How can I get mom to go for a diagnosis?

Does your mom live with you or by herself? Is it imperative to get a diagnosis right now? Sometimes, relatives need to get the person to a safe place that they can be cared for and that's why they need a diagnosis.

If her cognition is still pretty good, you may not be able to get her tested if she resists. You might just write a list of things that you've noticed and share them with her doctor. You might say that you need to see the doctor for some issue that you are having and ask her to accompany you. While she's there, the doctor can ask her a few questions. Be prepared though, because on a good day, sometimes they do really well and you end up wondering what in the hey happened.

Or what if you go in with her to get a flu shot or to review her medications. I'd make it about other things and not her state of mind. I told my cousin that she needed to have her blood work done, get medication prescriptions, physical therapy for her balance problems, etc. Once there, the doctor did a mini mental eval in the office.

What Sunnygirl1 has written is good advice. I had a real bear of a problem getting Mom evaluated, and I needed that evaluation for placement of her into a retirement community. I did exactly what Sunnygirl1 has recommended. That was three years ago. Mom now has advanced Alzheimer's and lives in a locked-down unit in a nursing home. So, you can see how quickly things can progress. Remember above all else that the elderly will have a great fear of abandonment. You must always assure your mom that you will not abandon her. And, I hope you won't. Gentleness and kindness is very important at this time, as your mom's fear is only going to grow. The road you and your mom are embarking on will not be easy, but you can do this.

Making an appointment with a doctor for something besides cognitive issues is a good idea. I'd write the doctor a letter ahead of the appointment listing what you observe - this is where taking notes helps a lot. Then you can let the doctor be the "bad guy" and refer her to a specialist if he or she sees these issues as a problem.
Good luck,
Carol

My father refused to go to a doctor for five years. I finally got him in. I still don't have any diagnosis, just lots of impairments, and nobody can/will do anything. So, don't assume that getting her to comply with doctoring is going to help. You can't force someone to get help. Believe me, I've tried.

At the monthly meeting that I organize for community members interested in Dementia, Dr, Nathan Schor, a well-known geriatric psychiatrist, suggested that, in cases, like yours, that you write a letter to her internist or GP. The letter should contain your observation in detail (suggested format by date and use bullets or numbers for easier reading.) Your letter should state your relationship to the person in question, your mother. It should detail your concerns, such as her refusal to be evaluated.
HIPPA prevents her physician from replying to you. But he will be aware your concerns the next time he sees your mother.
This may sound like a frustrating approach, but sounds like you need to try everything. Good luck.

I cared for my mother for about 8 years prior to her death and I have been in your shoes, What all these women have said is true the situation you are in is a hard one and it will get worse. I was frustrated beyond belief that Mom could be so aware and concise in the doctors office (on her best behavior) and the doctors all thought she was fine, however within 15 minutes of leaving the office, she did not remember ever being there and the doctors were not seeing this side of her. Half the time I thought the doctors must be thinking I was the one in need of help! I use to set up appointments and I would write a letter to the doctor telling him everything that Mom was doing and what we needed help with and ask that he please read the entire letter BEFORE seeing her, not scan it while sitting in front of her. I wanted them to be aware of what was going on and her actions but I also did not feel 100% comfortable with saying all of this out loud in front of her, Did she have dementia, yes
she did but she had lucid moments and it hurt her to hear all this stuff being talked about and she remembered none of it. She would even argue the point in front of the doctor and she sounded fine so I cannot totally blame the doctors for not listening to me. Sometimes I feel like it is with our friends as well, "If they have not lived it, they do not understand it." Unfortunately it got to the point with Mom that we had to force her to go to the doctor because she did not want to leave the house. My sister and I had to finally join forces and tell her that she was going even if we had to drag her. I also talked with Mom and tried to tell her that testing was needed just to make sure she was fine and if anything was wrong get medication. This is a very hard disease and I feel for you!

In the last of the 8 years caring for Mom I reached my breaking point because I could not handle everything alone and my two sisters were not helping. I wound up hospitalized for exhaustion and told by two doctors that I was heading for a stroke or heart attack and could not keep caring for Mom so I had to leave her for the final 6 months of her life. So please take care of yourself and seek help from all siblings in your family.

