1. Expert Q&A: Protecting a person with dementia from financial abuse - Weds 26 June, 3:30-4:30 pm

    Financial abuse can have serious consequences for a person with dementia. Find out how to protect a person with dementia from financial abuse.

    Sam, our Knowledge Officer (Legal and Welfare Rights) is our expert on this topic. She will be here to answer your questions on Wednesday 26 June between 3:30 - 4:30 pm.

    You can either post questions >here< or email them to us at talkingpoint@alzheimers.org.uk and we'll answer as many as we can on the day.

  1. Taffy

    Taffy Registered User

    Apr 15, 2007
    1,314
    Hi All, I would very much like to here from anyone who has known or knows of a
    sufferer, that has had cataract surgery. Even your thoughts would be a help. Briefly, I'll explain my asking. Mum was diagnosed about six years back with a tumor in her actual eye, further testing showed a satellite tumor and the start of a cataract also. It was decided because of mum's age, dementia, the sight been not affected and the likelihood of something else taking mum, it would be best, to keep a very close eye on the situation.Mum started with 1 monthly tests then over the years it went to 6 monthly. March of 2006 it was decided that if the tumor(which they expect is a melanoma because of it's thickness) still remained dormant, then the specialist would decide at the september visit, if he would remove the cataract. The Sept appointment came and mum refused to go,by this time she had very little knowledge; if any, of her eye problem. Her GP felt just let her be and let nature takes it cause. Mum now been in the care home, her medical notes are been reviewed. I received a phone call from the home saying: mum's notes would be put before the homes visiting GP concerning further treatment.My concerns...mum will not be able to comprehend any of this...mum would need to see a doctor who's speciality is melanoma....so she would go back to the same specialist....4 hour round trip...at least one and a half to Two hours having consult and ultra sounds etc... which is all going to be very stressful...then the surgery, if the tumor is dormant... what about the effects of the anaesthetic...the after care...will she rub it, probably yes...the return trip next day to have it checked...what if disturbing the eye sets the tumor off...the cataract will eventually prevent mum from seeing...should I just let her be. Please keep in mind that she hasn't fully settled in yet, at the home, but things at present are looking promising.Regards Taffy.
     
  2. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,678
    Kent
    Hi Taffy.

    I have had cataract surgery and it was brilliant. It was simple, painless and made the world look as if it had been spring cleaned.

    But after surgery, to prevent infection, hygeine had to be scrupulous, and the application of drops, was complex. I can`t remember exactly, but I think there were 3 or 4 different drops to be applied at different times, ie. 3 hourly, four hourly, etc. I also had to wear an eye shield for a few days, and to sleep with.

    Because of the fact I am unable to keep my eye still, I had to have a general anaesthetic, whereas a local is usual. What type of anaesthetic would be used for your mother, I wouldn`t like to guess.

    You can appreciate the complexities, even without the further complications of a melanoma.

    My husband has cataracts on both eyes, and categorically refuses to have surgery. He still watches TV and reads the paper, in the evening with electric light, which I`m unable to do, so I`m not pushing it.

    I would discuss your fears with the home`s GP and see what advice you are given.
     
  3. Skye

    Skye Registered User

    Aug 29, 2006
    17,000
    SW Scotland
    Hi Taffy

    It is a difficult decision, isn't it? I can understand your worries, the cataract operation itself would be a worry, but when there is a tumour involved as well, it makes the decision so much more difficult.

    I think I would ring or write to the nursing home doctor and ask for an appointment to to discuss your mum. It could well be that he also will recommend leaving well alone, but if he thinks the operation should go ahead, at least he should tell you what is involved. I actually don't think he would make that decision himself, but would refer your mum to a consultant for assessment. It's by no means a straighforward situation.

    The caratact operation on it's own is not a difficult one, and presumably the NH would deal with the drops. It's the other issues you need to know about.

    Let us know,
     
  4. Canadian Joanne

    Canadian Joanne Volunteer Moderator

    Apr 8, 2005
    15,985
    Toronto, Canada
    We chose not to

    Hi Taffy,
    We were in a similar situation with my mother 2 years ago. After waiting 6 months for the appointment, we saw the specialist. My mother was then in the beginning of the severe stage of Alzheimer.

    Based on her behaviour in the chair, the specialist said that she would require general anesthesia. This could cause a catastrophic decline in her AD, while he said the surgery would only marginally improve her quality of life.

    There weren't only the risks of the surgery, it was all the aftercare which Sylvia mentioned. We knew my mother would pick away at whatever was on her eye. With her hygiene issues, that could bring a horrific infection.

