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I am a 76 year old widower of about 2 and half years. My sister is 74 with uncontrolled diabetes which causes her to pass out and she has fallen and broke her shoulder. She has been acting unstable since before the fall, but she is acting bizarrely thinking people are listening on her phone and taking money from her bank account etc. etc. She is well educated but thinks everyone else has the problem. She lives alone and I live alone about 15 miles away. I am concerned because she is belligerent and domineering and has only 1 friend who is also concerned about her. We have no other family except a younger sister that is 62 who my subject sister hates and gets angry if her name is mentioned. I know she needs help but I also know she will not tolerate me suggesting that she get some help because she thinks everyone else has the problem. I don't know how to deal with this without completely alienating her. I know she will not be cooperative. I called a local senior services but they said without her consent there was nothing they can do. I'm at a loss because I can barely take care of myself. Any suggestions? Thank you.

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It is time to report your sister to APS as an adult at risk who is non cooperative with getting physical and mental workup, and who is in unsafe circumstances. This would be early onset if this is dementia, and there may be other components but without a workup no one can ever know. Leave this to others who have the authority to act and followup. Call APS in your area.
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Is she taking any pain relief for that broken shoulder? What treatment did she have for it?

She's probably struggling to wash and dress herself at the moment. Does she say anything to you about any practical difficulties she's having?

The thing is, you can do nothing and your sister will be - can't think how to put it, but screwed seems closest. Or, you can risk alienating her and be frank with her and hope she'll at least tell you what she *would* accept in the way of help. However she chooses to respond, she can't end up worse off because you ask her to face some home truths.
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john45ok Mar 2021
Her shoulder was dislocated and the are 4 bone chips visible but not interfering with the joint the orthopedic Dr says it looks like the shoulder is knitting back together well (its been 4 weeks) She is taking some pain meds and I know they can add to her bizarre behavior but she was exhibiting it before the meds. She is having difficulty dressing etc. and I am going to get her some help. Thanks for your response,
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There could be many medical or mental health reasons why your sister was acting unstable prior to her fall. Unfortunately, without the legal authority of PoA or guardianship, you can really do nothing. You don't have to avoid her completely but you should have clear boundaries for yourself when engaging her. Alva is correct that the most you can do is call APS and get her on their radar as a vulnerable adult. Eventually they will gain guardianship of her, and they will manage her medical and financial affairs, finding placement for her in a care facility when ever that becomes necessary -- if her unstable mental and medical health can't be solved. I'm so sorry for this distressing situation. May you receive peace in your heart.
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If her diabetes is uncontrolled this also could be the cause of her dementia like symtoms. A UTI could also be the problem and that is serious. Can become septic. There could just be something physical, low potassium, thyroid, pneumonia. She needsvto see a Dr. and haveva full rundown. I agree, Adult Protection Services should be called about a vulnerable adult. Or, you will just have to wait until something happens that lands her in the hospital.
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*UTI = Urinary Tract Infection
APS = Adult Protective Services
POA = Power of Attorney

Just FYI (for your information) :-)
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Thank you all for your help. I knew this wasn't going to be a comfortable situation for any involved but wishfully thinking there might be an easy way to approach it. I will have a talk with her and insist she have a workup and I will arrange a home healthcare agency to help her function at home. She called me last light and admitted that she is overwhelmed trying to cope. That is the first time she has shown anything other than denial. I am hopeful she can cooperate. If not I will contact APS, she might get made at me but I know she is in trouble without help. Thanks again for your advice and encouragement.
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Beatty Mar 2021
Excellent start.

Two fallers in our clan won't tell the 'worry worts' or the 'bossypants' about their falls - but surprisingly have told my DH. He doesn't know why... maybe coz is he neither. He calmly nods. Give them a safe space to tell someone.

I am trying this approach too (against my nature!) If they see their own problem, accept it, then maybe they will be more open to throwing some ideas around.

You smile later if you are told "Oh I'm so glad I decided to xyz". (That they decided for themselves is often key).
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