How can I provide advice to a narcissistic geriatric brother?

That sounds like a sad situation with your brother. I don’t know what is causing him to be apathetic about his health, but I will say it might be something he can’t control. My cousin became neglectful of her health in her early 60’s. She stayed in bed, didn’t bathe, stopped taking meds, etc. She ignored any advice. Eventually, I got her to a doctor and she was diagnosed with severe dementia. So, cognitive decline can be exhibited in different ways. It’s difficult to get someone to listen if they are not interested.

Yeah. Good thought. A real concern is the isolation. Maybe he avoids interaction, except on the computer, so as to get by with no hygiene, med discipline and even house cleaning. The family is predisposed for mental illness such as bipolar depression. The surgery was enough stress to have caused it to surface. For me, my disability was brought on by military service. The VA is taking full responsibility. In 2022 the Congress initiated action to break the log jam of compensation increases. This allowed primary care to focus on their patients and not get involved in records checking. But it was handled through the law firm of Woods and Woods. They only exact a fee for appeals' They are the representative for increases in disability and here they charge nothing. VFW, DVA and others can't navigate the legal system as can W & W. So maybe my brother has a breakthrough mental health condition. He certainly presents this way. Thanks for the input.

This is a very difficult situation to be in, like walking into the middle of a story with no "right" answer. I am going to try to say this gently - even though he is your sibling, he is a separate individual who may not share your values and view of life. It sounds like this may have caused friction between you for many years.

In order to help him, you may have to set aside what you think of as the correct, normal or responsible way to live and try to view life through his eyes. To begin this, forget labels like "narcissistic" and statements like "I think that to be a member of the family..." No matter what, he is a member of your family. How you choose to deal with it is up to you.

Here are some questions to ask yourself:
If he did alternative service and you joined the military, you have had different mindsets for over 50 years. Do you have other siblings who get along better with him? Can they step in and help figure out his needs?
Do you think he may be depressed by his situation? This can be debilitating enough for people to forego normal hygiene, stay in bed, skip meds...
Has he always been a "loner", or did it start after the back surgery/pain?
Did he ever marry or have a long-term relationship? Children?

If this is new behavior on his part then maybe family intervention is warranted, but neglected teeth make it sound like an long-established pattern.
If he has indicated that he wants help to change, then intervention (family or professional) is warranted.
If he has obvious cognitive impairment, then intervention is warranted.
If his condition is causing frequent medical emergencies and family members are being called on to help, intervention is warranted.

Here is the hard part -
If he is a competent adult, seems content with his situation, and doesn't want help from you or anyone else, NO intervention is warranted.

Do you have other family members pressing you to be involved? If so YOU get to decide, based on the above, whether it is something that you need to do. You might decide to just help out the other family members, keeping in mind that you cannot change your brother.

I watched my Dad, a very compassionate man who was always willing to help, make these decisions about a couple of his brothers many years ago. He maintained close, loving relationships with most of his siblings, tried very hard to help the one who wanted to change, but had to "let go" of two who showed no inclination to change. At the same time, he encouraged us to maintain our relationships with their kids, our cousins. He taught us sometimes that is the best you can do.

Pleas share your thoughts on my very different point of view.

I accept that view. There is a genetic predisposition for mental health in the family. The area that has been identified is bipolar depression. It takes stress and trauma for it to "blossom "and the health issues fit that category. Mom was bipolar in a period before much was known. And her mother was questionable. On a summer visit she was very much in the background. She was a terrible cook. Grandpa did a lot to shield this and may even have suffered malnutrition. He smoked though and did lose a leg probably from Bryson's or something related to circulation. My older brother is very gay and would impose himself on me and my territory. A large family has that problem anyway. His younger brother, my next eldest, is also gay living in Paris. He was excommunicated because his wife is Catholic and forced the issue. I don't mean to rant, but the evidence runs deep for Larry to have developed bipolar as I do now. Another stressor besides the physical trauma was the death of his wife/husband who was a doctor. I'm very suspicious that the stoic and marginal lifestyle Larry is leading is not being divulged fully. His doctor mate earned $250,000 a year and it is hard to reconcile that Larry has no inheritance. This is a topic he keeps confidential. My younger brother helps with food ordering and when he comes back, he mentions how Larry is not bathing nor refilling meds. I stay away because of the tension. I have excellent backing for my bipolar health and have been awarded over 100% in VA disability. We are thinking about a gofundme.com account to solicit geriatric housing. There, he can get monitoring and the vital aspect of socialization. I am doing much better after moving on from Whole Health classes that were redundant for me. Even in university I didn't repeat classes and staying in my comfort zone is helping. That's it for now. I have more about our basic mode in existence but will expound when I am asked to. Thanks.

Hi Pedrot,
I'm so sorry your brother is having such an awful time in life. It's nice of you to be concerned. However, given all the things your brother has had wrong with him possibly he just can't bring himself to deal with them. If he was in the Viet Nam war then he must be near his 80's. I'm 79 and when a person gets this old, you get tired very easily even if you are healthy which I am. It could be that your brother is just too tired to do everything that used to be simple such as bathing, taking medications and then having all the pain or uncomfortableness he must have. I know that I have to make myself keep to a routine to do all the normal things that used to come naturally.

It sounds like you have enough yourself to deal with, with your military disability. And thank you so much for your service! I don't know where this country would be without guys like you! Perhaps you should just let your brother go on as he is since you aren't welcome there. Sue had some good suggestions about this.
The other thing that would certainly help is to pray for your brother. God is there for him. Just talk to God about all of this and God will help your brother and you. I'll say a prayer for both of you also.
I wish you the best.
PML

@pedrot, thank you for your post. It is extremely hard to watch anyone slowly crumble, let alone family members. Be kind to yourself, there is only so much you can do. If someone is still considered competent enough to take care of themselves by medical staff, even though you see obvious evidence they cannot, your options are limited. Do what you can but don’t be swallowed up by it. You might try calling your local social services on aging, to see if they have any options (I know, I know- but sometimes miracles happen).

Try using some basic sales techniques - ask questions that may lead your brother to think of better answers as opposed to telling your brother what you think, which will just result in pushback. Have you thought of? Do you think such and such will work? Do you see any problems with blah de blah.

Good luck, this won't be easy.