dates, politics, her past life so I'm not sure it's anything to be concerned about but I have logged it.

She also just cannot get her head around just doing life really. Things like collecting phone messages, working out a new tv, which rubbish goes in which bin when the council changed the service, buying a ticket to get on a train. Again she has always been a little like this (and having DF used to help as he did it all no problem) but now it's very noticeable. Then she'll get all in a tizz about it and hang onto the fact she can't do x or y. She can drive but will only go to the local shops. Not on an A road anymore. I would say she is safe but not confident and I think she will probably give up driving in the next couple of years too. She needs a car where she lives. It's a village with a cafe and pub but nothing else. The small town is 3 miles away. Has everything she needs. A few buses go from there to various places but no train station.

I try and visit when I can - maybe 2x month right now. It was 1x week when DF passed. But she lives 2 hours away. I have 2 kids 10 and 12. Luckily I'm freelance and right now don't have much work but this will change. I don't have siblings.

I'm trying to work out best plan of action. She is happy where she is. It's a lovely old tiny detached cottage. But it needs upkeep and like I said she gets in such a state about doing all these things. I am happy to help but she does gatekeep a bit too which doesn't help. And it's somewhere that needs a car really. She has lots of friends scattered around the region and is sociable with them which is a massive plus. They are generally older than her but she does have a couple who are younger.

I don't know whether it would be best to stay put and look at additional support (not sure what?) and how she would get about if she doesn't feel confident driving, look at just moving into the small town - but she won't get a cute old period cottage there. Or she could move into the small town into sheltered accommodation? Is that the next stage up? Independent living but a bit of support? Or we could think about moving her closer to me. She loves where she lives though and only knows one person here from her past who actually still lives 1 hour away! If she moved here it would be into an annex with us. I am unsure about this too as much as I love her I do find it quite draining. I find this very difficult to admit. And I feel she's be so dependent on me here as she wouldn't know anyone. I could definitely help her as I know a few people here her own age, there is a WI etc. I just wonder if it would just be too overwhelming? Or maybe this is the right time to do it before she gets even older?? I also feel concerned by her being on her own both in terms of her low mood and managing there. It might make me feel better knowing she's just next door.

I'm also wondering if I can get her into the GP for a general check - both for her persistent low mood but also her cognitive function. I do think she is just a bit forgetful and scatterbrained but I am also aware she has changed a bit since covid/dad going. And maybe if I could get second opinion on those first that might help inform what we do about making sure she is thriving a bit more in her (hopefully) next few years.

Sorry for the brain dump.

Would she consider something like Home Share? Tbh I think a lot of elderly people are both lonely and don’t really want anyone else around, which is understandable.

Age UK befriending might be a good option.

I would definitely write to the GP about your concerns about cognition and coping - they may call her in for a review. But I wouldn’t hold your breath on that one - ultimately what matters is her day to day life, not a diagnosis.

She could refer herself for a driving assessment to Regional Driving Assessment Centre - do you think that would help her confidence? There’s a cost involved but they are a lovely bunch and will keep people on the road if possible (or give them objective advice that they need to stop).

You don’t give her age. (Your idea of elderly might be very different to mine. And I have friends in their sixties with siblings in their eighties.)

I’m afraid grief, or any extreme stress, can have significant effects on cognitive capability - but it’s not necessarily permanent.

What does she want to do?

Get her a PA/ befriender who can slowly take on more responsibilities, including driving her into the local town .

Don’t move her into your annexe.

I would consider equally the assisted living setup in her local town or moving her in with you. As you haven't said her age, it's difficult to know how long it will be before she really needs much more care and attention. And since you live quite a distance from her, that will become more problematic for you. So if she's likely to be needing more and more help, I'd move her into your annex and help her integrate into the community there. But if she's got several more years of independence, then do the assisted living as a stepping stone, with the annex in reserve for when things start going pear shaped. It's difficult either way.

Sorry she's 82.

She is unsure what to do. I think she wants to stay put ideally but is aware where she is might not be the best option if she cannot drive. The house itself works fine. She has an upstairs and downstairs bedroom/shower but is actually fine mobility wise right now. She also worries about the upkeep but I have said I am more than happy to help sort all that, along with sorting bills etc. Perhaps just finding a taxi/volunteer driving option could help? I think from my end, it's just what happens if she does get worse and is just struggling being at home alone? Things fine right now but might not be. Maybe I'm overthinking it all!

Yes she is lonely but also wouldn't want to be living with anyone else. I encouraged her to get a cleaner in once a fortnight but she didn't like it and cancelling them! I'm not sure I can imagine her in an assisted living set up to be honest but perhaps I could go and take a look.

Driving assessment good to know thanks.

The cognitive thing I am hoping that it more to do with grief and stress rather than dementia.

So difficult to know what to do for the best. I'll talk to her again.

Leave her where she is and introduce gardeners, cleaners, taxis, local handymen and paid help basically which can be increased as necessary.
Ask her GP for a memory assessment but tbh, any diagnosis which could take many months, won’t change the practical problems which will only get worse. Make sure you have POA.
Do not move her into your annexe! I’ve seen too many people end up on antidepressants this way. Surely she wouldn’t do that to you anyway?!
What were her plans for coping as she aged?

