First conversation with GP regarding possible dementia

IaaLoTW

I recently flew back home from overseas because my 80-year-old mother was experiencing medical and cognitive problems. Prior to the middle of last month, the only thing I had noticed was her saying she was getting more forgetful, but her doctor had tested her and she was fine. Come to find out this was the simple, three word memory test.

In the middle of last month Mom ended up in the hospital due to rectal bleeding. While she was there she became very paranoid. She said things like the hospital was trying to kill so they could take her house, they were recording our conversation with the ear pulse oximeter, they were blocking her text messages, etc.

I made it back to her house in the first week of this month. She was home, but her mental condition had not improved. Her granddaughter, who had been living with Mom for five months, said ever since she had returned home at the end of last month, Mom has been unable to care for herself.

The granddaughter also mentioned a period of paranoia that occurred shortly before the hospital stay where Mom accused her of wanting to put her in a home.

The finances were a mess because Mom closed her checking account. This was done to stop payment on a recurring PayPal charge tied to scam software. I had advised Mom to close the PP account, but she did this instead. Closing the checking account absolutely snarled her bill payments and when I showed up her Medicare supplemental insurance, phone, and electricity were all at risk.

I arrived on a Saturday. Her GP works Tuesday-Thursday. Tuesday morning I put a call in, explained what was going on, and the GP had me take her to the ER. There they found she had heart failure, mild ischemic small vessel disease, and high levels of CO2 in her blood. She has COPD and has been on O2 for over 10 years. This hospital stay lasted a week, and then there was a week at a SNF.

During the last hospital stay I saw some, but not a lot of, improvement. She has significantly improved at the SNF, but she is still not at her previous baseline. She comes home tomorrow. I'll be the primary care give with some support from Home Health. The goal is to see if Mom still has capacity to live on her own (with visits from Home Health).

We have an appointment with her GP tomorrow. My goal is get some actual diagnostic work done. Other than explaining what's been happening. Can anyone recommend things I should communicate to the GP?

Emily 123

Ultimately if there is no other cause that can be screened out (thyroid, low B-12, UTI) you'll want her to have more in-depth cognitive testing because you're trying to anticipate her care needs.  It will help to share what she can and can't do in terms of ADL's and  IADL's.  

https://www.webmd.com/a-to-z-guides/what-are-activities-of-daily-living

Given that your mom is already anxious about the idea of having to move from her home, and a bit suspicious, it may be easier to put down on paper the changes you and her grandaughter have seen, and discretely give it to the office staff at check in so that the provider can review it before the appointment. Give the examples of the paranoia, noting that it got worse in the hospital (not unusual).   Many of us position ourselves behind our loved one's line of sight during doctor's visits and provide non-verbal input during discussions.  Very often the person with dementia is unaware of their changes, and so frank discussion of losses that they don't think they have  provokes anger.  Avoid that, even if it means communicationg 'around' your mother a bit.

The office should have a form that can designate who they can share healthcare information with-get your name on that and get it signed during the visit.  If your mom's provider offers an online healthcare portal it's a good time to get access to the account or set it up, using your contact information.   

IaaLoTW

Thanks Emily, that's all good input.

Fortunately, Mom had a Durable, General POA and and Advanced Directive/MPOA drawn up about 8 years back. I've been leaning heavily on those for the last two weeks while sorting out the bank accounts, credit cards, bills, medical providers, etc. They were a real lifesaver and I don't know what I would have done without them.

So far, Mom hasn't pushed back when we've discussed my concerns with other medical providers. I've been careful to include her as appropriate and she recognizes something is wrong. We've got to the point where she's agreed to sell her house and move to assisted living, but I'm really hoping (as I'm sure she is, too) that she'll continue to improve (hospital induced delirium and not dementia?).

I'll go over the ADLs and IADLs now.

EDIT: Her ADLs are pretty good. Her IADLs were pretty bad. I'm hoping they'll be better when she gets home this time.