Now I am in your Mom's shoes. After just two years I believe that I am now experiencing signs of dementia. It is really a two edged sword to now be on the other side. I asked my Psychiatrist/Research doctor two years ago to test me for memory loss however he felt that I was under too much stress. Now after being on Zoloft for two years I am asking to be taken off due to side effects and worsening of my memory. Am I scared, yes I am because I know where I am heading and I do not want to go there. I am 64 and have a 24 year old daughter that is just beginning her life so who will help me as I did my mother? Sometimes "knowing" is good because we can hop on the road to curing our illnesses but sometimes it is not good when you know there is no cure, you realize where you are heading and know you are taking your family down that road with you. You do not want to be a burden and yet you are fully aware that you will be and you will lose all your precious memories of the past and present and you become afraid to tell your family because what lies ahead is a downward spiral and other people take away your freedom of choice in almost every area of your life "for your own good." This is horrifying!

Love your Mom and be thankful for the lucid moments, write letters and try to explain the situation to her doctors as best as you can. Push for tests even under the guise of them being for something else. Remember that when your Mom is difficult she is not doing this on purpose, she has an illness that she cannot control and it will get worse and each day is a new "adventure," Remember she is frightened and may deny signs and symptoms, ALWAYS make her feel needed...we all need a purpose to live. Do not do everything for her, she needs to be active and able to do things on her own. Rest, you will need it and most importantly LOVE EACH OTHER!

Hopefully you can get her doctor to understand. My MIL's doctor didn't and still does not. My wife has given up. The only thing I'll add is that we BEG our son not to ever feel that they have to care for us the way we do for his grandmother. It can be a living hell.

I agree with the post about a written memo to the doctor. I've done with several relatives. I write out a detailed list of what has been going on and forward it to the doctor BEFORE the appointment. I STRESS how urgent it is for the doctor to review the memo. He doesn't need to tell me anything. I just want him to have the info when he sees my loved one. That way, he knows the history and knows what to ask and look for.

Also position yourself behind the patient, so when they start answering questions incorrectly, you can nod that it's wrong. I let the doctor take the lead. Most know how to handle it as they see it a lot.

All of the comments above are great suggestions and heart touching stories. I would tell mom that I was going to the doctor and she always wanted to go where ever I went so that worked. Plus we both go to the same doctor, so that helps. I also would take her for a ride and not tell her where we were going until we goth there, that usually helped lower her anxiety level. I normally would tell her it was just a check up and not go into detail. So I was able to get her to a neurologist shortly after she moved in with me and got the official diagnosis. It was a visit I will probably never forget. He was a young doctor and he pulled his stool up right in front of my mother and looked her straight in the eye and said "Joanne, you have dementia, you have Alzheimer's" I had to leave the room. I wasn't expecting the doctor to be so blunt and matter of fact. I met up with him before I left the office and told him exactly that, his comment was "It's my job to let her know. She can hate me, that's ok. But it had to be said". Mom was very quiet for several days after. Mom has never wanted to discuss it, denial is her preference. I respect that and always will. Keep on being there and loving her. Keep reassuring her that you are there for her and whatever she needs you will see to it that it gets taken care of. Hang in and above all - take care of yourself. Remember, you can't take care of some else if you don't take care of yourself :)

jajocaregiver08, when is the last time she had a complete physical? Insurance companies now will drop you if you haven't seen your primary within a year. Tell her she will lose her insurance if she does not see the MD yearly. You go with her, and you make sure they order all the right tests, including memory.

I asked my mother's GP to do a memory test, and all he did was pass the buck to a neurologist - after his office staff said "sure we do that here". BS. At any rate, my excuse for taking her was that she had hit her head and needed stitches, and I told her I wanted to make sure that she was ok, that the GP was not qualified to evaluate head injuries.
Sadly, the neurologist also just came out and said mild cognitive impairment, with my mother in the room, prescribed a drug that mom can't take because it makes her ill. . . and it would not help anyway. So there you have it. Mom was depressed for days, which made the dementia worse. So now we don't talk about it. We don't talk about anything that upsets her anymore. My life is a series of answering the same questions over and over, and responding to the same comments over and over.
This is a cruel and heartbreaking disease.
And I'm bound and determined that I will NOT expect my daughter to care for me. Nor will I allow her to.

pamstegma, ins companies will DROP people who haven't seen their primary in a year? Amazing! I haven't seen a doctor in several years, and don't intend to, unless I'm unconscious or something's broken - God forbid! Have seen too many people, including my mom and in laws who are attached to doctors at the wrist and ankles to be willing to live that way....

