Iron levels

[Charles66]

My 89 year old Mum with a Alzheimer’s diagnosis :
Following a routine blood test we have been told she has a significant drop in her iron level. The GP is talking examination, followed by cameras. We know this will cause Mum significant distress. We have POA for Health and Welfare so can we refuse any invasive exploration. Can we insist on iron tablets , injection etc

 

[Jaded'n'faded]

You can certainly refuse any invasive procedure - I don't blame you.

You can certainly suggest an alternative such as iron tablets though I'm not sure you can insist as the doc may say it's not suitable without the exam first. But you may want to have a general talk with the doc about plans going forward, DNR, etc, if that's what you (or your mum) would want.

 

[Scarlet Lady]

Hi, @Charles66. I don’t know how advanced your mum’s dementia may be, but generally speaking, invasive procedures are definitely not the way to go for someone with Alzheimer’s. Old people can have significantly reduced iron levels because their bodies can no longer absorb iron properly. I understand that this is very common, but many doctors are unwilling to accept a diagnosis of old age and are adamant that there must be a blood loss somewhere, indicative of a malignancy. Hence the suggestion of endless examinations and invasive procedures. My mother endured 18 months of this and it was horrendous. She was like a wounded animal. In the end, they found nothing and she was given two iron infusions which sorted her out. If that had been done in the first place, it would have saved months of hell.
Fortunately, in my aunt’s case, her GP and I are in complete agreement that if anything nasty should crop up, she will be diagnosed and treated realistically based on what she can cope with. She is 92 with advanced Alzheimer’s. There would be no point in prolonging her life unnecessarily.
I agree with @Jaded'n'faded that you need to have a frank and open conversation with the medics and make clear what your opinions are.

 

[jennifer1967]

my husband had low iron levels and they wanted to cameras up and down. he totally refused so instead they gave him a CT scan as with men it can be a sign of bowel cancer. didnt see anything but in the end decided that a maintenance dose of iron tablets along with 6 monthly blood tests would be done. my husband said even if they found something, then he wouldnt have the treatment so was not worth putting him through invasive tests.

 

[lollyc]

My 89 year old Mum with a Alzheimer’s diagnosis :
Following a routine blood test we have been told she has a significant drop in her iron level. The GP is talking examination, followed by cameras. We know this will cause Mum significant distress. We have POA for Health and Welfare so can we refuse any invasive exploration. Can we insist on iron tablets , injection etc

I have found that an honest discussion with GP is the best way forward. They are unlikely to suggest inaction, for fear of being accused of ...well, who knows what?, but once you indicate that you don't want invasive treatments, they generally seem to be relieved that the situation is clarified.
We have decided than Mum will only have essential treatment, as she finds every medical appointment distressing.

 

[Chaplin]

My 89 year old Mum with a Alzheimer’s diagnosis :
Following a routine blood test we have been told she has a significant drop in her iron level. The GP is talking examination, followed by cameras. We know this will cause Mum significant distress. We have POA for Health and Welfare so can we refuse any invasive exploration. Can we insist on iron tablets , injection etc

We’ve just been through something similar with mum, 87 living in a nursing home with advanced mixed dementia, she has uncontrolled diabetes and is losing weight. GP had a conversation with me and we said nothing invasive but keep her comfortable. She sought advice from hospital about medication for mum and they immediately wanted to do invasive examinations. We said no, she is too frail but they agreed to virtual discussion with us and mum. You can refuse as POA and you know your mum better than anyone, knowing what she can tolerate. I was firm but thanked them for their interest in her situation.

 

[Jerseygirl]

My mum with alzheimers had a recent blood test showing very low iron too and dr gave 3 months tablets. Doctor asked for a faecal sample which came back as blood in it which could be cancer, or just polyps or nothing, but doctor knows mum would struggle with camera and would be too weak if surgery needed. However he spoke of if mum could manage a ct scan instead so waiting to hear from consultant if recommended or not.

