This would be helpful for many struggling with an undiagnosed LO. I hope it begins being implemented in the ER .

@ Anxiety ,

Thanks . Well she will have to go to neurology now via transport . She has an appt next week . The hospital set it up . My nephew said they were really good at the hospital .

Waytomisery, so sorry about your sister.

A lot of us are having hard times. 😞

Let us know how things go with your sister. I hope you and your nephew get some answers soon, and her in a good facility

@ Geaton ,

I didnt have time to write all this until now .
I did not mean for them to do a cognitive test in the ER if they had just fallen , infection , UTI etc . I know that is not the right time . I meant if they were brought to the ER for increased behavior problems , confusion etc . and nothing was found but they are acting strange and they have had a history of falls . The article suggests doing a cog test . This can be helpful to some families .

Now I have an example where doing a Cog test in the ER helped to get someone placed , who was refusing to follow up with neurology or to have a companion at home . Instead this person has been home alone while the only family she lives with worked during the day , and no other family nearby.

My own sister ( lives with her son ) She has unofficially diagnosed dementia ( even though MRI clearly states chronic moderate ischemic disease of white matter , which is indicative of vascular dementia ) . It’s also obvious she has dementia and the primary will not give her a cog test or diagnosis and my sister has been refusing to go back to the neurologist for a recent cog test and get that label the whole year after that MRI . ( The MRI was originally done in the hospital to rule out stroke a year ago when she had terrible delerium after back surgery ).

Prior to that back surgery , she had been to a neurologist 2O months ago for varying neurological symptoms which they were not sure what she had at that point . First they thought ALS , or Parkinson’s , then they said they didn’t know . Her mini cog test was lowest score for normal at that point . A CT Scan showed nothing . She was to follow up 6 months later . I personally think the neurologist at that point dropped the ball not doing the MRI then .

Then 18 months ago she ended up in the hospital with metabolic encephalitis and almost died . Had some bad seizures . This resulted in a significant step down . My sister has been refusing to follow up with neurology , meanwhile her cognitive status has been noticeably declining .

She was much more confused and anxious 4 days ago . First my nephew took her to a walk in place that evening to test for UTI , they also tested for Covid , did some blood work etc , found nothing and she went back home . She had no UTI . The next day she was even worse so my nephew took her to the ER . This would be an example of what I was talking about doing a cog test in the ER , if nothing was found to explain what was wrong and no recent fall but they had a history of falls in the past as the article suggests , a cognitive test could be done .

My sister did not have many falls in the past , but they still ended up doing a cog test . The ER found nothing acute with my sister ( no stroke etc ) to explain what was wrong . But they knew something was wrong . So They kept her overnight in the ER observation unit . (They have those by me too , meaning you don’t get officially admitted ).

The next morning my sister was seen by PT, OT, and speech for evals . A MoCA was done . Determined she can not be home alone . My nephew works so they did not send her home . They recommended short term rehab and then placement due to the need for 24/7 supervision.

Just like I originally suggested on this thread , doing this Cognitive test instead of sending her home again, was helpful for my nephew to be able to place her , which has been needed . It would help other folks too trying to place a relative .

She currently is in rehab on private pay until my nephew finds a bed for her in a facility for placement . Since she was not officially admitted at the hospital for the minimum 3 nights , Medicare will not pay for rehab . I will drive out and help my nephew move her in her new room .

@ Geaton , Thanks again for your responses . It was also helpful having someone confirm what I thought …..that as for now we are “ waiting “, for something to happen to force a change .

Yes . We were cringing big time at the diner , as the two of them filled their pockets , NOT discreetly at all !!

Way,

"Brought a lot of food home including the crackers in the bread basket , jelly packets , butter , and sweet and low that they stuffed in their pockets ." oh my I laughed pretty hard at that since it's a perfect description of what my Mom and Aunties did at restaurants -- no matter now fancy. So cringy!

