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My great uncle, who is more or less a grandfather figure to me has started to have delusions as well as, not being able to remember where he is while driving the streets. He has drove 70 years of his life and he will be 90 in February. The other day he didn't know how to get home and should not be still driving at all. He would never ever agree to go to a home or have a caregiver come into the house. He has convinced himself that his house is full of bugs and has paid numerous exterminators large sums of money to spray these bugs that do not exist, but the poor soul is convinced they are there. He falls asleep while cooking and almost burnt the house down. I do not know the steps to take or what to do. He has no children and no spouse. It is just him, his sister who is also in her 80's, me and my mother who is also not in good health. I just feel so lost and not sure what to do.

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As others have said - please do somehow remove keys or replace with non-functional keys. Disabling the car is another item on the to-do list. My brother talked with mom and took the key, but on the way out I said I know she has another, please disable the car. Sure enough, next day I get the nasty phone call about the key, and brushed her off. The very NEXT day I got another nastier call telling me to get down there right now and fix whatever I did to the car. So, she managed to locate that second key and WOULD have driven if the car worked. She was not savvy enough to check for the battery cable, so this worked until we finally removed the car and sold it.
Now, being a guy, he might likely figure out the battery cable - there are fuses that could be removed as well. You may have to get creative in disabling the car, but the sooner the better! Once it does not work, you can "have it taken to shop" and keep putting him off as to when it will come back...
Relying on a doctor, the police or anyone else to tell him not to drive WILL NOT WORK! In our experience, most doctors do NOT want to intervene and having someone who works for a PD, they generally also do not want to get in the middle of it until AFTER the fact - too late then! Even IF doctor or PD will tell him and even IF the registry revokes the license, he is far enough along that this will NOT matter - if the car is still available and can be driven, he will likely do it. Consider people of "sound" mind who lose license to DUIs - it does not stop some of them!! He either will not remember being told not to drive AND/OR will not adhere to these instructions - I'm fine, I can drive, etc - this was mom's mantra... oh I don't go far... doesn't matter mom, you could go two feet and hit someone.
As for those companies that keep spraying, contact them and tell them to back off. They are, on some level, ripping him off (elder abuse?). Offer to spray for the bugs yourself, but just use water or something harmless if you know there aren't any.

He needs to be assessed by a doctor, or if he will not go, some aide companies will send an RN or Nurse practitioner to do the assessment in home (we went this route). From there you can seek out additional help and make plans. But for now, ensure he cannot drive and like someone said, disable the stove... does he have a microwave? might make for some safer cooking.... and yes, you can cook REAL food, not just "dinners", but he may be beyond that capability too (requires learning how to cook each item if he isn't used to it)
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The delusions and driving difficulties you describe are really common in dementia. Given his age, he almost certainly has developed some permanent cognitive impairment. It's often a mix of Alzheimer's and vascular dementia, but sometimes it's another form of dementia.

He needs to be medically evaluated but you don't have to start with a neurologist or neuropsychologist. In principle, a generalist can often make the diagnosis, especially if you bring in information about how long he's been having difficulties and what types of things he's having trouble with.

The clinician should check for reversible causes of cognitive impairment, because treating them can help him think better. But in people his age, it's really rare for them to go back to being cognitively intact. So your family should start planning for how you will support him through this.

I would recommend you start by contacting your local Alzheimer's association. BTW they have guidelines on driving and they provide guidance on when to intervene regarding driving (seems justified in this case), see here:
http://www.alz.org/documents_custom/statements/Driving_and_Dementia.pdf

You will need to see whether your granduncle is still able to give POA for health and legal to someone in the family. He has to have mental capacity to understand the documents, and of course, he has to be amenable.

