1. cuppalover

    cuppalover Registered User

    May 14, 2008
    2
    Glasgow
    Hi everyone,

    I've just joined the Forum today. What a relief to find people I can talk to.

    I have to take my Sister in law to see her Dr. tomorrow. We went to see him on Monday to express our concerns about her, mainly imagining her Grandson had visited her when we knew he was over 100 miles away, and telling my husband (her brother), that her husband who died 4yrs ago had been to see her. Her Dr. of course could not discuss her with us, but asked us to get her to make an appointment with him. She was not very happy with us, but did make the appointment while we were there.

    Apart from the memory problems she is fit and able to look after herself and her home, but we worry about her outside the home as she is inclined to be confused when she is in an area she is not too familiar with. Unfortunately she lives alone, and we live several miles away.

    I have no idea what her Dr. will suggest tomorrow. Does anyone know what usually happens at such visits? The Dr. has asked that one of us should be with her. Are there any questions we should ask or tests we should mention?

    All suggestions would be most gratefully received.

    Cuppalover
     
  2. citybythesea

    citybythesea Registered User

    Mar 23, 2008
    632
    coast of texas
    First of all, welcome to TP. You will find that we have many carers who are willing to help support you and give advice or guide you as needed in the right direction. Some areally good at easing fears about life and the system.

    I don't live in the UK I am in the US. I would suggest tho' in a gentle way that a mental status test be done on her. I would suggest this to her first tho. My suggestion is to go in the back door, if someone other than you and your husband has noticed this and brought it to her attention then I would tell her that it needs to be done for her own safety of health. If she has been understanding of her health in the past she will jump at the chance to prove anyone wrong. Sometimes a person is capable of passing the test in the early stages. Don't worry you have a baseline to start from after that. If she passes make sure that you praise her and keep in mind that this would need to be repated in a year, at minimum. (My brother had noticed my mother slipping..as did I...so when I went with her for her yearly I requested she take one to prove him wrong...that year she passed...the next year we redid it and she did not). I also recommend that you keep a diary of little odd things as to dates and times of what is going on. If you happen to notice an instigator to the problem write that down also.

    In the US we have what is known as HIPAA. It denies access to anyone the medical records of a patient without the written consent of that patient. Over here when a Hipaa policy is signed the patient can also designate a relative/friend to have this released to them. If you have those I would recommend getting her to allow the DR. to release/talk to you . If she trusts you she can be approached by saying that if she is incapacitated you made need to do this on her behalf. I also recommend that you talk with her about a Medical Power of Attorney. This gives you/the person she wishes to trust with administering and taking care of health decision issues after she is incapacitated. It does exclude DNR issues at the very early stages of AD. If she is in her right mind have her do a DNR also.

    Something that needs to be approached also is a Durable Power of Attorney. This will make handling her affairs much easier for you as she has designated you on her behalf after her incapacity. There is no easy way to approach these subjects and tho they seem cold hearted they are very important. I also recommend you and your husband doing the above and updating it also like a will. It is something that many of us do not think of and unfortunately if we do not take it into our matters then circumstances beyond our control can take it out of our hands.

    I do not know if it works the same in the UK but if a person becomes incapacitated before POA"S are written then a family member will have to go to court to get Gaurdianship (Which also gives you the right to conduct transactions on their behalf.) I have seen that go out of the hands of the family and go into the hands of unknown friends who took advantage of the situation.

    You asked about questions to the Dr. I would ask for a comlete blood workup so that he can see if everything is working right. Malfunctioning thyroid, or even female hormones out of whack can cause this. Perhaps even a mini TIA. Your sister-in-law needs a complete physical that is very thorough. I do not recommend blind siding your sister with accusations but with concern at wanting to get to the bottom of her problems, once she feels she can truly trust you and that you care for her well being it will be easier for her. I am sure she is confused and scared right now also.

    I also do not recommend you broach health and monetary/business issues at the same time. Sometimes a dementia patient can become overly excited and it just leads to spinning of the wheels because he/she cannot cope with too much in their mind anymore. Remember also that if you sister-in-law is diagnosed with AD she can still lead a life that over time will constantly change. You will have to choose battles wisely and some just aren't worth your frustration. Also remember that the memory shortens and unfortunately usually short term goes first. I like to say "she has only shortened her memory".