Regarding the police intervening with elder drivers... they only deal in actual crime (and not "white collar" crime, either, like elder financial abuse). Elders like your MIL need to break the law and get caught (ie getting pulled over for something while driving without a license). Even in this scenario, they get a ticket and have to be brought home (their car gets towed/impounded), then they go to court, lose their license for a while and/or pay a fine, get scolded, but no jail and no one takes the car away -- it will sit in the impound lot until it is rescued (another hefty sum plus proof of ownership).

When such an elder goes home they can still continue to literally drive without a license as long as they have access to their working car, until stopped again. Rinse and repeat. Cops can't pull over anyone for DWO (Driving While Old).

I think APS social workers are pretty savvy. Most of the time they are called for good reason. But they do need to have compelling evidence to take action.

I think you are right when you say you will just need to wait for a catastrophic event to stop her (or for something to happen to her SO/Butler). Watching a slo-mo trainwreck is nerve racking...

@Geaton ,

I posted below after your last post but I would add that , mother in law is always neat , things are put away . She has her SO as her butler , I witnessed her directing SO to get something or put something away for a few years . She has had a cleaning woman every 2 weeks since my DH was a child .

Who knows how “ cleaned up “ she is hygiene wise when we aren’t there . My parents used to take their infrequent showers when they knew my siblings were coming to visit a few times a year . My parents would put on a show for their twice a year visit . My siblings thought my account of what things were really like was not accurate . After my siblings left my mother would complain how exhausted she was from having to shower and dust the house before the visitors came .

MIL and SO said they eat soup a lot . Not cooking . They also go to restaurants a couple of days a week and order a huge meal and bring home for leftovers . We took them to the diner . They ordered appetizer , salads , soup , entree and ice cream . Brought a lot of food home including the crackers in the bread basket , jelly packets , butter , and sweet and low that they stuffed in their pockets . 🙄🙄🙄🙄

APS won’t do anything yet . Like I said people who don’t know her may not pick up on it yet . Not until she gets worse .

I personally have never dealt with APS .
I had a good experience with the Agency of Aging for my Mom in my state . I think I would try them first , if we can’t get in touch with her primary doctor .

Way, I know you have done everything in your power to get mil off the roads!!

@Geaton ,
We never heard anything . I am assuming it went nowhere . It wanted very specific details, dates, places , what she did wrong . I don’t think they cared about my description of her mobility .

A doctor or a policeman could notify DMV also , the have a different form . I believe that would carry much more weight than “ family concerns “ . SO’s policeman son doesn’t care , like I said .

In MIL’s state you have to report any accident to DMV resulting in death , injury or more than $1000 worth of damage to car or other property . MIL did say that was reported , I guess the insurance company does that ?? In her state DMV will consider retesting if anyone ( not just elders ) has 3 accidents within 18 months .

So it seems it takes a lot for DMV to send out a letter to retest . So far MIL has never mentioned having to go for a test from my prior report . I would assume if she ignored it her license would not have been valid any longer when she had her recent accident and the police would have been able to see that at the scene . I assume it’s customary for the police to check her drivers license on his computer in his patrol car to see if it’s valid. The other driver called the police .

Way,

When you say it went "no where" with the DMV... is it possible they sent out a letter to MIL about retesting but no one else saw it but her... and she's ignoring it? That's what my Mom sort of did with her license cancellation letter that came from the DPS. I tried to intercept it from her mailbox but never saw it. I called DPS and all they could tell me was that a letter was sent out. My Mom is now away in FL and when I was in her house recently, I found the cancellation letter. She totally denied getting it. I'm shocked if her DMV really did nothing about your information.

Have you yet or are you thinking of reporting her to APS, even though she's a good showtimer? Just to get her on their radar.

I think my Mom would still keep an immaculate house even if she only had 1 working neuron left.

@ Geaton,

MIL’s reasoning is not her normal . She recently had a fender bender and gave us the most ridiculous reason why it was not her fault . It was her fault , she had a stop sign . Made a right turn , she did not have right of way . 2 years ago MIL’s sister told us that her driving is awful . She always had a lead foot and braked late , but her sister told us MIL does not stop soon enough and ends up partly in intersections . We witnessed that ourselves when we were behind her that same day . The aunt jumped in our car to ride with us to avoid going with MIL in her car . We were all going to a restaurant . MIL and SO went in MIL’s car .

