So Many Medical Conditions - It's Confusing

Wilted Daughter

There is so much to consider medically it is exhausting for me to monitor. Mom is 90, 130 lbs, 5ft. 4ins with...

Moderate Cerebral Atrophy/Moderate Cerebellar Atrophy, Aphasia, Nocturia, Type 2 Diabetes, Hypertension, Hypotension and Microvascular Ischemic Disease, Heart Disease..

The atrophy's and Microvascular Ischemic Disease is part of the Dementia (dying brain cells which affects parts of the brain related to cognition, coordination and balance). 

The Diabetes is a difficult for me to manage due to mom's confusion, miscommunication, misunderstanding (i.e. if her tested blood sugar level is high her resolution is not to eat). We have VN and PT but the focus is on overstating her test "numbers" without offering pragmatic solutions. 

The low blood pressure causes fainting and she's been in the hospital twice within 6 mos., while there they discontinue medicines (diabetes, blood pressure) now they want to change medicines without knowing the effect(s). 

I'm so tired of managing mom's conditions, her appointments, her clinicians...I informed her if any condition has serious symptoms (fainting) then she should be admitted for observation. I don't know what else to say/do over talking the conditions gives me anxiety and mom likes the attention (her high blood sugar #s are without symptoms). Oh and no one speaks to Dementia. 

What's a caregiver/daughter to do...

terei

I would expect that with her condition that you could receive help from hospice.  I would call and have her assessed without delay.

harshedbuzz

I am an only child who coordinated medical care for both parents. It does feel like an awesome responsibility at times- especially as my mom ages and when my dad's dementia progressed. 

At a certain point around stage 6, we moved to a more palliative approach to dad's care and re-thought every medication used in terms of whether it was needed or more of a preventative approach, side effects and how it affected his quality of life as they became the one area in his life where he felt he could exert his autonomy and battle with my mom who was his hands-on caregiver. We looked at each med and whether it made sense- we jettisoned his statin and BP (his BP had dropped with weight loss/disease progression) med, since he'd lost weight the T2 diabetes was less of an issue and we dropped Metformin, we kept the COPD meds that kept him breathing comfortably and also the ADT that slowed the progression of his prostate cancer.

He had a DNR and we chose to avoid ER/hospitalizations unless there was an obvious urgent issue. Dad fell a lot in the last year of his life and we were fortunate he never fractured a hip, wrist or thigh. 

In your shoes, I would recommend these books-

Being Mortal: Medicine and What Matters in the End: Gawande, Atul: 9781250076229: Amazon.com: Books

Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures, and the Patient with a Serious Illness, 6th Ed.: Hank Dunn: 9780997261202: Amazon.com: Books

HB

M1

WD, agree with the others that palliation/Hospice might help.  With her diabetes:  if she's a type 2 diabetic with asymptomatic high blood sugars, I just wouldn't check it, period.  Why worry about a number you're not going to do anything about?  Has she ever had symptomatic low sugars?  Low is much more likely to kill her than high at this age.  Hard decision to make from a  distance, for sure, but you do reach a point where it just doesn't matter.  Good luck, none of this is easy.  But at some point, the only relevant question becomes whether she is comfortable or not.  If she is:  great.  If she's not:  what can you do to make her comfortable?

Wilted Daughter

Thank you all so much. I will review the books.

I was informed she did not qualify for Hospice due to no near death prognosis. I will readdress palliative care but it's been an uphill battle. 

Most attention is on her Diabetes numbers and adding medicines with no conversation or attention to Dementia. Her testing is a security blanket (gives her something to control) but she's confused and frustrated when insurance changes the testing equipment. 

At this point fainting, limited mobility, confusion, delusions, agitation, and confabulations are most worrisome. At mom's age I'm trying to make her as comfortable as possible within a rational approach. When she falls, mostly due to blood pressure, heart issues or medicine side effects, she is taken to the ER. I'm following information from ADA regarding best practices so her clinicians will not push back with numbers, medicines, and appointments. The checking of numbers, adding/reducing medicines is a cycle that needs immediate change. 

Thank you again and Happy Easter!