What if My Mother’s Extramarital Cravings Are Linked to Dementia?

A good friend of mine's mother developed a strong case of FTD. She would disappear for hours, found an ex-con "boyfriend" for whom she spent thousands of dollars. All the doctors agreed on the diagnosis but my friend was unable to take away her car keys because she wasn't a "danger" to anyone yet according to the police. My friend cancelled all of her mothers' credit cards but mom kept opening new ones. Finally, when her mother left her car running in the middle of the block and wandered away, not knowing where she was, my friend was able to take the keys away and kept strict controls over her mother's money. It was the sad decline of a wonderful women. The writer's mother really doesn't know what she is doing. The family shouldn't look at her as a "fallen" woman but a woman with a terrible disease. This situation should be talked about openly and with kindness. The afflicted would never hurt their family members in this way if they didn't have this terrible illness.

For the sister living in Canada, calling local adult protection services where your sister lives and reporting self neglect can be helpful. The can connect her with medical services, services to help her manage her finances and also maintain her housing.

As for the first letter, one word of advice Mind your own business. Your mother's sex life is between her and your father. Get a hobby.

Kwame answered the questions asked but completely ignored the larger situations. LW1, your mother’s sex life is none of your business. Stop invading her privacy and spying on her. LW2, your sister moved far away 60 years ago to get away from your officious meddling. Just because her defenses are down doesn’t give you the right to step up your bullying. There are great social services in Canada. You can alert them to her needs. Then step back and leave her be.

Today's quiz? Given this list of facts, what is the subject of this story? (1) Grandmother had a form of dementia. (2) Mother is looking for sexual satisfaction wherever she can, except at home. (3) Doesn't this hint mother has the same form of dementia as grandma? (4) As her loving child, who should I tell, what should I do, how do I help her & my dad? (5) Oh, and by the way, mother controls all the money. Is this story about the risk of STDs? Is it about a child's obligation? Is it about family unity? Is it about oncoming dementia? Or is it about money?

The picture I get is that the richest country on the planet has no comprehensive program to care for its aging population. What do people think is going to happen to make this better? Repealing Obamacare? We need a national health system that provides all necessary services for all Americans. We can cut costs to a third of what we pay now. Private providers are free to compete with the government, if they can.

The first question raises interesting issues about competency and sexual decisions. My wife and I are senior citizens and feel fortunate that, at our ages, we still enjoy an active, sexual relationship. We've raised, both jokingly and with seriousness, whether we should amend our power of attorneys to explicitly give the other authority about making sexual decisions if we're not capable ourselves. Should that authority belong to the other, having been partners for years and knowing the other one well, or should it belong to some assistant living or nursing home doctor, nurse or administrator, what our relationship with look like in our final years.

LW1 appears to be obsessed with a fear of dementia (somewhat understandably), but I think she’s overstepping her boundaries with her mother, and using the dementia as a cover for her moralizing. She should talk to her mother about the affairs, encourage her to follow her doctor’s recommendations on regular evaluations, then mind her own business.

I so disagree with your advice to the second letter writer I am compelled to write. If her sister were merely ornery and not assertively self-destructive I wouldn’t have bothered. But no where in the unwritten contract between families does it say you need to give up your own peace and hard-won financial security to take care of someone who has spent a lifetime not doing it themselves. Basta! Enough! No! If the sister in the US did not exist, her sibling in Canada would be taken care of my social services there. And that’s what I recommend.

I have a lot of sympathy for both situations, as a nursing professional and an only child with a 93 yo mother, now living in a nursing home in Canada. In the first situation, it seems unfair and unwise to diagnoses a person based on perceived changes in sexual activity. There are many more questions that need to be asked by a competent professional, preferably a woman. While I understand the health concerns, moving forward in an aggressive way with threats and accusations will undermine the integrity of the person and the family. Don't diagnose without a thorough assessment. In the second situation. My mother had been living independently for several years after my Dad died. Slowly, I began to notice undeniable changes and tried to reason with my mother, who also didn't want me to interfere. Fortunately, my father had my mother sign a POA years before either of them were sick.You can't talk to anyone without it. Friends took advantage of her financially. After selling her condo, we tried several assisted living situations until she ended up in hospital for 8 weeks. I eventually got her into a nursing home, but the processes was difficult and time consuming. I would suggest seeking some help from local friends, finding a good lawyer and working with her health care provider. It took me 2 years, countless trips back and forth before I could sleep at night. Good Luck!