You probably will eventually need to work with an elderlaw attorney, but as they are expensive, it's good to start by talking to the Alz Association, your local area agency on aging, and other resources first.

good luck.
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Whoops, sorry, national association of elder LAW attorneys. :)
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Nebbish1964 makes a good point, an elder care attorney would be a great idea. There's an organization called NAELA (national association of elder care attorneys) that can help you find someone local to you.
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Tough situation. Tougher still because, as I see it, you seem to be the only one who can take care of these seniors in their old age. From my perspective, you need to get POA...power of attorney, in order to keep him safe, and his sister whom I get may be living with him. I believe the place to start is with an attorney who will lead you through the process. You will have to have your uncle diagnosed as a danger to himself and others in order to get the POA and POA for Health Care. I'm not sure what they call them, but the city in which he lives has counselors and "case workers" listed under senior care, I believe. They are a TOTALLY good source of information and services for the aged. Good luck to you and keep your uncle safe....whether he likes it or not. It's a long journey and process...but worth it.
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I see many posts from people who describe their LO as someone who would "never agree" to having help in the house or moving. I totally get that. Hubs wouldn't ever have agreed to a caregiver but after he got so sick & his dementia was such that he was evaluated as needing 24 hour supervision for safety I hired a caregiver. Hubs kept saying we didn't need him but meanwhile I'd grown a spine and said "you may not need him but I do!" By then hubs didn't really realize how much of what he had been doing I had taken over (neither did I until he got sick--just kept taking on more & more myself in complete denial of what was happening to him). At some point you (hopefully with your durable power of attorney in place) have to override them as their decision-making ability has gone away. I know it's hard to do but for their safety and that of others you have to. Hubs was furious when I got the dr. to recommend he stop driving but he didn't argue and was just sarcastic about it (until of course the day when he forgot that he didn't drive--but that was later on...)
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Yes, he needs to be stopped before he kills someone. Good grief.
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HIS DRIVING DAYS ARE OVER. STOP. HIM.
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He doesn't know or care if he will get a vehicular manslaughter charge on his record! What is that all about??? His brain is mush. He gets behind the wheel and god only knows where he thinks he's going - if he rams a school bus or goes into a ditch or ends up 100 miles from home - he shouldn't be driving because
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Why is he still getting behind the wheel of something that could be considered a weapon? Does he want a vehicular manslaughter charge on his record?
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Take the knobs off the stove. Find out where his car keys are, take the keys off, and substitute blanks that look like his keys. (bring someone over with you to distract him while you do this, or have them take him out someplace while you search around.) This is VITAL, he should not be driving, and it is up to someone with wits to put an end to this. Find and take those car keys.....He obviously needs to go into assisted living with all the other stuff, but: stove knobs (or disable it somehow) and car keys (disappear them).
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Yes, have the car disabled and the stove. First, take him to his primary. Some insurance supplementals require a primary doctors order to see a specialist. All my Mom has is a neurologist who handled any medication she needed. If he won't go to a doctor, then you need to call in Office of the Aging.

So sorry you have to go thru this. Looks like you have enough on your plate. I would get his sister involved if she is of sound mind. My GF's mother was over 80 when she handled her husbands affairs and her SILs too. His sister is his closest relative. You can always help her with things she may not understand.
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I agree. First thing - someone needs to disable his car. If you have any relationship with his doctor or can forge a relationship, reach out and let the doctor know what's ACTUALLY happening. Let him be the bad guy and order no more driving. Also, convince him the insurance company wants his driving abilities assessed or he'll be dropped. (Therapeutic lies are sometimes necessary for the health/safety of a loved one.) Then there's the whole other hallucination issue to address. I agree that getting a social worker from the county in to do a needs assessment. Look at it as you're making arrangements/taking steps to protect him and lead him to safety without personal confrontation. Also, someone needs to get POA - the country social worker may recommend this if she knows the issues ahead of time? Find resources to intervene.
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I agree with ThisIsntFun. High quality care makes all the difference (as does good food), but I can vouch for this, as my mom went from objecting like mad and crying non-stop for the first week to thinking of her apartment as "home". She still misses life within her own four walls, because she wasn't ready to let go of that (my dad's condition forced the move, and she agreed to it, but then didn't acknowledge that she'd agreed to it and fought it all the way, it was just too big of an adjustment for her). But she does find life much easier now.
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Many elders will put up a big fuss about leaving their homes, but when they do they are actually relieved and much happier to have someone else take care of the cooking and cleaning for them. (Provided you find a good place for them).
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Hi Sara,