I took mom to the doctor and told him in front of her that mom was having some memory problems like......and could he give her a pill for that? He got the message and took over. She had a good day with her rheumatologist and made me look like a complete fool. After awhile, he caught on. Pamstegma has a good idea too. I wrote a note to the doctor to not mention the word Alzheimer's along with my medical POA for her before he came in to see her. He never has. Its in writing, but I keep all her medical records. I refuse to scare an 88 year old woman. What is there to gain by that?

Assuming she lives with you, tell her you've got to go to the doctor's, but it will really be her doctor.

My mom is the bravest person I've ever met as she was youngest of the 3 sisters and her older sisters she was very aware that they had dementia when she started to recognize some of the same symptoms they had in the beginning she was starting to get but she was still aware enough at the time to read the writing on the walls for her destiny and that her progression would probably be similar. This is why I consider her the bravest person in the world I ever met. Can you imagine knowing that destiny and still want to go on? But because she was aware she allowed me to take her to a 3 hour evaluation. She wanted me with her during it and I wouldn't have wanted any other way to provide her comfort during this arduous interview and I had my own questions I wanted to ask also - like is it ok to fill in a word for her when she'd be getting frustrated tryin to pull it from her thoughts-they said it was fine if it made it less of a struggle for her and she was happier that way-asking about medications like aricept- questions had she'd been by herself, she would not remember or think to ask. Heck I'm guilty of that when doctors start telling you things about prescriptions or etc. and unless I write stuff down while I talk to my doctor I'm likely to forget some of the details. If you can provide her with comfort that you'll be right there taking notes and also asking questions and provide some levity on some of the subjects the evaluation team bring up...Here was where my mom and I started busting up laughing--the safety of the home interviewer asked if we had smoke detectors that worked with good batteries in them-- It was hard for my mom and I to get it together enough after I immediately said "OH Yeah" pretty much in sink with her. My dad wasn't a real patient person nor are most people when that alarm goes off when cooking and I had to explain why after that because my dad's profession used to be electronics so he extended the wires in the detector and put a 9 volt battery connection so it hung about 4ft down from detector so whoever got there first could yank out the battery and didn't need to step up on a chair-TO make it stop! My mom would not have been able to explain that and had i not been there she could of only gotten frustrated by explaining why she was laughing. My mom's GP scheduled this 3hour appt when I was with her at that appt so my mom was pretty well locked in. I hope you are able and your mom is comfortable with your being with her at appts. Mine wouldn't have been comfortable if I was in with her during her appts. Plus the waiting time always seems shorter when you're sitting in that cold room waiting for doctors if you have someone fun to chit chat with. We loved each other's company and had it been my dad to take her(she'd given up driving), it wouldn't have been fun at all.
My point here as long winded as it's been, make it comfortable and when it makes sense giggle about stuff like our smoke det. story to lighten the mood take her by someplace she likes to go after appts.-my mom liked Noah's Bagels to pick some up and bring them home to have with my pop and then he'd be thrilled too--mmm food! giggle.

There was one part that I had to help my mom through and that was the pre-questionaire to have completed before the appt. A few actually were about sex and her and my dad and the questions alone intimidated her. So I just showed her we put a big slash through it and say N/A (not applicable). So she didn't have to be embarrassed no matter what the answer might be, it wasn't relevant to this interview as far as she was concerned nor did she have to explain anything to me. just zip not applicable. and we went onto next questions. And she was comfortable when we'd look over the questions from then on she knowing if it was something she felt was irrelevant or embarrassing or whatever,she was in charge if she wanted to answer it or not. And you better believe when we got close to those questions at the interviewing and I could tell they were looking at the question and saw the big N/A and I knew when they'd be coming up. I just said there will be some questions my mom felt were intrusive and embarassing to her so just skip over the one's that show N/A you will only make her uncomfortable and those were her decisions to make as far as what she feels is relevant.

My further point is to let her know she still has her own say so or not to say so. It brings confidence back into a world that's become scarey. c

My wife preferred the psychological defense mechanism of denial and since she was the "boss", I gave in and supported that position. I tried to employ all the behavioral techniques found in current sources. I maintained this imprudent position until I had my mini-nervous breakdown and descent into depression. From that point, "I came out of the closet" and told the whole world that we both needed help. That was the turning point. Everything then started to improve. I now support early diagnosis and aggressive early treatment. I am now a dementia care activist.