    So we felt that a marginal improvement was not worth all the risks and stress and aggravation. Mother is still fine and we feel we made the right decision.

    I think the decision should rest with the family and not with the doctors. Certainly take their advice in mind. Have the meeting with the visiting GP & tell him/her how her own GP feels about it, based on knowing your mother.

    Good luck.
     
  5. Taffy

    Taffy Registered User

    Apr 15, 2007
    1,314
    Thankyou, Sylvia, Hazel and Joanne. Sylvia, I didn't even think of infection when I mentioned that mum would probably not leave the eye alone. The one thing that concerns me most with mum's care now is the hygeine, she sure has the nack of slipping through the radar when it comes to shower or change of clothes.

    Hazel, I did speak with the registered nurse at the home to-day, I asked about after care, and addressed the possiblities of mum not leaving the eye alone. The drops wont be a problem and the care assistant can remind her not to touch the eye, this clearly wont work as she often rubs her eye now. I have noticed that sun and bright light irritates mum's eye.

    Joanne,yes, the stress, risk and aggravation I'm sure would be great, not to mention I would be back to square one in way off, the eye needing to be closely monitored in case the melanoma started to take off. I will speak with the NH's GP and I will also discuss it with mum's old GP he's always been honest and I will never forget how he always treated mum with dignity. I would like to meet this other GP as he will be caring for mum if need be. At one time, I could always look at a situation and know in my own mind what to do, but now, it's like my confidence is shot to pieces.
    I'll keep you posted. Take Care. Taffy.
     
  6. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,678
    Kent
    Dear Taffy,

    I was told by by surgeon, the two biggest risks factors following cataract surgery are heamorrhage and infection.
    Haemorrhage is rare, as is infection, but the eye must NOT be rubbed.

    The light sensitivity your mother has is typical of cataracts. In sunlight, everything looks like light shimmering on water. Electric light is offensive.
     
  7. Kathleen

    Kathleen Registered User

    Mar 12, 2005
    639
    West Sussex
    Unless a care assistant is assigned to sit with your Mum 24/7, how is reminding her going to work? From you Mum's viewpoint, she is going to be told off constantly, poor lady.

    I would definitely see if her old GP could write to the home and the new GP practice to give them the background on your Mum's eye problems.

    You know your Mum best and surely have the right to make decisions over something as important as this.

    Good luck, you seem to be doing all the right things.

    Kathleen
     
  8. Taffy

    Taffy Registered User

    Apr 15, 2007
    1,314
    Hi Sylvia & Kathleen
    All mum's medical notes were faxed to the care home shortly are admission.Dad hasn't been keeping to well lately so I have not mentioned this with him, as yet, he is usually happy to leave everything to me anyway.I don't know this care home GP or anything of him. When mum had the Power of Attorney drawn up she did stipulate that she wanted me to be able to make decisions on any medical treatment if she wasn't of sound mind. It is only a General power of Attorney with a clause that it would still be effective if she wasn't of sound mind, now I'm not sure if this means financial only. I will ask her solicitor.I have thought about this and all the risks involved, I don't think it would be in mum's best interest to have surgery.I hope that dad or myself can make the decision, if it comes to that. Thankyou for your views. Taffy.
     
  9. forgetmenot

    forgetmenot Registered User

    Jul 6, 2007
    25
    London
    cataracts

    [QUOTE=Linda
    I was very interested to see the correspondence on cataracts. My mother has vascular dementia and has had cataracts for 4 years - she was referred to a consultant this year. I went to the hospital with her. It was like taking a child - she has lost so much weight and is very tiny - they had to prop her up on pillows on the seat so that they could do the tests and it was ouch, ouch every few seconds when they weren't even touching her. They were very thorough though and treated her well, but asked her questions about what she can see. My mother is one that states yes I am fine to everything when she is not. I told them that and they said if we operate consent has to come from her. I was put in a very awkward position and felt very helpless - surely the next of kin's views are taken into account.

    regards
    Linda
     
  10. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,678
    Kent
    Hello Linda, Welcome to Talking Point [TP]

    Do you have a EPOA for your mother? If so I`m sure you can make decisions for her on health matters, as long as they are in her best interests.

    Take care.
     
  11. sue38

    sue38 Registered User

    Mar 6, 2007
    10,856
    Wigan, Lancs
    Hi Linda,

    Unfortunately the exisiting EPA (in England) does not give the attorney the power to make decisions regarding medical care, but just financial matters. Come 1st October it will be possible to make a lasting power of attorney which as I understand it will give the attorney the ability to make such decisions.

