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Luckily I did not visualize it but at my mother's 90th birthday party, she said to me "I pulled Gordon's (her nephew) shirt down because his belly was showing." ARGH! Say what?? How embarrassing for him and others who witnessed it! The minds of elders ...
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For required outings (medical appointments) the best you can do is try to correct her behavior, but we cannot change other people's behaviors. It might take some time, but enough corrections might help. Then again, it might not. As others have said, those who work with the elderly are probably somewhat used to this kind of behavior. Others not so much. If she cannot contain herself, limit or eliminate non-essential outings. If she asks why, you can try to explain it and perhaps she might get it. If not, no more outings! Perhaps loudly apologizing to the person it is directed at, explaining so mom can hear, say how rude the comment(s) were - maybe she'll get the hint! My first thought was like someone suggested, having apology cards to hand out! If you did that, she might ask what it is, and you can explain how you apologize for her rudeness. But, it might be an exercise in futility to get her to change. sigh...

As others have suggested, if she was not like this previously, it might be the start of dementia. Our mother would say not nice things to us, either about one of us or someone else, but not in front of the person (filter). Now, with dementia, it is not quite contained (lack of filter.) So, it was always there, she just doesn't keep it private so much anymore. She is not very loud about it, but still, I can relate to how you feel. Pointing out someone who is on the heavy side is common for her, however she has gained 20 pounds in the year+ she has been in MC. She was already up there in weight before that! When getting bigger clothes for her, I repeated what the staff said about her clothes getting too tight. OOOO, THAT set her off! She does not even realize how big SHE has gotten!!! She is mostly okay during medical appointments now, but could get very testy during the initial stages - I just exited the exam room when she started that crap!
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