Geriatric psychiatrist?

MLS2021

My mom has had the same GP for years and told he told my sister we shouldn't  have to go to any specialist and that he can handle her Alzheimers care. She was diagnosed by a neurologist. 

My mom is mid stage 6 and has lived with me for almost 5 months and she is declining. More delusions like my sister's sons are really hers but she let my sister adopt them and we are starting to have more wandering in the middle of the night. She is currently on 10 mg Lexapro and .5 mg Xanax as needed, which has been needed more lately and when she lived in TN with my other sister they put her on 250 mg x 3 of divalproex DR for headaches. She was on all of these before she came to live with me plus donepizil and mamentine, which have been discontinued.

I am not comfortable with the GP's ability for prescribing and tinkering with  behavioral or sleep medications.  I am considering  going to a geriatric psychiatrist  but I am not sure if it is the time to go and what happens at the visit.

Sorry if this doesn't make much sense.

harshedbuzz

MLS-

Psychiatry is the specialty for the management for psychotropic medications. For a PWD and/or is elderly, a geriatric psychiatrist is the best and safest option for medication management. Yeah, a PCP can write these scripts; they can probably deliver babies, too, but I'd opt for the specialist. 

Dad's geripsychs were the single most critical members of dad's care-team after my mom. He was warm and engaging and dad loved his visits to the office, or later in MC, when the affiliated geripsych would stop by to see him. 

They were able to craft a cocktail of medications to proactively dial back the anxiety and agitation that drove his behaviors rather than reacting with benzos after his mood/behavior had already tanked. This approach reduced the risks and incidences of side effects and allowed him to remain at home almost until he died. 

Trust your gut and find her one.

HB

MLS2021

Thank you, HB! I appreciate your comment and that I should trust my gut.

I was hoping for some comments on what to expect from the first visit. I am not sure what they will ask or if my mom would be able to answer their questions.

I am an introvert so advocating for my mom makes me step WAY out of my comfort zone but for her I would do anything.

LicketyGlitz

I absolutely second harshed advice, ML! Mom's geriatric psych doctor was the more important person on her care team. Dr. Susan worked with us to find the right meds, dosage, and dosage times to give Mom some relief from the worst of the behaviors she experienced. It did not stop them, but made them more manageable for her and us without turning her into a zombie. It takes time, but a good geri psych doctor will work with you endlessly to help your whole dementia household out!

jfkoc

You likely will need a "drug"specialist. How about asking the diagnosing neurologist for a referral?

Stuck in the middle

I think it is important that the doc know what symptoms your LO is experiencing and what her capabilities are.  That means you need to write a memo for the doc to read before the appointment and you need to attend the appointment with her.  She doesn't know she has delusions, so you will have to provide that information.

In the memo, discuss her ability to perform basic life tasks, such as eating, toileting, bathing, dressing, managing money, and traveling.  For example, an unimpaired person can plan meals, shop for food, cook, eat, and clean up.  A very impaired person might require spoon feeding.  How does your LO do?

Iris L.

Read the Beers list of medications.  Many meds may have a paradoxical effect in older adults, even those without dementia.  It's important to have a geriatric specialist prescribe these psychoactive medications and to watch for side effects. 

 Iris L

MLS2021

My younger sister pretty much lived with my parents her whole life. She went through a divorce and so my mom went to live withmy sister in TN for 7 months. Two months after my mom went to live with my sister my father who was in hospice care passed away. Unfortunately,  the sister my mom went to live with is a drama queen and refused to "fib" to my mom so her drama and anxiety worked my mom up. Because of this, my younger sister who is my mom's  POA and first health surrogate decided to bring my mom back home but home was to me because of the stressful marital situation of my younger sister.

I think the move to TN and the death of my father caused a decline in my mom. She can pretty much dress herself  if I lay out her clothes and guide her, otherwise things are on backwards etc. She can go to the bathroom on her own unless it is a bowel movement  because she no longer knows how to wipe properly.  She can feed herself but could not prepare her meals. She is definitely  mid stage 6 but is still mobile and not incontinent. 

She has had delusions  for a while  according  to my sister in TN and now we have some hallucinations  or just unable to recognize  what thinks are. The divalproex  sodiumhas helped her headaches and sundowner agitation. 

Here in Tampa, the major university  USF has an alzheimers  institute  and that is where she will go for the geriatric  psychiatrist. 

I had to stop replying  because right now she is agitated  looking for something.  We spent about 2 hours looking for something  that she couldn't  explain what it was. She kept wanting to get something  downstairs.  My house is one story so we think she thought she was in our house in Michigan  where she has lived in for 44 yrs.

