Geriatric appointment concern

justbreathe2

My DH PCP sent a referral for a geriatric appointment after I discussed my concerns about my DH mild cognitive impairment and the care we are not getting from the neurologist.

My DH is not having any specific issues now except short term memory. His neurologist previously said he will not be able to help with any psychotic medications if he should start wandering, etc. My concern is being able to get help when I need it without having to wait months for an appointment.

The appointment is scheduled, but learned she is a geriatric nurse practitioner. I asked about the appointment. She will go over history with a short memory test. I have not told my DH because he will not go.

Tonight, my DH asked me why I made this appointment because he doesn’t have any problems except short memory, but feels he is doing better.  I told him that I was concerned with getting medications if he should need them.  So that led him asking me if I think he is worse. He doesn’t want anyone messing with his brain. And, why cannot we wait until it comes up….etc.   I did not argue only to say it might help me in the future. He was angry, but told me to do some research with what the geriatric doctor will do.

So when he finds out she is a geriatric nurse practitioner and not a doctor he is going to be upset.

Can anyone give me some help with how to handle.  Should I cancel and wait? He will be very upset enough with the testing. Will she not hold anything back…diagnose him with a stage, or symptoms to they may happen.

Thank you.

M1

i think you are very right to establish with someone before there's an urgent need. But since there's not any urgency, I think you can afford to be picky and get what you really want. I would call your PCP and say quite specifically that you'd rather see a physician than a NP. Alternatively, you can find out who her supervising physician is (there has to be one) and ask to see that person, even if it's a longer wait. A geriatric psychiatrist may be more help in the long run than a general geriatrician, BTW.

mom2boyz

Good evening. Although I know a lot of people are more comfortable with doctors, nurse practitioners can do most things a doctor can. You can usually get appointments quicker than with a Dr also.

Something you can tell him is it's just for monitoring how he is doing. They like to get a baseline and have them come back every 6 months or so depending on their condition to see if anything changes.

I wish you the best!

justbreathe2

Thank you M1. I will look into it. Early in his diagnosis we met with a clinical neuropsychologist. He was not able to prescribe medication. He was also very difficult to get into an appointment, and waited days for a return call. The healthcare in our area are very limited.

My DH will not like the psychiatrist title because he will be worried about testing, or they are messing with his brain.

This is all so difficult for me to handle.

Karen711

https://alzconnected.org/discussion/70032/geriatric-appointment-concern

Agree with M1, good points all. My DW and I have the same PCP and she is on board to help. But also, one plus to us going through the pain of diagnosis through a neurology practice is that we are established there and now can get help there when needed. Even though now my DW says she will never return there, I have kept up the relationship. Let us know how it goes.
Best Wishes, Karen

Iris L.

I don't see anything wrong in starting with the geriatric nurse practitioner. She has oversight by a physician. She will perhsps be more available than the doctor. Tell her your concerns about anticipating potential problems. Ask if she knows about silent UTIs as a cause of sudden behavioral changes.

Iris

M1

Justbreathe, remember you don't have to tell him explicitly that he's seeing a psychiatrist. You can just tell him it's for a second opinion.

harshedbuzz

@justbreathe2

Kudos to you for proactively adding geripsych to your team— I wish I'd done it sooner.

My dad historically denigrated mental healthcare and those who needed it. I anticipated a geripsych to be a hard sell, so I told him the doctor was a second opinion to make sure he was getting the best care possible. The geripsych had a better chairside manner than any of the neurologists we saw, and dad actually enjoyed the visits.

HB

orth

my DW refused to go to a neurologist and our PCP set her up with a nurse practitioner. This was a great move and we do not use terms in front of DW that would upset her. Most of the main conversations are through a patient portal. I hate having to work this way but DW does not see or accept any decline. She gets very anxious and angry if any of these conversations arise.

Jeanne C.

Others may disagree, but I really like to see a nurse practitioner. They have the ability to do much of what an MD does but they still use the nurse training they have, which, I think, leads to more conversation and partnership. For my own care, I see an NP and myhusband usually saw the NP at the memory care practice.

Kibbee

DH and I have had very good experiences with advanced practice nurse practitioners,. We’ve seen them in a number of different specialties, and the ones we’ve encountered have been extremely knowledgeable and have been able to prescribe as needed. (There may be some drug types they cannot prescribe but thus far we’ve not run into any problems with that.). The other thing we like about APNPs, is the amount of time they were able spend with us. Perhaps their schedules are structured differently than MDs, because they seemed to have more time to really talk with us and understand our situation. We’ve found APNPs to be compassionate, and very responsive and thorough in their care.