 

[Charles66]

Thanks so much for your supportive replies. We have requested another blood test be done in the New Year and will not be accepting any invasive treatments.

 

[Charles66]

We have also requested iron tablets.

 

[Muttimuggle]

Gosh! I only just read this. My mother has depleting iron levels too. The doctor asked for the stool sample which was difficult to help her with (but nevertheless got done) . I said the colonoscopy or gastroscopy would be too invasive for my 90 year old mother with "moderate" dementia, living alone with some care in place.
I wish i had looked at these posts sooner as I was also ominously waiting for the outcome to her referral which stated "suspected cancer" although this referral by the GP certainly got her seen slightly sooner. I am expecting she will also get a CT scan and then iron tablets.
I really never knew that anaemia was incredibly common in the elderly. I checked by a search and found this to be true. The GP never mentioned this fact. She is also on the blood thinner Edoxoban so that is bound to feature in whatever reason there is , if found. Thank you for the insights.

 

[Muttimuggle]

My 89 year old Mum with a Alzheimer’s diagnosis :
Following a routine blood test we have been told she has a significant drop in her iron level. The GP is talking examination, followed by cameras. We know this will cause Mum significant distress. We have POA for Health and Welfare so can we refuse any invasive exploration. Can we insist on iron tablets , injection etc

My Mum aged 90 with mixed dementia was found recently to have the same thing after a routine blood test. I said that the invasive colonoscopy or gastroscopy would be too much for her and the GP tended to agree given that any internal bleeding caused by a potential cancer would raise the question - What would we do about it anyway! A referral was made to a n anaemia department in the hospital. I received the telephone consultation call. She had to do the poo sample as well and nothing showed up but, as the anaemia clinic suggested this is often the case. My Mum is on Edoxoban which is a blood thinning medication which would, of course, make any internal bleeding worse. Actually there were 2 GP visits several month apart and the second blood test had shown a further decline. After the first test I made sure Mum, who lives alone got some red meat ready meals in her freezer. She had been tending to eat the same thing many nights which was white fish, veg and potatoes...but as the blood count declined further it clearly wasn't the case that diet was causing it that much. So now she is on iron tablets, the Edoxoban continues and we press on. After this, I learn on here I think, that it is very common in the elderly for them to become deficient in iron...and lots of other things too as the body becomes less able to process nutrients.

 

[jennifer1967]

my husband was prescribed a maintenance dose of iron tablets once he was better blood test. they have now stopped them, not sure why but he hates them even with laxatives so i havent contacted the doctor. if he had symptoms eg tiredness etc then i would.

 

[Lawson58]

My husband is vegetarian and we tried hard to make sure that his diet was sufficient to maintain good health. However , he has been anaemic for a while which is something common for people with heart failure. He has also had an internal bleed and two nose bleeds which required hospitalisation so is a candidate for further bleeding.

He has taken iron tablets for a long time but his iron levels started getting very low so GP ordered an iron infusion, to be done at the clinic and not very invasive at all. I am not too sure how successful it was as he is still tired, and has low blood oxygen levels. GP was talking about trying one more infusion before considering colonoscopy or endoscopy so we wait and see.

 

[Moggymad]

My 92 yr old FIL with advanced dementia recently had an endoscopy. He is already in hospital having had an operation on a broken femur so already on some moderate pain relief. They said they would just numb the throat. He somehow coped with it surprisingly well given he was showing some signs of aggression following the op. I doubt very much he could have tolerated a colonoscopy procedure though. It did explain the reason for coughing up dried blood & wasn’t due to the fall he’d had. Think it depends very much on the individual.

 

[jennifer1967]

my husband had this problem and they wanted him to have camera up and down but he refused both. he was given a ct scan with dye that lights up the colon and barium meal swallow. he said he wouldnt have had any treatment even if it did show up cancer so there was really no point in going through the cameras. he had polyps in his stomach lining and his swallowing is out of rhythm. ive had both with sedation and although not nice, its over very quick.