Family tradition and caring for the elderly

This is a story about the mother of my partner.  

My partner and I share some ethnic heredity among our respective family histories.  Specifically, Irish immigration to America in the late 1800's, early 1900's.  Some of the similarities among our ancestors are quite amazing.

I had a grandmother (1901-1984) that undoubtedly, though undiagnosed, had BPD.  Compounded with alcoholism, my childhood memories of irrational, abusive, relationship destructive and venomous behavior remains very clear in my mind.

My partner's (age 55) and I (43yrs old) visited her mother a few days ago when we attended the (third) wedding of my partner's niece (30 years old).  We live over 400 miles away.  The visit to her mother (age 79) brought very strong flashbacks to my own childhood.

I am trying to gather information for my partner and her sister to help them cope with this situation.  

Their mother is in a minimal assistance facility and is dependent on public assistance.  She refuses, in a classically belligerent way to leave her apartment.  Several months ago, she spent about a month in the hospital for severe skin infections on her feet.  The doctor strongly recommended rehabilitation before being released to her apartment, which she adamantly refused.  Consequently, she has had the opportunity to neglect her physical needs and her feet have disintegrated to a "mess".  Need I say more about that?  

She doesn't bathe or care for her activities of daily living.  She is paranoid and the odor of her apartment is unbearable.

My partner is taking action to try to have her moved to a facility where she can get the care she needs.  As a note, after her hospitalization, we arranged for her to come to our town to live, and she refused.  

My biggest concern is actually for my partner and her sister.  Not unlike my own mother, who turned the destructive tide of the family legacy, these two adult children have developed mechanisms, some productive, some not so productive to cope with the situation.  

The mother of the new bride is particularly stressed, as she believes her daughter to be "just like" her mother.  The mother has coped by developing co-dependant behaviors between both her mother and her daughter.  My partner has been much more fortunate, due to the distance of proximity.

Questions:
1. Are there any techniques for dealing with BPD in elderly particularly regarding paranoia, anger and irrationality?

I read in one of the forum exchanges that you recommended "including" the BPD person in the planning of care and alternative options.  I must say that, in my experience, this has not seemed to be a reasonable option.  Although normally appropriate and desirable, such a situation appears to me to be down right dangerous-- for everyone involved.  Comment?

2. What information is available regarding the genetic predisposition to this disorder?  Can environment effect outcome or is therapy essential to change the family history tide?

3. What can loved one's do to "help" when the person refuses and threatens, and verbally abuses them?  What "roadsign" may indicate that the "helper" is incurring too much damage in the exchange?

4. If a young person (the bride) refuses to get help, is there any hope?

5. Where and when does the grandmother's individual right to choose to live in an unsanitary, self-destructive way become unacceptable?

Footnote:  To my knowledge none of the above people, except for myself, have had therapy or treatment.

Sorry for the length of this submission and thank you for your response.

Regina

[HFHS M.D.-SW]

Dear Regina,

It must be difficult trying to provide the level of a care to someone who may not realize they are suffering from a psychiatric illness.
Borderline Personality Disorder is a long-standing pattern of instability of mood, interpersonal relationships, and poor self-image. It is also possible that there are other co-morbid disorders in your partner's mother.  One must consider major depression, substance abuse, and possibly dementia.
These need to be evaluated.  The condition you describe is not
characteristic of borderline personality alone.
To respond to your questions:
1- Treatment is difficult as patients may often regress. Some benefit from intense psychotherapy, others may benefit from groups. For symptoms of anger or paranoia, a psychiatrist may consider medications.
2- Some studies show a possible genetic predisposition to poor impulse control and mood instability, but more research is needed. Environment in the form of psychosocial stressors may possibly contribute to the pathology.
3- It is difficult to assess when a care giver has given to much for to little appreciation, the care giver must balance between their own well-being and a feeling of guilt or sense of abandonment.
4- This is an individual issue, of how important the relationship is and how much frustration can be beared.
5- In the state of Michigan there are four condition in which a person may become committed by the court.
   A. Suicidal plan or intent
   B. Homicidal plan or intent
   C. Inability to take care of self
   D. Inability to understand the need for treatment
In the best interest of yourself, your family and friends, it is best to discuss these concerns with your psychiatrist or therapist.

My best wishes.


Sincerely,

HFHS M.D.-SW