FOLLOW THE MONEY In the complex, difficult situations described by the caring, dutiful daughter, my takeaway was that her own mother had taken over the finances and exhibited deteriorating judgment. So I'd focus on the potential problem that could consume family financial resources. Another consideration is that the mother's extramarital affairs represent medical threats that threaten the safety of other family members, most directly the father. I would choose to discuss that with the siblings, if they will agree to be discreet. Getting the siblings on the same page about defending the father's right to be protected from sexually transmitted diseases that can be fatal, such as HIV AIDS, hepatitis, multi-drug resistant gonorrhea and syphilis and human papiloma virus, is essential. Ideally, the siblings may be willing to sit down with the mother and confront her--perhaps in the presence of her physician, so that she can agree to engage in safer sex (not such a great bet if her skills in decision making and planning are impaired--i.e., she won't carry around condoms or use them). But I say that if the financial security and health are threatened, the siblings would do well to intervene discretely. Then if the mother disagrees to cooperate, confront the matter with her and the husband together. The alternatives of having the couple run out of money and needing to rely on the siblings or in the worst case, dying of sexually transmitted diseases are too drastic to make nice!

I have to express my astonishment that the ethicist flatly tells the second letter-writer that she does "owe" her sister "special obligations" & though "some people would like to think" they are binding only if voluntary, "that's not the case." He writes as though he is stating a bald fact -- actually, he sounds as if he is quoting an inconvenient law which the letter-writer must unfortunately submit to because -- well, the law's the law, and she has no choice. But Mr. Appiah is actually stating an opinion, even if it may possibly be one common to many philosophical thinkers. He may consider strongly that people should feel they have an obligation in this situation. But all that he tells the writer is that she DOES have an obligation. And that's that. I am not arguing for or against his position, but I do think he should make it clear that there is no unquestioned authority for it. I find his implication that it is the only possible position-- let's say, philosophically dishonest.

Rather than start a bunch of drama bringing other people (father, brothers) into your suspicions, why not first confront your mother yourself. Is it possible she has been married for 30 years and seeks to explore her deeper sexual desires while she can? Most every human that is in touch with his/her sexuality likely has a number of unexplored desires and maybe these are not satisfied in her current marriage. You don't really allude to any other strange behaviors in the story. Address the situation yourself first and that way you can keep the drama between your mother and yourself. You may also give your mother the chance to come clean to your father on her own terms, which she deserves after 30 years of marriage.

Is letter writer number 1 a doctor? I'm appalled that she would diagnose her mother with FLD. Maybe her mother is just tired of her quotidian life.

The Ethicist missed an important point. The father should be told immediately. The mother's affairs, regardless of the reason for them, endanger the father's health. Venereal diseases are particularly likely when the spouse who is engaging in affairs is irresponsible or may be. Ethics be damned when health is a principle concern.

I'll chime in again there's a thread of dementia denial in some of these comments. True, it's theoretically possible the mother is seeking outside her marriage what she isn't getting in it, and presumably it's difficult for even adult children to think about their parents having sex. But remember, the mother had already seen a doctor about FTD, and both she and the letter writer had experience with it through the grandmother. Outside the medical profession, close family members are in the best position to notice the changes in behavior and cognition that could signal dementia. In the earlier stages of my mom's Alzheimer's, when she could still carry a normal conversation for like five minutes, friends she hadn't seen in years would call her and declare her fine after a brief conversation. The faux reassurances from various acquaintances eventually grew tiresome. Likewise, the letter writer's observations about her mother hold much more weight than anyone's hypotheses on equal opportunity late middle age sexual liberation.

I think that perhaps a woman in her 50's is more likely to be going through menopause than dementia. Menopause can cause many mental and physical symptoms. Many doctors tend to overlook this potential cause of psychological behavior in women of this age. The women in my family had severe reactions to menopause from severe depression to psychotic reactions such as seeing things that weren't there. These eased greatly when menopause had completed. My mother also had some dementia, but more than 20 years later. Hyper-sexuality can possibly be hormone driven which is what menopause is all about. This may not be the only cause, but should not be overlooked as a potential contributing factor.

there is a world of difference between being "excused" from feeling guilty and not doing anything at all to help a member of your family. I think this is a part of the reason why, so often, it is female family membes who take on the reponsibility for caring for aging or ill parents. I have always noticed that females seem to feel and to understand empathy more than do men and our Western society has built these assumptions into most family expectations. Hence, you may take excellent care of your sister and still feel guilt or, you may not and still feel nothing. If what you refer to is social acceptance and approval of the refusal of a sibling to act for another, most of our awful medical systems-in the US, at least, seem to have had the solutions for this refusal of responsibility , built in them. Once we simply allowed the unwanted, uncared for to live and die under bridges, or in the crawl spaces beneath our cities. In millenia past, such people might have been considered holy fools and thus the responsibility of religious or other social orders, as well as many cities. Gult, however, is far more a personal and thus a delicate issue-not easily dealt with in-or by-news media.