Thank you for your suggestions. 

harshedbuzz

MLS2021 wrote:

I am an introvert so advocating for my mom makes me step WAY out of my comfort zone but for her I would do anything.

I hope you were able to get mom settled down. 

One benefit of technology is that it makes communication and advocacy on behalf of our LOs easier for everyone. You can do it when it's convenient for you, without mom hearing and without making eye-contact with her doctor. 

Try to communicate through a patient portal. Make sure your mom signs the HIPAA forms to allow docs to talk to you. I am sure an outfit like USF has one. This way you can describe what your concerns are fully without mom overhearing. I found it useful to send dad's geripsych a short video clip I made with my phone of dad being aggressive and threatening. Dad was so good at "showtiming" (holding it together and being charming) in the office and always tested higher on MMSE and MoCA than his behavior at home would suggest. 

You might want to discuss getting a new POA from mom if a CELA feels she is still competent to consent (the bar is pretty low). Otherwise, I would talk about getting guardianship. The sibling who wipes the butt, should be the one making the calls. 

HB

MLS2021

HB -

My younger sister is the POA and we are both her health surrogates and go to the doctor's together.

I did video her on my phone last night because  this was the first time her agitation  lasted that long and sent the video to my sister. She doesn't  get violent or angry just frustrated  but we were still able to make her laugh though we couldn't  distract or redirect her.

I am grateful  that as siblings we all agree on mom's  care and that quality of days is better than quantity  at this stage.

Hopefully we can get an appointment soon.

MLS2021

Iris L. wrote:

Read the Beers list of medications.  Many meds may have a paradoxical effect in older adults, even those without dementia.  It's important to have a geriatric specialist prescribe these psychoactive medications and to watch for side effects. 

 Iris L

Yes, that is why I want to take her to a specialist.  Hopefully  I can get an appointment soon but it usually  takes a couple months to get in and see this particular  doctor.

Rescue mom

My DH just had his first visit with a geriatric psychiatrist. I was really stressed about it, but it went really well. We had to wait almost  3 months. The local Alzheimer’s Association gave us a list of 5 geri. psychs. in the area, all had waiting lists that long (we’re also in FL, you are super-lucky if you can go to the Byrd Alzheimer’s center in/near Tampa. It’s worth waiting, short of crisis)

It all started when DH, in midstage Alzheimer’s, started having delusions that were a problem, he’d rage and threaten.

I asked his PCP and neurologist for help, they said go to Geriatric Psychiatrist; which are called GPs here.  (The PCP actually said it was against state law for him to prescribe the needed meds, that’s true for pain meds but I didn’t know about these. Regardless, the PCP, who never helped but necessary starting place, would not.)

I was worried about the first visit b/c DH cannot self-report and gets angry if I contradict him. I wrote the geriatric psychiatrist a one-page double-spaced note explaining what was happening. I gave the receptionist the note when we arrived, and asked her to be sure the doc read it first.

This GP was not warm and fuzzy, not at all, even by my standards (and I prefer straightforward and to the point, myself) but his handling of DH and how he asked questions was stunning. So much better than any doc we’ve dealt with. 

The geriatric psychiatrist doc uncovered/figured things out real fast. DH had no problems with it. I could not repeat or describe his questioning “technique” but he was masterful And gave an Rx that seems to be helping.

As others have said since, that’s what he does, and he’s known for being good at it. But he is absolutely the best medical person we’ve seen.

Meanwhile, I’ve heard and experienced too many bad things about PCPs and dementia patients to recount. PCPs are great for a lot of things, but they cannot do everything, and dementia is tough for most of them to deal with. 

MLS2021

Rescue mom wrote:

My DH just had his first visit with a geriatric psychiatrist. I was really stressed about it, but it went really well. We had to wait almost  3 months. The local AA gave us a list of 5 geri. psychs. in the area, all had waiting lists that long (we’re also in FL, you are super-lucky if you can go to the Byrd Alzheimer’s center in/near Tampa).

Yes, that is the wait time here in Tampa.

This GP was not warm and fuzzy, not at all, even by my standards (I like straightforward to the point myself) but his handling of DH and how he asked questions was stunning. 

I have heard that about most of them so I am prepared. 

Meanwhile, I’ve heard and experienced too many bad things about PCPs and dementia patients to recount. PCPs are great for a lot of things, but they cannot do everything, and dementia is tough for most of them to deal with. 

I agree!!!

Thank you so much for sharing your experience. 

MLS2021

I was concerned about her confusion the other night. I suspected a UTI which the doctor confirmed.