Yeah, I get all that, I've been in the field for a while and dealt with all sorts - but understanding why she is the way she is doesn't help lessen the stress of it and she's not going to change for the better, she will only get worse. Heck, she even forgets about her injuries sometimes and makes them worse. Her brain has lost the ability to reason even the most simple of concepts. It's like if you were trying to tell someone 1+1=2, which isn't something you can dispute, but they insisted it equaled banana for no other reason than because that's just what their brain has them convinced of at the time. They can't even tell you why they think it means banana, but it definitely is to them no matter how hard you try. Then, the next minute suddenly 1+1=5, so at least it's closer, but still not on target so cooperation still doesn't occur.

The major issue is when this lack of reasoning occurs for important things that can't just be left ignored, like using the bathroom. For her, the bathroom process is already complicated for many reasons... She has a prolapsed bladder, which essentially means she can't empty her bladder properly and the best way for her to pee is standing. Most of the time, if she sits she cannot pee at all. Further, she has a huge hole in her left foot that refuses to heal because she not only has heart failure leading to bad circulation but diabetes that is poorly managed, especially now, and the standing constantly on it is making the hole bigger. Oh, and the multiple infections in it... She's also morbidly obese, so when she does stand it's difficult to begin with, then she has all that extra weight on a foot that she should be off of. Sometimes she gets up 3-4 times in a short span because she can't fully empty her bladder in one go. Now add in the fact that she can't understand basic reasoning... getting her to pee is sometimes an impossible task. The safest method we have currently is to stand her up in front of her recliner (this is where she sleeps because her back is messed up bad), put a pad under her while she holds onto something sturdy, then let her pee right there. If she starts to go backwards, she can fall into the chair. If she goes sideways, I'm right there to hold onto her.

So here's where the reasoning comes into play. I make it very clear what the plan is, but the words don't connect for her. I can hold her hand and guide it to where to push herself up to help me like she always has, very routine, but she will insist on grabbing the wheelchair to pull herself up. This is very unsafe because the wheelchair is not good leverage and easily tips back, so she falls backwards and is too heavy for me to fully lift her when she isn't helping me properly. I explain in many different ways - vocal tones, body language, using different words, etc - she still insists. I have to then wait for the words to somehow sink in, or else keep her sitting. The good news is in this scenario she can't just pull herself up by herself, so the only danger is her growing frustration in that she can't do it exactly how she wants to. Eventually she cooperates and I can get her standing, then the problem is getting her to pee. I figured out on a whim that calling the pad a "pee catcher" seems to help it sink in for her, but not always. I can show her visually and by touch that she is covered and it's safe to pee. Still, more often than not, it's a battle to get her to understand that she has something there to catch the urine, it just doesn't register. We've had hour long or more battles on her worst days, just to get her to do something she so desperately wants and needs to do - pee.

The medicine forced dementia is getting worse all the time too. The last few days she has accused us (caregivers and kids both) of tying her up and not letting her walk. Of course we don't do this, and when she says she is actively being tied up there's nothing around her that could be tangled, sometimes she says this while completely naked. She has also forgotten all of our names, calling her son Mark (which is her brother's name) and any of us caregivers Barbie (which is what another relative goes by). She has been forgetting where she is, asking for people who are dead, seeing things that aren't there, it's awful. I feel so bad for her, but there's nothing I can do but try to keep her from hurting herself in these cases, which sometimes just pisses her off and gets me hit.

The falls have all occurred during these instances of confusion and stubbornness, but she doesn't remember falling when we remind her that doing it her way gets her hurt. Still, we can only fight her so much. If she decides to and is able to get up on her own, I can't pin her down. All I can do is try to provide her the safest way of doing what she wants to do. Sometimes there is no perfect way that she will allow, then she hurts herself, like falling. =/