Having affairs is not evidence of dementia.And the last thing you should do is use your discovery of this as some kind of threat--if mom doesn't go to the doctor, you'll tell your dad. If the affairs were the only sign, there would be little if any evidence ofanything beyond a desire for more sex. So use whatever evidence you have besides sex. Talk to your dad and your mom. And keep your discovery to yourself.

These letters bring to mind a quip from the demented man who served as President of the United States decades ago. "There you go again", Prof. Appiah. Please, oh please, leave the bits of advice that require education, training, and experience in matters medical to others. You are a Professor of Philosophy. Not a Medical Doctor. Not a Neuroscientist. Not a Nurse or Social Worker or other professional with expertise in FTD. I cannot comprehend the hubris that allows you to feel entitled to address FTD in a public forum. Nor can I understand a person who seeks council from YOU on this matter! Are both of you so clueless that you do not understand that there is such a thing as EXPERTISE? A responsible and ethical response to LW1 would be a referral to a local medical school neurology department or, better yet, to an organization that advocates for those with FTD and affected relatives and caregivers, in order to get a referral to an expert. One sentence from you. Then you can move on to other matters that are well within your bailiwick, like the ethics of running topless.

Re: Mom thinks she is a sex goddess - This year I found out about my husband's secret online sexting affairs with women his daughters' ages. When he retired 4 years ago he took on a new career as an emaciated porn star. He spent $1000 on roses alone, spent our $cushion, took out secret loans, mailed romantic cards that may have included our savings, called women daily. He invented a fantasy life on facebook, telling women he was divorced and several years younger, played for sympathy and attention. I found hundreds of nude photos and videos he had made, always pleasuring himself. He had been a sexual anorexic with me for 6 years. He managed to do all of this while I was in the same house or during a quick trip to the store. He went to sex/porn counseling until I insisted that he see a neurologist. The MRIs showed atrophy of the frontotemporal lobe and dx Behavioral Variant FTD. His mother and grandmother had dementia. The neurologist said counseling would not help. He has to take an antidepressant. I took over finances and just about everything else and he has been good since discovery. He can no longer access internet on his phone and uses a laptop only under supervision. As a spouse, I believe the husband should know if his spouse is cheating and putting him in danger of STDs, and Mom should see a neurologist and get an MRI.

1st LW: If for no other reason, you owe it to your father to tell him what you suspect. Your mother may be exposing him to HIV, not to mention all other STDs. It may break his heart now, but better now than later--when perhaps things get totally out of control & the mother has ruined the family financially. Your father & brothers may very well suspect or know what you do & are also afraid to "spill the beans." 2nd LW: Move her while you can, before she is completely engulfed by her dementia, is perhaps incontinent, is perhaps so belligerent or in such ill health that it would be difficult to get her admitted into the best care facility that you could today.

As a Canadian myself, I want to say that your sister will have excellent and FREE medical care if she maintains her permanent residency in Canada (citizenship is not required but permanent residency is). However, she must have valid Canadian id in order to use healthcare. I would look into getting her Canadian id reinstated ASAP, as there have been recent similar cases, where someone living in Canada for 60 years discovered they were not citizens, and lost their healthcare. https://www.msn.com/en-ca/news/canada/i-have-no-country-after-more-than-...

Regarding the mom, I don't see a downside to approaching her alone first. In the event that she is still competent, she has a right to manage her own behavior. Her incompetency shouldn't be the starting assumption, despite the fact that there is reasonable cause to suspect she is impaired. Regarding the sister in Canada, the writer should acquaint herself with local governmental services where her sister resides. At her age and in her described condition, her situation may change drastically and suddenly. The writer needs to anticipate that while exploring other courses of action that will take some time to execute. Many baby boomers will soon be dealing with similar difficult situations. We need to start thinking about them now.

I lost a good friend to FTD. It's a progressive disease so the daughter will see its impact on her Mother as time goes on. From diagnosis to death, it takes from 7 to 9 years. I agree she should not upend her parents' marriage but such risky sexual behavior might also put her father at risk. If the mother does have FTD, she probably is not taking precautions. I would hardly expect rational behavior from her under the circumstances. The Mother needs a complete medical workup.

