Alexis McKenzie's mother had mild dementia, but things sounded all right when she telephoned home: Dad was with her, finishing his wife's sentences as they talked about puttering through the day and a drive to the store.
Then their phone service was cut off. "I mailed that check," McKenzie's father insisted. No, he had mailed the phone company a bank deposit slip instead. McKenzie visited and discovered spoiling food. Dad, the caregiver, was in trouble, too.
Dementia can sneak up on families, even people like McKenzie, who is the director of an Alzheimer's assisted-living facility in Washington. Alzheimer's sufferers are often adept at covering lapses early on, and spouses sometimes compensate.
Doctors frequently are fooled as well.
Now specialists are pushing for the first National Alzheimer's Plan to help overcome barriers to early detection, urging what is called dementia-capable primary care, more screenings for warning signs and regular checks of caregivers' physical and mental health.
For a doctor to ask someone with brewing dementia, "How are you?" isn't enough, says Laurel Coleman, a geriatric physician at Maine Medical Center who is part of a federal advisory council tackling the issue.
"So often I hear, 'The doctor only asks my mom how she is. She says fine and it's over,' " Coleman said. "That's not dementia-capable, or dementia-aware, primary care."
Family input should be mandatory, she told a recent council meeting. It's the only way to know if the patient really is eating and taking medicines as they claim, and not forgetting to turn off the stove.
The question is how to square that input with patient confidentiality, especially if the person never filed legal forms clearing family members to intervene, as happened with McKenzie.
Also, regularly seeking the input takes more time than a typical 15-minute visit and is poorly reimbursed, says Coleman. But she says more primary care physicians are starting to be trained in dementia's challenges.
The government's Alzheimer's advisers want doctors to steer families toward advanced-care planning, including designating a health care power of attorney, as soon as dementia is diagnosed.
A health care proxy won't be used until the person is quite sick. Experts advise also signing what's called a "release of information" allowing the doctor to discuss the person's care with whomever is named.
Email
Facebook
Google
Twitter
Favorites
More
Advertisement