It’s hard to know what to do because it’s impossible to know if your mother’s cognition or mobility will worsen dramatically or how much longer she will live.

I would leave things as they are for the time being. If she had a set idea - e.g. moving near you - then I would go with that. But she doesn’t, and she will probably blame you when she doesn't like it.

If you have all her bills switched to direct debit that will make things easier. And if you haven’t got LPA already, arrange that now.

I suspect she may be in cognitive decline, and your dad’s presence was hiding it while he was alive because he filled in all the gaps. My mother had dementia and during the first year she had similar issues with not being able to work out everyday things and 'getting in a muddle'.

If that is the case, your mother can be supported in her own home until a care home is unavoidable. Assisted living wouldn’t be appropriate because they do not accept people with dementia, so if she moved there and deteriorated, she’d have to move again. If/when she does need to make a move, being near you would make your life easier (not in your annexe! I'm thinking of a care home.)

My dm was in roughly the same situation (but didn't drive). We gradually introduced a few things that helped.

• A gardener two mornings a week to cut the grass and tidy up. Gave dm a reason to get up and tidy. Someone to make a cuppa for.
• Then a weekly taxi trip to town and the supermarket. Pre-booked the same time each week with the same driver who helped carry the shopping.
• Another pre-booked weekly trip to an old people's lunch.
• A cleaner who started as an outdoor window cleaner and then charmed her way to inside windows and then bathrooms. Gave her someone to moan about.😁
• Finally, a farm foods delivery.

She did much better with a known routine, a reason to be up and dressed, and people she came to know. We managed to keep her happily in her own home until about 10 days before she died.

Thank you. I've emailed the GP. Difficult to broach it with her without her anxiety about it all increasing so may just say I think it would be a good idea to get a health MOT especially as you've been feeling a little low and anxiety recently and hope she okays it. I'm absolutely dreading someone saying yes she is declining mentally but I guess whatever happens I do need to have a bit of a plan in place. I think the idea of her staying put is good and getting in extra help, and if it becomes clear there is more to it than just struggling a little now dad has gone, we think again.

What is she like financially?

If she is comfortably off, I would focus on adding some paid help in such as a cleaner and gardener. It’s good to be used to someone else coming into the home and might make her feel a bit less lonely. Speak to some local taxi firms to see if they could set up an account for her, it will still be loads cheaper than running a car. It’s good she is within walking distance of a cafe and pub and I would really encourage her to walk there as much as possible- even if she has coffee or lunch on her own, it’s still out and about in a sociable atmosphere.

If she hasn’t already got power of attorney set up, now is the time to do it. It means you could also do online shops for her if she isn’t confident on computers.

I think based on everything, keeping her where she is right now is the best for everyone. Selling up and moving is a huge endeavour and will probably cause a mental decline. Personally I would not move her to your annex. 2 hours each way is a big distance but having her in your home and entirely your responsibility is too big a commitment if you’re in any way unsure.

It's a good idea to phrase it as a 'health MOT'. I guess you won't be able to accompany her as you live a distance away? Bear in mind that your mother is likely to misreport or not remember what was said, so you may not get a clear picture.

My mother was referred to the memory clinic and forgot to go to the appointment. After that her she asked her GP to contact me about her medical issues and appointments and they were happy to do so, which was helpful.

My mum's mood has improved greatly since she was prescribed low dose sertraline - she had stopped wanting to engage with pretty much anything (when she stopped caring about the Archers we knew it was serious...). She now has R4 on most of the day and is sending me out to the library for books she's heard mentioned.
We missed the window to move to more suitable accommodation (and I think having to sell the family home would have been very damaging to her anyway) and instead have carers visit daily. This is also fantastic for her mental health as she gets 4 x 30 mins conversation a day minimum. It's a small team of very local carers so she knows all about their families and pets; and they pick up on any changes in her health very quickly.

I'd echo the suggestion that her cognitive decline may speed up more rapidly than you are expecting. Therefore, if you don't already have PoA in place (both medical and financial) please do it now while she is deemed to have capacity. Otherwise, you will find yourself in an avoidable nightmare. I also think that trying to keep her where is familiar for as long as you can is the best option, but do be aware that there may come a time when that's no longer feasible. Then you will need to decide if you can care for her in your home or if a care home near to you would be a better option. You probably want to be thinking about and even talking about that future with her and your DH rather than have it as a rushed decision later on.

@twentyyearsagotoday you will get lots of good advice here but also over on

https://www.mumsnet.com/talk/elderly_parents/5543019-cockroach-cafe-summer

A previous poster asked a very pertinent question. What were her plans for the later aperture of her life - as in now? If she has learned to be helpless expecting you to step in then in my opinion she should have shared that with you some time ago. With no medical background I would never diagnose an illness. What I will observe from much experience is that dementia is readily diagnosed when cognitive decline has been apparent to those close to the elderly person for decades. The diagnosis can be frightening and the mood and anxiety exacerbated.

I have an elderly aunt who has always been scatty and abit vague about real life for my whole lifetime. I am mid sixties. She never truly grew up. Was very indulged by her parents and husbands. Never had to work and was/is financially very comfortable. Her diagnosis has not helped her at all. I would say she has cognitive decline. We hold perfectly good if not shallow conversations.

As other posters have said for your own sake do not move her to you. [Bouquet]