Stop pushing Mom to go in for a diagnosis of dementia. I wouldn't want to go either. It is flu season, maybe she would agree to go to the doc for an evaluation of the sort of shot would be best for her. Then give doc information before the visit. Is she seeing a geriatrician? They are more accustomed to working with medical issues of the elderly. A family practice doc is not the best for working with elderly or dementia.

I was in a similar situation. My mom refused to believe that anything was wrong with her. Years later - she still doesn't think she has dementia and she lives in a memory care unit.

Going to the doctor did not work for us. Her doctor was not helpful at all. I told him my concerns and he thought my mother was fine. He did a memory test and she passed. Well duh, it was her short term memory that was an issue, not her long term memory. Also, at the time, my mom was in amazing health for a 90 year old. Everyone thought she was 80. She is also a very proud woman and took offense at my suggestions to get an evaluation.

The local hospital had a geriatric assessment center. She wasn't feeling well and I asked her to meet with my friend who was a nurse. She agreed, within 15 minutes - I had the diagnosis. It took me several tries to get there, but once I did it was a relief. Getting a flu shot sounds like a good also. If you have to trick her, than trick her. Good luck!

A geriatrician is key. If you/mom live someplave rural or remote, geriatricians can be few and far between. Hopefully you are close enough to a metro area or university medical center that you can connect with a doctor or practice that specializes in your mom's age group and telayed issues.


And good luck. Seriously. These elders can be stubborn beyond belief. They lie and resist and gaslight you til you feel like you're the one with failing neurological system. For us adult children, these years are terribly draining and distracting.

Whenever my mom's doctor's appointments were in the morning, she always appeared pretty alert and articulate. If the appointment was later in the day, her dementia was more apparent. I believe that was because of Sundowning. For that reason, you might consider an appointment later in the day, so that the doctor will have a better idea of her problem. Best wishes.

A "diagnosis" is not going to tell you what her mental status is. It is just a diagnosis, and a diagnosis can range from very mild to very severe. I do not think there is any "diagnostic testing" for dementia----the diagnosis is made on symptoms & complaints. You can't make her do anything she doesn't want to do, and "tricking" her into it is only going to cause her to get angry & not trust you.

You know what her mental status is---do you really need a "diagnosis"? If you're pushing her because YOU want to, I'm not surprised that she is refusing. Just take it for what it is---a "diagnosis" isn't going to change anything.

Your observations of what kinds of difficulties she is having is often a better assessment of her mental status than what we doctors are able to do in the office. (Asking families about 8 behaviors related to dementia has been shown to work as well for identifying likely dementia as many office-based approaches.)

But you should still strive to get her seen. The doctors should assess her for many common problems that either cause memory problems or make them worse. These include things like electrolyte disorders, medication side-effects, thryoid problems, and more.

It's true that many primary care doctors won't do the evaluation correctly and will either punt to a specialist or say things are fine or diagnose Alzheimer's before they've ruled out other related problems. I agree that it's good to put your concerns and observations in writing and send them before. Otherwise, it can help to be persistent/insistent with the doctor.

Of course, for all of this you have to physically get your mother in to see the doctor, and that's often very hard. People here have a lot of good suggestions. Be sure to take care of yourself through this process.

Providing the doctor with information ahead of time is generally helpful since so often the elder is able to act well enough to fool a doctor. Letters are useful for this approach.

I agree that a geriatrician is the best choice. Sadly, there are not nearly enough to go around. At 90, your mother is in good health and the neurologist likely figured she was excellent for her age. Sometimes, that's the best we can get.

This is frustrating for caregivers who want a diagnosis, but the reality is that since there is no cure and the drugs given for symptoms help some but not all (for a time), the real gain may not be that much anyway. It would be entirely different if she were 70. Then I'd push it further.

I hope that you can find a doctor who can help your mom (and you) lead some kind of quality life for her remaining years. That, to me, is the most important factor.

Good luck,
Carol

A difficult situation but unfortunately not uncommon.
you might try to get the person in to see a doctor under another reason rather than dementia. I.e. diabetes, gait problem which is often related to dementia. High blood pressure, something less dangerous than dementia. You could talk to doctor in advance such that they know the deal when you come in. Then might be 'routine tests' I.e. CAT scan to check brain plaque etc.. Try not to go to hospital if you can help it. If they have slight dementia a hospital stay can send them big alarms. Better with a doctor. Good luck!

Occationally tape some 'bad times' & 'good times' to show dr. - everyone is using cell phones now a days - then you will also have documentation of your concerns to show the med. professionals

Moecam: You meant to write occasionally.