LW1: Your mother’s extramarital affairs are her business and your father’s business. They are not your business. Mind your own business. To the extent you may think she may not be attending routine doctors’ appointments, it’s fine to gently remind her that it’s always a good idea to see the doctor once per year for a routine physical. And then, to the extent she may volunteer further medical information to you, it may be appropriate for you to remind her to see appropriate specialists from time to time accordingly. Otherwise, this is an issue private to your mom (medical aspect) and to both your mom and dad (marital aspect).

nb:The concerned offspring in letter number one needs to talk to both parents and arrange an evaluation without any discussion of sexual behavior. There's enough going on with projecting that into it, and quite possibly the adult child's conclusions are wrong. It actually doesn't matter right now. In both cases there is the obvious argument for having one's "affairs in order". In the first case, the spouse should have access to the banking and savings and computer passwords, and in the case of the sister in Canada, an attorney should be involved if she refuses to give her sister DURABLE power of attorney. That's a specific type of POA. The first lady is only in her 50's and this is a fine example of a medical surprise that can come along in one's life. So is a bus, a heart attack, a blood clot or falling on the ice. All of us who are in families owe it to our relatives to have a will and some advance directives, and to have made it clear what should be going on if and when we are no longer able to make our intentions understood. Young families need to think about guardianship of their children in the event of terrible accidents. There are terrible accidents every single day in the news with autos, generators, fires, trains, busses, ferries, boats, buildings, terrorists.

For the second writer, I concur that the writer is responsible for managing her sister's transition to both living and financial management situations more suitable for her probable medical condition. A doctor's evaluation is essential to know just what that is, of course. This is what families do, whether we like each other or not. This doesn't require the writer to relocate or to have her sister move in with her. Regardless of funds, there are long term care facility choices available if that's what's needed in both countries. In any situation, an attorney can have power of attorney. Bill paying can be automated now. The writer probably would wish to be her sister's medical proxy, but someone else could be named.

I'm sorry, but the only evidence of FTD in case number 1 is that the Mom is seeking some sexual gratification from people other than her husband. Would FTD be automatically assumed if it were the Dad having affairs? What other behavior is erratic? I think it's highly unfair (and perhaps a little sexist, from the child and the Ethicist) to presume that seeking out new sexual partners warrants a visit to a doctor. And, I find it extremely odd that the child seems to "know" what "unusual sexual behavior" is for their mother. Seems more like wishful projection to me. It's quite possible that the Mom and Dad have not had any good sexual relations for many years, and the Mom is feeling like "hey, why not and I've always wanted to..." . That's her right as an individual, whether people find it distasteful or not. It's of course quite possible that she has FTD, but nothing is even mentioned that perhaps she realizes she is getting older and wants to have an exciting sex life and is not getting one in her current situation. Is she making erratic financial or other decisions? No? Then the child should stay out of it or at the minimum just ask their Mom about it, *without* making presumptions. Jeez...

For both letter writers: since Trump and the Republicans have revised/revoked/emasculated the law requiring financial advisors to consider their clients' interests (instead of their own), you should be especially careful. You need expert advice, imho, in the situations you describe. https://www.google.com/search?source=hp&ei=nBNNWviuDMvZmwG9rISACw&am...

Both letter writers are desperately in need of professional HELP, for their loved ones. Now, not just in the future. Anyone displaying these symptoms needs a evaluation by a M.D. and /or a licensed Social worker. This is not only for planning purposes, but also for legal protection. Protection of the Patient AND of the Family, against charges of neglect or abuse. Do it ASAP, the situation will only get worse. Best wishes.

As difficult as it may be, the letter writer with the mom sowing some late oats might want to have a frank talk with her to make sure she is not endangering herself with her online relationships--using protection to avoid STDs, using common online dating security techniques like meeting in public places, and so on. Keeping an open line of communication without shaming her would help protect her. I know that's a lot to ask. And, BTW, she might just be healthy but bored with monogamy and discovering new things about herself. She's not too old for fun.

Interesting issues. A friend of my mother's may also have had FTD - after 20+ years of what appeared to be a happy marriage, she started going out at night and moved in with a strange man only a few months after meeting him. Wrecked the family (3 kids, in high school and college), husband died of a heart attack shortly after the explosion of her moving out. And then she died relatively young of dementia. No one understood what was going on with her - other than that it was as if she'd been shot up with hormones and was constantly talking about sex, among a group of women who were 'reticent' about anything related to 'marital affection.'

My remote layperson diagnosis agrees with the writer's suspicion of FTD. When she was in her '50s, my former neighbor developed an obsession with another neighbor who had a wife in child. She would knock on his door 15x / day, inviting him to her place, in front of his family. When he wasn't home, she'd sit outside his apartment. I thought something was up not because of her unfortunate attempt at an affair with a married man, but the totally indiscreet way she went about it. I gave the heads up to her out of state son. While unbeknownst to me she had already gotten a diagnosis of FTD, her son saw her latest behavior as a sign she could no longer live independently, so he moved her into a facility. I would posit that if by now the mom is getting laid online, she has already been sick for some time, may no longer be aware something is wrong with her, and there likely was a missed diagnosis a few years back. I'm sorry.