There are other examples we saw this past weekend where her reasoning was not her normal . We have been suspecting it for at least a year . It was much more obvious to us this time . She’s also constantly repeating things and doesn’t remember she already said them . One of the things she kept repeating is that her brain is fine and if she thought she could not drive she would stop . We never brought up her brain or any cognitive problems . I believe she realizes she’s having issues. We tried to convince her to stop driving based on her slow reflexes .

DMV asked for specific incidents , on specific dates . I gave a general description of her not stopping safely at intersections , At a stop sign I witnessed her halfway into one and not even making a complete stop . I also mentioned her mobility problems . This went no where . But I tried because the MIL’s sister said it was terrible when she was in the car with her .

And yes SO’s son very much knows his carefree days are over if MIL can’t drive .

I’ve known my MIL for 40 years . She’s not herself , and we’ve been suspecting cognitive decline each time we visit the past year or so . This time it was much more obvious .

Her mobility is so bad that she can not dress herself . Her shoulders are frozen from arthritis . One arm is worse . SO has to help her dress . She’s like a T Rex . Short arms only move from the elbow . She even said while we watched her struggle to get her jacket out of the closet , “ If I had to move quick , I would never be able to because of my shoulders “.
DH said to her “ like driving ! “ MIL ignored what he said . Talking with her this weekend it was very eye opening even compared to 6 months ago .
DH has been saying she’s not been “ right “ during phone calls either , and she keeps calling him at work . She forgets DH still works .

MIL is presenting in some ways very similar to my own mother and FIL who had dementia . They could show time well , where a doctor would not notice .
But if you spend a whole day with them it is noticeable .

Way,

I'm re-reading all you wrote on this thread. You say you're pretty sure MIL has dementia, mostly based upon her falling? And you don't think she should be driving because of how many times she's fallen? Otherwise she seems to be doing all her ADLs...? You don't mention that she is confused or forgetful, just stubborn/fiercely independent / private and doesn't want to lose that.

IMHO I'm not sure this is cause enough for her to stop driving. Physically disabled/handicapped/paraplegic people have drivers licenses, too -- and do just fine. You don't say you're finding all sorts of dings and scratches on her car, or that she's getting lost, or any of the other signs of declining driving ability, unless I missed it somewhere in this thread.

I'm curious what the report to the DMV process was like? When I did it for my Aunt in FL, I provided her DL #, address, and was able to provide specific accounts of multiple incidents that were witnessed. I could also verify that she was under an ophthomologist's care for triple vision (from rheumatoid arthritis). Then either the DMV or the FL Dept of Public Safety sent her a letter telling her to come in for a re-test of her eye exam, which she failed (and the only reason she made it to that appointment is because my dopey cousin drove her there!)

So, I'm curious as to what evidence you were asked to provide when you reported her? I'm wondering what compelling issue is required for MIL's state DMV to take action.

Personally I think that the Dept of Public Safety should required elders to take the virtual driving assessment through OT starting at a certain age, like once at 75, then again at 80 and then maybe every 2 years after that, then every year after 90, etc. My Mom was an excellent driver up until very recently (into her early 90s).

I wonder if the SO's son knows that if something happens to your MIL, his carefree days are over??

@ Geaton ,

Thanks for taking time to respond . We took the trip this past weekend to see her .
MIL leaves no papers around not even a purse . She keeps her keys in her pocket and a wallet . She wears cargo pants with pockets on the legs . She gave up a purse many years ago .

She would notice if one of us went upstairs .It’s a small two bedroom condo . She has her SO who lives with her who has diagnosed dementia and cancer . MIL treats SO as the butler because it’s difficult for MIL to get out of her chair or upstairs . MIL sits in her chair all day in the living room where the stairs lead to upstairs . She’s like the gate keeper . I am very preemptive as well, when possible . DH not as much so if there is much resistance , which there is .