    I hope I have helped you some. Good luck.

    HUGS

    Nancy
     
  3. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,567
    Kent
    Hello cuppalover, :)

    I suggest you play it by ear tomorrow.

    Once you know what the GP has in mind you can take it from there. These things usually move quite slowly and GPs seem to have their own way of doing things.

    If the GP doesn`t conduct a memory test he might make an appointment for a consultant to see your sister.

    Please post with an update after the appointment.

    Take care xx
     
  4. ChrisH

    ChrisH Registered User

    Apr 16, 2008
    281
    Devon, England
    Hi Cuppalover

    Welcome to TP. I too was really relieved to find this forum. There are so many kind people here who offer all sorts of advice and comforting words, even when their own situations are far worse.

    You've got over the first hurdle of getting your S-I-L to go to her GP. I went through this process last Sept. with my mum. Her immediate reaction to my announcement that I'd made an appointment for her was 'You've done WHAT!!', followed immediately by 'Well actually I was planning on making an appointment myself', although she said it was because she wanted to ask if she needed to continue taking the statins she'd been on for a while. She was aware however that she was 'mislaying' things and forgetting names etc. and I said it was a good idea to get checked out while she was there.

    Her GP was brilliant. First he reviewed her meds and decided she didn't need to be on anything any more. Then he checked her blood pressure and said he'd arrange for some blood tests to be done. Then he said something like 'I understand your memory has been letting you down a bit recently'. To which mum responded that it wasn't really a problem as it was just mislaying things at home, not outside, and that she always found them eventually. He then suggested that it might be a good idea to a MMSE (mini mental state exam). He had a pad full of forms (I think each asks slightly different questions so they don't get the same form each time the test is done). If you Google MMSE you should get more details of exactly what it involves but basically it covers basic info like 'What day of the week is it?', 'Do you know where you are at the moment?' 'What floor are you on?'. One of the questions involved counting backwards from a given number in 7's (I had problems with that! Maths never was my strong point:)). She was asked to memorise 3 items and then had to recall them later in the test. She had to follow some instructions e.g. 'I'm going to put this pen on the floor and I want you to pick it up with your left hand', and there was also a drawing that she had to copy. The maximum score is 30. Anything between 0 and 23 shows 'disturbance of cognition'.

    Mum scored (I think it was) 28, but the GP still referred her to a psychiatrist. I think it was because of the way she answered some of the questions. e.g. in answer to 'What floor..' instead of saying 'We're on the first floor' she said something like 'We'll I know we're not on the ground floor. We had to come up some stairs' - she couldn't find the right words. The other thing she failed miserably on was the drawing - even after 2 attempts it was totally obvious she was never going to get anything like it and it was just 2 overlapping shapes not something by Rembrandt! When we'd arrived at the surgery she couldn't remember the date she was born to enter it into their computerised checking-in system.

    The Dr asked me if there were any other problems I'd noticed. I had already written him a letter explaining my (and her friends) concerns but I remembered a couple of other things and I think mum was a bit shocked as she obviously wasn't aware of what she'd been doing. My problem is that I'm an only child and live nearly 200 miles from mum and there are no near relatives either, so I'm totally dependent on what she tells me on the phone (of course there are no problems!!!) and what I can find out from her friends. It's really awful having to go behind her back but I know she won't tell me much and she gets a bit agitated if I try to press her for information.

    The power of attorney thing that citybythesea mentioned is also worth thinking about sooner rather than later. Over here it's called Lasting Power of Attorney (used to be called Enduring POA) and there are 2 versions. One deals with Property and Affairs (covers things like paying bills, managing bank accounts and invesments etc) and the other is Personal Welfare which deals with things like arranging care or going into a home if necessary. These do not have to be registered straight away (it costs a fair bit to do that) and you don't have to have both. There is plenty of scope within the document for the person to put limitations on the attorney. I suggest you google it for more info as it's quite involved. The person has to have a certificate signed to say they are competent to sign the doc i.e. that they understand what it is, what it's for and that there is no pressure on them to draw up the LPA. The attorney (or attorneys if more than 1) must not be present at the interview. I'm actually sitting here waiting for mum's gp to phone me back to discuss making an appointment to see him to sort this certificate bit out. It doesn't have to be the gp, it could be a solicitor or some other person (there's info given on who can and can't sign the cert). In another part of the doc the person can name up to 3 people who MUST be notified when the POA is registered to enable them to object if they think the person is still able to deal adequately with their own affairs etc. If a POA isn't in place and the person gets to the stage when they can not longer manage things like money it can apparently be a bit of a nightmare to sort it all out.