SDianeL

If the Nurse Practitioner is a Psychiatric one, that's OK. If not, ask specifically for a referral to a Geriatric Psychiatrist. They are better able to prescribe & monitor medications as needed for agitation, etc. Don't tell him what kind of doctor he's seeing. Tell him is primary care doctor wanted more tests. (you don't have to tell him why). Call and ask to speak to the person he has the appointment with and explain the situation. Ask them not to tell him their title. Tell them him behaviors (write them down so you don't forget). Ask them not to say Alzheimer's or Dementia to him. Bottom line is lie or lie by omission then change the subject. Fibs will become common with this terrible disease.

ImMaggieMae

Tell your DH that the disease is messing with his brain. The doctors are there to do everything they can to try to get his brain to function as it should.
The most helpful person my DH sees every 4 months or so is the NP for his neurologist. She is very thorough and professional and does most of the testing, etc. for his neurologist. He was already taking an antipsychotic when we got the first appointment with the neurologist. It was prescribed by a hospital psychiatrist when an ER visit for extreme agitation kept him in the hospital for a week. The hospital psychiatrist was very knowledgeable about dementia and very sympathetic to what caregivers have to go through. The neurologist continued with his Risperidone.
His PCP first prescribed an antipsychotic, Seroquel, but at a very low dose that was increased once during the month he was on it, but probably not a high enough dose to keep him from that ER visit. Many doctors don’t like to prescribe antipsychotics. I would ask the NP’s office ahead of time if she can prescribe one later if needed. It seems at a certain point they are the most effective for delusions, hallucinations, wandering, aggression, etc. I’ve seen that here, on the forums, where loved ones are prescribed all sorts of other drugs and when they end up in a care home, the antipsychotics are prescribed in order for them to stay calm enough to fit in.

Caro_Lynne

@Jeanne C. totally agree with your about nurse practitioner. When LO's primary is not available, we see the NP. He's so compassionate and also able to prescribe meds.

Mimi50

I think you should keep the appointment. Tell him that you want to see if his medications need to be adjusted. So far my husband who was diagnosed 2 years ago. With vascular dementia is not giving me trouble about going to the doctor. I have not been on here for quite sometime. The last time I was he was in the Early Stages. He now is approaching mid stages. More searching for words and sleeping more. When they are first diagnosed it is overwhelming. You are not sure what to do. Give yourself break and time to process everything.

Mimi50

It makes things a lot more difficult. If getting access to healthcare you need for him. Which adds to your stress. I am so sorry and sending virtual hugs. One thing I started doing. When my husband was diagnosed. Is I have small notebook that I write down any changes. That I see he is not aware of the fact that I am monitoring any changes. When he has doctors appointment I take it with me.

housefinch

It sounds like you may be giving him more information and details than he can really understand or process anymore. He sounds like he’s getting angry and inflexible upon hearing the otherwise reasonable plan. I would give him a very vague amount of information as you are driving to the appointment. Nothing before then. I think you need to reframe your approach for someone whose executive functioning can no longer manage that information appropriately. You’re driving the bus now. I’m sorry.

justbreathe2

https://alzconnected.org/discussion/comment/217085#Comment_217085

Thank you for your comments. This is what I hear from many people.

justbreathe2

Thank you for your comment. We have a good relationship with his PCP, but it is always rushed since the doctor spends only 20 minutes with us. He cannot help my DH psychotic meds if he should need it in the future.

justbreathe2

https://alzconnected.org/discussion/comment/217199#Comment_217199

Thank you Mimi50, thank you for your comments. Yes, I also keep a journal with dates, meds, changes I see. It has been helpful. Wished I had started jotting down the dates when I started to see the changes in him.

justbreathe2

https://alzconnected.org/discussion/comment/217217#Comment_217217

Thank you housefinch for your comments. Yes, I have learned not to argue, and I give little information as possible. My DH asks many questions about doctors and appointments. Sometimes it is just difficult coming with few words, or no words. Distraction is also a helpful tool…

justbreathe2

Thank you everyone for your comments. I plan to call to learn more about the appointment and see if geriatric psychiatrist is available.

My DH apologized to me at bedtime and again the next morning for getting upset with me. He knows I am doing my best. He saw it on the calendar and it was sudden reaction with it that I was not prepared.

I will let you all know how it goes after his appointment on August 1. Thanks!