SO’s son is someone my DH grew up with . The son is happy with this situation the way it is because MIL drives his parent wherever he needs to go . So the son is not interested in our concerns . And this son is VERY high up in the police department .
Will try to get primary name and number . I agree , you can lead a horse to water …

I think what the article suggests could be a good thing, but the testing has to happen after the ER visit, by the primary doc, long enough so that one is testing the elder after they've recovered from the reason for the ER visit and done their full and appropriate course of treatment (eg: antibiotics for UTI ). Otherwise, the follow-up cognitive test would not produce a result that would accurately reflect that patient's "typical" pre-fall cognitive and memory abilities.

Then, there is the co-pay, the getting the elder back to the doctor, the denial and non-compliance, etc. You can lead a horse to water...

Way,

Do you know any of MIL's neighbors, friends or church? Having a neighbor who is helping to watch out for her and provide info can be invaluable. With my MIL, I went to her neighbor/friend and introduced myself and told them our concerns. I asked her to help, then handed her a Target GC for her to buy anything my in-laws needed, and to use it herself as well. She was an excellent ally. Someone like this may be in a better position to find out critical info, like who her primary doc is (the neighbor can pretend they are looking for a new doc and who does MIL go to? etc.)

IMHO I don't think much will be able to happen without making the trip up there and staying for several days... if you are able to do a reconnaissance mission you will be much better equipped to get things done. I secretly made a copy of my MIL's house key, took pictures of her paperwork lying about, pics of her meds containers, her driver's license, etc.

But this is just me. I believe strongly in being preemptive, plus I'm lucky to have the ability to be such (time, health and resources). I realize not everyone can be.

One of the reasons it's so hard to get diagnosis, is because we are all so different.

Mom insisted yesterday that her shoe size is 6 1/2.

She is an 8 1/2, which is not a red flag to the boys in my family or to any doctor.

But I know my mom, and I know women and I know Shoes. Her insisting she is a 6 1/2 , and me saying, " really I thought you were an 8 1/2 " , her reply was NO, always 6 1/2!!!!

To me it's a red , to others it's not. To my brother or a man, definitely not

MIL has highly significant mobility problems and refuses a walker .

The Falls Risk Assessment Tool (FRAT) is a commonly used tool where I live.

There are other versions but the FRAT is fairly quick & covers a lot.
2 sections: Risk Status (current) & Risk Factors (used for preventing)

Risk Status is scored accross 4 sub-areas;
1. Recent falls in 3 & 12 months
2. Medications
3. Psychological
4. Cognitive Status

Risk Factors includes vision, mobility, behaviours, ADLs, environment continence, other.

It has been used ro my LOs in ER.

It is scored as low, med or high risk. This can be noted on med records but also at bedside to warn staff.

@ Frequent flyer , I don’t either , but at a last resort it’s something , when the elder is absolutely refusing to go anywhere .

@Peasup,

MIL lives 4-5 hours away . And she would never allow one of us to go to a doctor with her at this point anyway . We are trying to get her to tell us her primary doctor’s name ,” for emergencies “ (so we can try to contact) . MIL said she will give us the name but then doesn’t . She gives little info , and when she does its weeks later about her falls and her recent fender bender . She’s been more secretive for some time now . She’s extremely stubborn , always has been .

This isn’t our first dementia rodeo either . It’s parent # 3 . Similar difficulties with FIL . Very similar and they have been divorced for 35 years !!! Maybe that’s why they divorced , they are too alike !

Went through it with my mother as well .
Unfortunately, we didn’t have cooperative LOs willing to admit they were having problems , then it gets to the point they no longer even recognize they are having a problem . Either way , they refused testing .

I resorted to the Agency of Aging to get Mom removed from her home . ( she had already stopped driving 15 years earlier ). Then Mom agreed to testing , she wanted to test out of assisted living to go back home . Of course that did not happen .

