Today was a very demanding and worrying day that does not bode well for the future.

Isobel was woken at 1am in order to go to the toilet, but the bed was found to be already wet. She was rather grumpy while she was cleaned up and the bed remade, but was asleep again by 2am. Isobel slept until half eight, by which time her bath was already run and tea made. She was in an extremely uncooperative and aggressive mood and refused to bath or allow herself to be washed or cleaned up in any way. It has at times been a considerable struggle over the past few weeks to attend to her hygiene, the main difficulties relating to teeth cleaning (refused on two days out of three, although mouth wash seems to have prevented any problems) and changing of wet pants which often requires lengthy negotiations. Today her refusal to bath or allow any alternative cleaning up was accompanied by incomprehensible rambling talk, much shouting and swearing and considerable violence in the form of punching and slapping. I was bitten once more, on the forearm.

For almost three hours Isobel sat on a stool in the bathroom. She would not drink tea that was brought to her - she had not drunk anything since before 10pm yesterday. Isobel also refused to eat breakfast, nor would she agree to take her medication. Isobel was due to attend the hospice day centre today, but refused to get ready and did not go. Her justification for this was that the hospice had closed - the same argument had been used on Monday and Tuesday and most of the days over the past three weeks, although previously she has always eventually attended. Throughout this time she continued to talk incoherently about various actions she had been told by unspecified persons she was not to do, such as bathing or showering. Eventually we put clean pants on her and she settled down in the bed, still refusing to eat or drink. Iona popped in for lunch.

Isobel was still convinced that we should go to see her mother in Norfolk today, this has cropped up on most days over the past two weeks and sometimes it has been necessary to get her to speak to her mother by phone in order to convince her that she was not expected to visit. I eventually got her to drink half a pint of orange juice at 2pm, her first fluid since before 10pm on Wednesday. She agreed to eat a bowl of cereal if she could first speak to her mother by telephone (she has not been able to dial numbers herself for some time). After speaking to her mother she accepted that there was no arrangement for a visit to Norfolk today and duly ate a large bowl of cereal. She still refused to take her medicine as "she did not need it and did not want it".

Iona returned after finishing early at work. I made several phone calls to Sarah Parker at the Ellenor Trust but was unable to speak directly to her. We arranged for a home visit on Wednesday the 30th and I will phone Wendy Lethem tomorrow morning if problems arise. It was suggested that a GP visit would be a good idea but Isobel says that she will refuse to see a GP.

It had previously been arranged that Isobel's friend Rosemary would call round at 4pm. Isobel had indicated earlier that she did not want to see Rosemary, so I had left a message on her 'phone to cancel her visit. Rosemary however came straight from work, as she had not got the message. Isobel still refused to see her, but Rosemary and I had an interesting conversation. Rosemary and her husband looked after his mother, who developed dementia (she is 89 now). Rosemary's mother in law had shown behaviour very similar to Isobel's, we swapped accounts that were virtually identical. Eventually Rosemary's mother in law had to enter a home as her behaviour became unmanageable - a possibility that Euan, Iona and I had discussed at lunchtime as it has been very difficult to care adequately and safely for Isobel in the last couple of weeks.

After Rosemary left, I sat with Isobel in the living room for an hour and a half while she conducted a bizarre conversation centred around various prohibitions ordered by unspecified people and a desire to leave at once for Norfolk. She refused to drink coffee that had been made for her. At times Isobel became very agitated and shouted, screamed and swore, but she did not use physical violence. For dinner I cooked Isobel sausages, citrus slices, onion rings, carrots and peas. She would not touch her meal as she claimed it would kill her. Isobel became extremely distraught when I ate my dinner, assuring me I would be dead tonight as a result, and that she would kill me herself in any case. We had a conversation lasting for a couple of hours in which Isobel said nothing rational, but was very distraught for much of the time.

Isobel went up to bed at about 9pm. She watched television and dozed intermittently. I was able to get her to drink a mug of milky coffee and eat four Hobnob biscuits. Afterwards she had rice pudding. I am not too concerned about the limited amount of food she has ate today, but she has not drunk enough fluid. She refused further drinks, and continued to refuse to take her medication. On the evidence of the previous episode when she refused to take her medicine for four days, the lack of steroids will not cause a drastic reaction but the lack of phenytoin may induce fitting.

Isobel dozed off about 11pm. I removed some sharp objects from the bedside cabinet. The present situation is only sustainable for another day or two. Apart from periods asleep or dozing in front of the television, there seems to have been major dementia for about 90% of the time; this is rather scary and needs at least one person monitoring it all the time and actively engaging her in conversation. Isobel was very unhappy for most of the day.