    I think the problem for the health professionals at the moment is that there are no legal guidlines for them to take into account the views of the 'next of kin' of an adult. To complicate matters further there is no legal definition of 'next of kin'. :confused:

    Sue
     
  12. Margaret W

    Margaret W Registered User

    Apr 28, 2007
    3,725
    North Derbyshire
    Epoa

    Agree with Sue, the old style EPOA only gives power over financial matters. There is a new Lving Power of Attorney which enables you to make decisions regarding where she lives and medical treatment, but once your parent has AD you could not take one out without difficulty, unless your parent is capable of agreeing to it. I am not sure of the significance of the October date. Someone has told me of a number of changes to be made in October, can you advise what they are?

    Regards

    Margaret
     
  13. Margaret W

    Margaret W Registered User

    Apr 28, 2007
    3,725
    North Derbyshire
    Epoa

    Sorry "Lasting Power of Attorney" is the correct title.

    Margaret
     
  14. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,678
    Kent
    Apologies, Linda for giving wrong information.

    I would have thought decisions on health were being made constantly, on behalf of those who are unable to make them for themselves. How wrong was I. :eek:
     
  15. sue38

    sue38 Registered User

    Mar 6, 2007
    10,856
    Wigan, Lancs
  16. Nell

    Nell Registered User

    Aug 9, 2005
    1,170
    Australia
    Taffy is in Australia and our rules might be different. I suggest you check it out locally to see what you may or may not do. It has set me wondering too, so I'm going to check up as well to see what is covered by POA and what is not. Thanks Taffy!
     
  17. Taffy

    Taffy Registered User

    Apr 15, 2007
    1,314
    Hi Nell, I seen the solicitor to-day, re the POA covering medical issues. I didn't get to see the solicitor that actually had drawn up the POA, but his co-worker explained the POA only covered financial issues, and continued to be effective even if mum was of unsound mind.What I needed to apply for was a 'Appointment of Enduring Guardian' so we all had our wires crossed, the POA has been very useful but the Enduring Guardian is what I really need, so I will have to think seriously about applying to the Guardianship Board.
     
  18. jessie07

    jessie07 Registered User

    Jul 12, 2007
    2
    i think there are two questions here. will this improve your mums quality of life and How much distress is it going to cause her to have the treatment for the cataract operation.

    I am an optometrist and work in domiciliary care. I also care for two parents with dementia. If the caract is slowly progressive it may well be better to leave well alone because there are a series of very acute tests that will have to be done before she can have the op. If these are not done properly, it can cause complications meaning you mum could end up with vision worse than she started off with.

    Although sometimes doctors may come across as impersonal, they speak from experience.

    My father has cataracts and i wont go through the process because he is quite forgetful and whilst he agreed on having the treatment one day he forgot about it the next!

    If your mum can still do the things she wants to do- i would suggest leaving well alone
     
  19. Grannie G

    Grannie G Volunteer Moderator

    Apr 3, 2006
    68,678
    Kent
    Thanks Jessie, your post has, unintentionally helped me too.

    My husband is 75, in his 2nd year since diagnosis, but probably 8th, year since onset, and has cataracts in both eyes.

    He is terrified of surgery, and has refused it once. He is still able to read at night, by electric light, and manages well. His biggest problem is light sensitivity, and he wears sunglasses and a baseball cap most of the time, out doors.

    He has regular sight tests and I dread him really needing surgery. I thought it was just the aftercare that would have posed the problems, having completely forgotten about the tests before surgery.

    Now I can see it will be a no go area, and will stop worrying about it.

    Thanks again.
     
  20. Taffy

    Taffy Registered User

    Apr 15, 2007
    1,314
    Hi Jessie, Thankyou for your reply,I totally agree with you. Mum's GP before her entry into the home also was of this view.The specialist who was caring for mum's eye tumour was prepared to do the cataract if there was no change in her eye when he reviewed it next, but mum refused to go to the appointment. Mum went into a care home 2 months ago and it is, the care homes GP that wants the review started again. I dont really have a problem with the tumour been monitored,but I am not in favour of any cataract surgery. I do appreciate the care homes concern as they are responsible for her wellbeing and a appointment has been made for this review in mid august. The eye specialist that will review mum will forward the report onto the original specialist and I'll wait and see from there. If necessary I will apply for "Appointed Guardian" through the guardianship board. Thanks again. Taffy.
     

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