FIL’s wife had died . So he was in shock , that’s how we were able to place him . For years he and his wife who was diagnosed with dementia were being very stubborn about leaving their condo . We had to “ trick FIL “ to go to AL . He was insisting on going to independent living. He needed AL for sure for his incontinence , that he was not managing . And we took his car . FIL refused testing as well , he finally agreed to have OT do it in AL because he wanted to be able to keep his medications in his room , which he wasn’t cognitive enough to self manage his meds . FIL asked the results and when told he blew up and said nothing was wrong with his brain . He refused to follow up with neurology.

Getting back to MIL , I got nowhere when I contacted DMV . Next step is try the primary . MIL never even tells us when she’s in the hospital overnight for a fall . We find out weeks later . We can not steal her car that is a lease , she would report it stolen , she won’t give us the keys . We don’t live nearby to disable the car everyday . She would just have it fixed . She showtimes well . I’m sure she seems fine to a doctor . Her memory is good , her reasoning is not at times . We spent a whole day with her . She’s still clean , lets the house cleaners in . I don’t believe the Agency of Aging would do anything about the driving . But if we can not contact the doctor soon , it’s an option to try . MIL has a lot of mobility problems . Really struggling to get out of a chair . I’m hoping one day soon she can’t get out of the car on her own and that will stop her from driving . In the meantime will try to contact the doctor .

@Anxiety ,

Yes if she wasn’t driving , we would just wait for the impending “ big fall “. She’s still clean , etc . She’s had bad falls , I can’t believe she had so far only broken a finger . But right now she has a large bandage on her knee from a fall two weeks ago . She said the ER said she may need a skin graft because the skin was torn away . She also had stitches on her arm . She’s all bruised up from the blood thinner she’s been on for the blood clot in her leg since May that she said last month it showed it was breaking up . She said she goes back to check the blood clot this month again . In the last few years , She’s had at least 4 face plants that we know of , resulting in bloody noses , black eyes .

Anyway guys , we will keep trying .

I'm sure your mil and my mom, have some brain dieing dementia, something is going on with them.

Weather or not they get worse or diagnosed before there time comes to an end who knows.

But with your mil it's more imperative , sence she is still driving.

Way, regarding your MIL and her refusal of cognitive testing but history of falls; if asked, would her primary care provider give her a referral for an occupational therapy evaluation?

It can be approached as an appointment to identify balance, vision or perception problems that might be contributing to her falls and show her ways to be safer in her home.

While there, the therapist will work in some degree of cognitive testing. You won’t come out with an actual diagnosis but you’ll get an idea of where your MIL is on the scale of cognitive decline.

A neurological or neuro-psyche referral for diagnosis might be the next step but the OT’s testing could be the eye opener your MIL needs to get her to move forward.

The article focuses mainly on the person who has fallen and taken to the hospital. I remember my Mom being in the hospital for 3 days as the hospital ran tests after a bad fall she had at her home. 911 was called. And it was during those 3 days that they doctors could tell she was dealing with serious memory loss (which was mild prior to the fall). X-rays showed a second brain bleed, the first one I had no clue about (guess my folks kept that one quiet).


I can understand the need to get a stubborn elder to have a memory test, but I don't think the ER is the right place. The last time I was in the ER waiting room, hubby and I sat for 4 hours before even being seen by a doctor. The waiting room was buzzing, lot of coughing happening (flu or covid??)... people on cellphones binging or talking loud with speaker on... couple screaming children... and this hospital was a state-of-the-art suburb regional hospital.

https://apple.news/ArvDsr4TSQUehsBUjzZftdQ

I hope the link works .

If the ER would test , this could help that desperate family unable to get a stubborn LO diagnosed or placed who is living home alone unsafe…… if there is a documented history of falls , and the family is in need of taking them to the ER in an attempt to get them placed .

I’m pretty sure my MIL has dementia . She , just like my ( deceased) FIL , says her brain is fine , will refuse testing at the doctor office . It would be nice if the ER would do cognitive testing the ( next time she’s there) , because she has a documented history of MULTIPLE visits to the ER for falls .