I so completely understand how lost you feel right now! I felt the same way when my father started to have delusions and couldn't drive anywhere but down the street without getting lost.

It is very hard to let go of the image you have of someone as capable and strong, especially when he has been a father or grandfather figure to you.
But take a deep breath, because now that you've noticed all of this, it's time for you to step up and be the one to take this situation in hand. There are definitely steps you can take to help him. Here are some suggestions:

1 - Take him to a neuropsychologist and have him evaluated. It will be about a three hour appointment, and the neuropsychologist will ask him a lot of questions. From there, a diagnosis can be made.

2 - Take him to a neurologist. They'll examine him, and possibly do an MRI of his brain. That way you can find out if there is anything organic happening that could be causing the issue. You can also have him checked for a UTI (urinary tract infection) if the delusions have come on suddenly. Sometimes UTI's can make our elders behave very strangely.

3 - You can remove his keys. If necessary, disable his car by disconnecting the battery. It is imperative to keep him off the road. This can be the hardest step, but it's absolutely necessary for the safety of your great uncle and of your community. (In our area, a man in his 90s crossed the median and caused a deadly head-on collision on the freeway just the other day. You do not want anything like that on your conscience.) If he does get diagnosed with dementia, his driver's license will probably be invalidated anyway.

4 - Because of the incidents with cooking and fires, you can call Adult Protective Services and report a case of "self neglect". They can send someone out to evaluate his situation, and can help you determine what steps to take to keep him out of danger.

5 - Call your local Area Agency on Aging and ask for a social worker to come out and do an evaluation of your great uncle's needs and environment. They can start to help him understand the need for more assistance, even if it's just having someone come into the home for a few hours every day to help him with cooking and basic chores.

If you feel overwhelmed, or if something comes up that you need help with, call the Alzheimer's Association hotline. There is an 800 number on their website that will take calls 24 hours a day. Trained staff will listen to your concerns and offer you practical advice. They aren't counselors, but it's amazing how much it helps to have someone who understands what's going on give you some practical steps to take.

Good luck. I know this is hard. Keep your chin up, and know that you're not alone. I hope you'll come back to this community for more support. There are some great people here who have your back. Take care.
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I agree with all of the above. The Area Agency on Aging helped me get my mom out of the house (which seemed unthinkable to all of us) and into AL.

At the very least, take his keys and let the local police know what is going on.
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Dear Sara,

Its so hard when elders get into their 90s. And especially for men they don't want to give up their independence or driving. But given what you have said it is critical he stops driving before he gets into an accident that could kill him or someone else. I would consult with a social worker and see what options are available. He needs to be assessed because its not right that he has delusions. It could be so many things, his pills, his diet, mental decline from age. You are right to worry for his safety and need to start making plans for him.
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My first step would be to notify the county's Area on Aging (name can vary in places) and ask their advice about an elder at risk. Talk to someone there to see about getting someone out to do a needs assessment. Someone in authority will have more sway over your great uncle than family will. Elders can get very stubborn and don't want their lives to change. Sometimes we need to help them do things to make changes. To me it sounds like he might do fine for now if he had someone to come in to cook, clean, and drive him places. Do you think he could afford that?
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Have you not read any other postings here? Talk to his doctor, the licensing bureau, his POA if he has one. Maybe go for guardianship and take over for him as he sounds no longer competent. Don't dither around and let him be a danger to himself and others. I don't want my loved ones on the road next to him.
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