Thank you Heather,
Based on your history, I am a wee bit concerned about Marge may not necessarily be as senile as thought. It is quite possible at her age that she does have feline dementia, but her eye signs do make me concerned that she may also have issues with her blood pressure.
We can see elevated blood pressure in elderly cats as a primary issue but it can also be secondary to kidney disease. The reason this would be a concern here is because high blood pressure can cause increased pressure within the retinal blood vessels leading to ocular bleeds as you have seen. In these cases, the cats appear temporarily blind due to not being able to see through the blood within the eye. (That said, we do need to be careful with these cases because we can also see high blood pressure cause the retina to detach off the back of the eye to cause permanent blindness if not treated immediately. So, if you ever see blindness without the blood, we'd want her seen urgently to give her at least a chance of regaining her sight.).
Furthermore, just to note, high blood pressure in cats often presents to the vet as cats that wander the house vocalizing/screaming in the house for no reason, notoriously at night. And while this can be related to dementia as well, humans with high blood pressure report mental confusion, dizziness, and headaches. So, it is quite possible that this could be at least playing a partial role in her
Now often treating the kidney disease with medications like Fortkor can help address these signs. Still, if her signs are not resolving then I would suggest having he vet check a blood pressure. If it is high despite Fortekor, they that may want to switch her to Semintra (More Info) or consider also treating her with blood pressure medication. Hopefully, if they can get this blood pressure under control, we will see no further ocular bleeds, risks of blindness, and hopefully she will settle a bit more mentally.
Finally, if she is going a bit senile, this isn't necessarily a death sentence for them. It just depends if it is negatively impacting her ability to enjoy her twilight years. I can tell you that the cat in my icon shares Marge's issues. I diagnosed her with kidney disease a few years ago and had to treat her blood pressure as well. Mind you she does likely have dementia as well (since just as old people often the mind and body has health issues), but she putters around in the garden, eats her meals, and loves a fuss. So, as long as she is happy and enjoying her days (with more good ones then bad), then she will continue to live her life. If any of that changes, then I would use that as my guide to considering letting her go. And I would say that would be my same thoughts on Marge. These are chronic diseases that we cannot cure but we can try to manage them (there are even some medications that can be used, though I'd focus on making sure those kidneys and her blood pressure are stable first). And as long as the cat is happy, using her box, eating, and interacting with you like a comfortable kitty, then there is no reason to put her to sleep at this stage.
Overall, Marge is an old lady and does sound to potentially having a blood pressure issue that is still causing her issue. Therefore, I would advise addressing that first and then monitoring her for mental confusion. If she continues to show dementia signs but can cope, then it is fine to continue as you are. If she is struggling then you could either consider medical management for her or use that as your sign to let her go. But at the moment, it'd be worth just making sure her blood pressure isn't making this worse for her at the moment.
I hope this information is helpful.
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All the best,
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