    I agree with Nancy that it is perhaps better not to overload you SIL with too many things to think about at once. Whenever I go to mum's she claims she's fine when she's on her own but when I go she gets in a bit of a dither. My problem is that because I'm self employed and have a family I can't go very often (about every 6 wks at present), and it's usually from Thurs to Sun so I tend to be a bit like a whirlwind trying to get the place cleaned up (she used to be spotless but now there are cobwebs), her clothes sorted (be prepared for dirty stuff put back in the wardrobe and clothes not changed often) - not to mention getting rid of all the stuff that's now 2 sizes too big cos she's lost weight! ('Of course I have a meal every day' - oh yeah!!!) etc. etc.

    I'll keep my fingers crossed that your SIL doesn't have this horrendous disease and that it's something as simple as a vitimin deficiency or something else curable. If it proves to be bad news then please keep visiting this forum. It really helps to know what to expect and to know there are lots of shoulders out there to cry on.

    In the time it's taken me to type this lot I expect a dozen others will have told you the same info in a much less verbose form. Sorry, I do tend to have verbal diarhea (can't spell either).:D:D

    GOOD LUCK and HUGS

    Chris
     
  5. ChrisH

    ChrisH Registered User

    Apr 16, 2008
    281
    Devon, England
    Update on LPA

    Me again:D Told you I get the verbals!

    Just thought I'd let you know that my mum's gp has just phoned and told me that the psychiatrist would be the one to deal with the LPA as he is obviously more conversant with mum's mental state than he is. Luckily we're seeing him on Friday so the gp suggested I take all the papers with me then and tell him before he starts her consultation that she wants to set up the LPA.

    Chris
     
  6. Margaret W

    Margaret W Registered User

    Apr 28, 2007
    3,725
    North Derbyshire
    HI Cuppalover, you will probably not pick this up till you have been to the doctor, so there is no point in me expressing an opinion. Let us know how you went on, and we can probably all add useful advice for you.

    Love

    Margaret
     
  7. cuppalover

    cuppalover Registered User

    May 14, 2008
    2
    Glasgow
    Thanks everyone for your replies.

    Well, I'm just back from the Dr's, and after conducting a few general memory tests, he agrees that Isabel, my SIL, does have a degree of memory loss.

    He is arranging for blood tests next Friday, and then thinks she will be referred to one of his colleagues at the local hospital.

    She was quite okay with the visit, but somehow I don't think the thought of AZ has occurred to her.
    I think the fact that she lives alone, has almost no contact with anyone apart from her visits to the local shops, and no interests outside her home, all contribute to this disease. Although I've tried to get her some interests outside her home, there is almost nothing for older people that interest her in her local area. She does go once a week with one of her neighbours to a local community centre to play Bingo. This is the highlight of her week, and she'll tell us over and over about it when we visit. I know she doesn't realize she has already told us about it.

    We try to include her as much as we can in our family get togethers.

    Something has just occurred to me. Recently when my husband went to visit her she said that she needed a new Freezer. He went to have a look at it to see if he could help. It was thick with Ice, and Isabel said she would have to replace it. He had quite a job explaining to her that it only needed defrosting.
    He helped her to put down some papers and emptied the freezer. The next day he went back to check and she had managed to fully defrost it and clean up, but she had put back all the defrosted food and turned it back on. What a time he had trying to get her to understand that the food could not be used. Fortunately there wasn't too much of it.

    Thanks everyone for letting me rabbit on. It does help.

    I'll keep in touch and let you know the outcome of the blood test.

    Cuppalover
     
  8. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    69,567
    Kent
    Thanks for the update cuppalover.:)
     

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