What is the importance of annual doctor visit?
My DW was diagnosed three years ago and is still in the mild stage but clearly some progression. She also has anosognosia. Our memory care unit recommends an annual evaluation. My questions is, why? The diagnosis hasn't changed and she's still doing pretty well. I worry that the appointments will upset her and don't see the purpose. Any wisdom to share?
Thank you
Comments
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most people don’t know that the @annual checkup” was a concept pushed by the AMA years ago to generate income for doctors. It’s not an evidence-based recommendation. I wouldn’t worry about it. If they give you a hard time, maybe you can just defer and tell them you’re working on it. People in charge don’t like to be challenged on things like that, but I guarantee you it’s a knee jerk response that’s not been thought through.
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Will they refuse to renew prescriptions if they haven't seen her?
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probably not, she only takes one.
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For a PWD, I think just about everything a doctor could identify in those simple checkups, is something you probably wouldn't bother having them undergo treatment for. If they're monitoring some known condition, well then maybe.
Of course, I'm not a medical professional and I don't even play one on TV.2 -
no reason for an annual evaluation as they should be constantly evaluating her needs and meds. I would ask what is the purpose. Do they do it in the facility? Do they bill you?
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There isn't any cost but I just don't see the purpose or reason to put my DW through it if there really isn't anything they can do other than tell me that she is progressing. I already know that.
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An annual checkup is good for both men and women, especially when older. For women, breast and other types of cancer can be caught in the early stages, and for men, prostate cancer is curable if detected before it spreads outside of the prostate.
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Ok I'll bite and play devil's advocate here. I agree that there are benefits to some health screening—mostly for those who continue to be healthy, it's not clear that cancer screening etc. applies to those with dementia and certainly not to those in memory care. And—just to play devil's advocate—who says it needs to be done every year? There is no data that shows that annual checkups improve health outcomes. The AMA's recommendation of the "annual checkup" dates back to the 1930's, well before most current evidence-based screening recommendations were in place. It's just worth it, to me, to not take these things for granted without evidence to back them up. For example: it's not clear that finding prostate cancers with current screening methods improves men's health or prevents cancer deaths.
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Thanks for this info, Victoria. I will print it out. I never had this type of medical visit.
Iris
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I’ve taken my parents to the annual Medicare Wellness visit for the past several years. it’s been a good way to touch base with the doctor and address concerns. The last visit caught mom’s low oxygen stat and she was on oxygen by the end of the day.
However - I can also say that it’s getting harder for me to get mom to the doctor due to her mobility issues. If she becomes wheelchair bound, I’m going to find it very hard to get her there. If she progresses into the later stages of dementia, I will find it hard to get her there. So I can’t say how many more years I will take her. If she goes to an MC where a doctor comes to her, I would continue an annual visit at the MC for the one on one interaction with the doctor and the chance to ask questions
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jscott - when you refer to “our memory care unit”, is your DW a resident in a memory care facility? Or are you referring to a memory care clinic? Are they recommending an annual evaluation for her ALZ by a dementia specialist? Or are you talking about an annual check up at her PCP’s office?
My DH is not a resident in a MCF. Thes are the things we do:
My experience over the years with both medical drs and veterinary drs, is that when I do annual visits, in an urgent situation, they are more attentive. Maybe it shouldn’t be that way but that’s life.
For my DH, he sees his PCP every 6 mos. I find this is useful to discuss non-urgent issues and his progression. This way, when I use the portal for a question, that are up to date on his health issues. And having up to date health info in his chart makes it simpler if his PCP is unavailable and another practioner in the practice needs to address an issue. At his most recent visit, the PCP signed the form for a handicap plate, we got the DNR form signed as well as a discussion of his health issues and what a conservative approach means for those issues. I have to say, it’s harder being in charge of someone’s healthcare that is not a good historian than it is being in charge of one’s own health. And I find it helpful to give his PCP what limited info I can gather and try to sort out if there’s an issue.
The appts with the Neurology NP that works at the Alzheimer’s Institute are not super helpful right now. But there are times when things change quickly with DH’s dementia. And if my DH needs assistance/medications/ appt quickly, I will be able to get it more quickly if my DH is a patient that has been seen recently.On the other hand, DH no longer sees many specialists on a regular basis. No annual visits to the cardiologist, or the pulmonologist or the urologist.
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Thank you,
It's the memory care clinic that does the annual "memory" evaluation and checkup. This isn't the annual physical which we do regularly. I just don't understand the purpose of the annual memory appointment and testing. I don't feel like I learn anything at this point and wonder if the stress of putting my sweetheart through the appointment is of value.
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Should someone with dementia receive annual flu, Covid shots, etc and other preventative care such as mammograms and colonoscopies? I have been wondering about this since my DH’s primary doctor never mentions it in his summary of my DH’s annual visit. I do not go in with him so I don’t have a chance to ask his doctor. He is in the early stages and I don’t want to bring it up to him. What is anyone’s opinion?
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Dementia is a terminal illness. My DW and I have elected to stop screening tests such as mammograms and colonoscopies. Personally, I am considering not getting my wife any more covid or flu shots. I go back and forth on this one…
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I would only do the annual Medicare appt with your PCP. You do not want to be put in the new patient file.
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I said no to the colonoscopy for DH. We do both get flu and Covid vaccinations. First because when he gets sick he gets dehydrated. When he’s dehydrated, he gets weak and more confused and falls. Unpleasant for both of us. Second because I don’t want to catch it from him (or vice versa) and be sick and still have to take care of him.
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While you have not been going in with him, it may be time to start. You can not rely on him giving the doctor accurate information or him telling you accurately what the doctor said. I have been going in with him since the start of this journey. DH just answers that everything is fine when the PCP asks him. I go in at the PCP, the cardiologist, and the urologist. At the dermatologist we had back to back appointments so he went first alone. If the derm hadn't told me that she froze several precancerous lessions, I would have never known. By the time my appointment was done, he had forgotten.
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Commonly Used Abbreviations
DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
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