Dad was diagnosed with early dementia in 2013. He has obsessive compulsive disorder, is a narcissist and is having severe memory problems. He has had multiple ER visits in the last 3 months, but is unwilling to follow doctor guidelines for nutrition and medication. He refuses help, but still expects me to come to his rescue when he feels ill. I have POA and am unsure if I should protect him from himself or let him self-destruct on his own terms.
It may take an ER visit, however letting him go it alone might not be enough. Some people can pass themselves off for short periods as being "okay." Also, ER doctors are NOT specialists and may not have the expertise to see or understand this issue.
Can you discuss this with his PCP (if he has one)? Ensure they have a copy of your POA/medical directive. If PCP feels he needs to be in a safe place, work on getting that done!
As another mentioned, dietary issues, unless it is a medical emergency like diabetics, are secondary to proper care and safety. Our mom also stopped eating "real" meals (could not follow recipes/directions much anymore) and those mac 'n cheese companies should have seen a spike in their income! Frozen dinners, packaged snacks, etc became mainstays. Although this was a concern, it doesn't matter a whole lot. Getting her into a safe place and not being alone was the primary reason we ended up moving her to MC. Given she now gets regular meals (oh most of them LOVE their desserts and ice cream!), she has actually gained 20lbs in a year! She did not need this extra weight, but getting her to move more and/or exercise with the others is not working!
So, if possible, start with a PCP. If it truly is a situation of him living alone with severe memory issues, the best course of action is to get him into a safer situation! He may not like it, may resist and may raise holy hell, but it will need to be done! You don't want to wait for a serious or fatal emergency. Our mom actually injured her leg just prior to the move and had cellulitis, which is dangerous. She did not have enough sense to get it checked or even tell one of us (her neighbor called me) and if we had not planned to move her just around that time, she might have died from the infection!
And to your question, let him be.
The key word here is narcissism. Once that word is part of a sentence one must know one cannot win. He will not change, specially now with dementia. So any effort of yours will be an uphill battle with no success in the horizon.
Love him, always care for him, place him where he is properly taken care of. That will solve most of the issues that are part of your question.
God bless you and your dad on this journey!
I agree with calling 911 and not meeting him at the hospital. Maybe they can get a home health aid from medicare to go to his home.
Here is an article regarding nutritional deficiencies and other medical conditions that can contribute to dementia or make it appear as if someone has Alzheimer's disease.
A B12 deficiency can sometimes be a culprit, it causes anemia, and it is an easy fix to give B12 by injection:
In older people, the first symptoms of pernicious anemia are often confusion, slowness, irritability, and apathy. Other symptoms of pernicious anemia include:
yellowish skin
fatigue
shortness of breath
headaches
numbness or tingling in the hands and feet
trouble keeping balance
Usually the B12 deficiency that underlies pernicious anemia is not caused by a lack of B12 in the diet. That’s because this vitamin is plentiful in eggs, dairy products, meat, fish, and poultry, and it’s efficiently stored in the liver.
Instead, a B12 deficiency usually occurs because an individual can’t absorb the vitamin from food. Fortunately, B12 injections, if started early, can remedy the deficiency and alleviate the symptoms of pernicious anemia.
helpguide.org/harvard/whats-causing-your-memory-loss.htm
I agree with others that you can’t force him to do what he won’t.
This is hard for you I’m sure.
Some people jump in and try to get things under control with legal proceedings, like Guardianship. Others meet the doctor and start using the Durable POA, in order to get the person into a facility or bring outside help into the home. Still, it's challenging when the patient is angry and resistant. I'd consider how far his dementia has progressed and consult with an Elder Law attorney, so you can find out your options and what evidence you might need.
I'm surprised that the doctors from the ER have not reported him to APS for an investigation. Those types of calls are not uncommon for dementia patients who live alone and often precede the need for family or county to step in for the patient's own protection. I would be more concerned with immediate dangers, such as fire, injury or wandering, when it comes to a dementia patient living alone, rather than their diet or preventative medications.
You don't say how old your dad is, so I don't know if he's too young, but if he's not in a memory care facility, maybe he needs to be?
My mom has dementia, depression, and end stage renal disease. I've pretty much given up on trying to manage her diet - and I don't believe in force-feeding - but the meds are now managed by me and home support together. If it weren't for the fact that mom doesn't have much time left (because of the kidney failure), I have no doubt I'd have to put her in an MC facility. It only gets worse, and harder to manage.
There are no nutritional guidelines that will cure dementia. There are no medications that will cure dementia. There are symptoms that may be helped by nutritional practices and/or medication. For example, if he had bouts of extreme anxiety an anti-anxiety med may help. If he is prone to dehydration, a larger intake of fluids is a good idea. But his overall conditions? They are what they are, whether he eats well or takes medications or not.
What do you mean by "he refuses help"? What kind of help is he being offered?
I agree with BarbB that it is perfectly OK to call 911 and not to get involved in the ER trip, if that suits you. I caution you not to expect to "teach" him anything by your absence. He won't learn that this is not a good way to get your attention, for example.
I am so very sorry that you are dealing with this challenging situation now, and that you've had a long-term challenge with his narcissism.