Elderly Mother - Showing signs of Dementia - What to do?

Hectors_House

comeandgo wrote: »

I know it has already been mentioned but I don't think you have answered. Has your mum had a urinary infection test? I have seen first hand, or I would never have believed it, that a totally confused, incontinent persons symptoms were caused by urinary infection. Antibiotics was all that was needed.

This is true. I work with an elderly lady in early stages of dementia and her mental issues got rapidly worse when she came down with a UTI.

You may be able to buy self testing kits that would at least alert you to get her doctor involved.

Tammer

Thanks for the recent messages. I will visit my Mum next weekend to ask what the doctor has said about her peeing herself all the time. I, too, feel this could be the root of a lot of problems. For example, she probably was hanging around outside mine when I was on holiday as she may have wet herself. Also, the need to pull into a Perth in her car possibly due to having wet herself and panicking. Truthfully, I don't like the thought of her visiting my house in this condition as she soaks the couch etc. This is possibly not very sympathetic of me, I know.

The problem is, as we've noted above, the doctor can't tell me anything and my mum is not coherent when I ask about the doctor, giving replies like "you don't know what they're like".

After visiting my mum I will try to get a phone call with the doctor to talk about things in general terms only.

poppy10_2

Tammer wrote: »

Police phoned my brother from up North to say my mum had bashed her car and people had phoned the police. The police said she had gone down a 1 way street, attempted to turn round but bashed her car causing some damage to the plastic trim. Police said she was confused, couldn't remember she had sons and soiled herself. My brother explained we've referred her to the doctor and the doctor says she's fine. The police said they would contact the doctor.

Put this in writing to the GP again - something along the lines of - "As you have been notified by the police, my mother recently had a road traffic accident caused by driving the wrong way down a one way street in a confused state. I am concerned that her memory loss is putting her at risk". The GP has a duty of care, and if anything were to happen to your mum, they would be in an indefensible position if they have failed to act on this information.

Tammer wrote: »

The doctor explained she cannot tell me anything if my mum hasn't said she can

This is not true. Remind the GP (in writing) to look up paragraphs 16 and 41-49 of the GMC's guidance on confidentiality.

You may disclose relevant personal information about a patient who lacks the capacity to consent if it is of overall benefit to the patient. When making the decision about whether to disclose information about a patient who lacks capacity to consent, you must make the care of the patient your first concern... You must also consider... the views of people close to the patient on the patient’s preferences, feelings, beliefs and values, and whether they consider the proposed disclosure to be of overall benefit to the patient. You might need to share personal information with a patient’s relatives, friends or carers to enable you to assess the overall benefit to the patient

Also ask them to get advice from their medical defence union (insurer) - e.g. the MPS:

Patients are assumed to have capacity, unless they have an impairment affecting their mind (eg, dementia), which means they are unable to make a specific decision at a specific time.
There is also a requirement to ensure all practical steps have been taken to help the individual make a decision.The overriding principle is that the disclosure of confidential information is made in the best interests of the person lacking capacity. This may involve releasing information about their condition – for example, to their carer, to ensure they receive the best treatment.

Tammer wrote: »

My thoughts are that either my brother or I should visit the doctor in person

Perhaps, but put everything in writing too. In-person conversations can be forgotten or not documented - most GPs will only write up a few sentences from a consultation. If you write to the practice, the letter will be uploaded and made part of her medical record - the GP can't later pretend they didn't know the risks. They are more likely to act if they think they could be pulled up in the event of something going wrong.

Tammer wrote: »

I phoned Social Services but they said they cannot do anything unless the doctor rules her unfit to make decisions independently or my mum asks for help.

Completely untrue. Social services can and should access capacity themselves - they shouldn't be relying on the GP's assessment. Capacity is time and decision-specific - even if the GP feels the person has capacity to make a medical decision, it doesn't necessarily follow that the person will also have capacity to make decisions on their accommodation, welfare and social care needs. And even if the person has capacity at one point in time, it doesn't mean that they will still have capacity the following month or even week. Social services have a duty of care, like the GP, and should be at least visiting to assess the situation and determine for themselves whether the person has capacity to refuse help.

Savvy_Sue

Tammer wrote: »

Thanks for the recent messages. I will visit my Mum next weekend to ask what the doctor has said about her peeing herself all the time. I, too, feel this could be the root of a lot of problems. For example, she probably was hanging around outside mine when I was on holiday as she may have wet herself. Also, the need to pull into a Perth in her car possibly due to having wet herself and panicking. Truthfully, I don't like the thought of her visiting my house in this condition as she soaks the couch etc. This is possibly not very sympathetic of me, I know.

The problem is, as we've noted above, the doctor can't tell me anything and my mum is not coherent when I ask about the doctor, giving replies like "you don't know what they're like".

After visiting my mum I will try to get a phone call with the doctor to talk about things in general terms only.

TBH, I wouldn't hold much hope for a sensible response to "what did the doctor say about you peeing yourself all the time?" She may not remember any visits to the doctor, she may not have told the doctor she had problems with incontinence, she may not remember anything said to her anyway!

The appointment with Neurology: if you suspect she didn't attend, the GP will have been informed. Would your mother give permission over the phone for you to speak to the GP and at least try to find out what that appointment was for?

Primrose

I would also investigate getting some incontinence pants and pads for your mum and also buy her a couple of Radar keys which you can buy online from various sources if you Google them. These are the keys that will unlock Disabled toilets at any time of day anywhere when other public toilets are normally locked.

kezzygirl

Uti would be ruled out as standard prior to dementia testing referral. I think she would be rather poorly if she has had a uti for the past five months and probably would have been in hospital by now. As I said in my last post,you have mentioned you doubt her capacity to accept or decline treatment, therefore the gp should talk to you about her as it would be in her best interests-people who lack capacity need safeguarding and this is the loophole we use to divulge info to ensure a person receives proper treatment ,given it's possible she is unable to make the decision herself. The other option would be a mental health act assessment- which you can request via social services. She sounds as though she is a risk to herself and others so this may be a viable option. Unless of course the gp to seriously has no concerns regarding her mental state- they would be consulted as part of the mha assessment as would her nearest relative.

Tammer

Hi all.
I thought I would update on progress and also have a question to ask.

My mum seems to have gone downhill a bit further. My brother has now taken her car keys off her (with the blessing of the police and a hospital doctor). My brother also gets phoned by a neighbour of my mum's to update him on goings on - a 'benefit' of his personalised car with his business number on the side.

On the positive side, a health visitor now visits periodically, my brother and I visit twice a week between us and her doctor has recommended a 'package of care'. She has also been assessed by Social Work and recommended for someone to visit regularly and is now on the waiting list. The Doctor has also agreed to share information with my brother and I, where relevant, and to advise us of any referrals or appointments so we can take her to them.

A worry remains about her financial position - not that she would run out of money but more that she would lose money by not being on top of her finances. With that in mind, I'm keen to invoke a PoA that she put in place a few years ago (and has no recollection of now).

To bring it into effect, I need her doctor to write a letter saying she has lost capacity. In recent conversations with the doctor, the doctor has said he doesn't think he should and this is more for a psychiatrist. This is possibly as my mum has passed the doctor's tests (for broad capacity - "who is the prime minister") but the doctor is concerned she needs support.

Can I ask - how have others managed to get the PoA invoked, so that it comes into effect?

My mum is going to the memory unit at the hospital in October so this may provide some paperwork to get the PoA invoked?

Skibunny40

Hi Tammer. I had a POA for my dad done years ago when he was fit and well and like you, filed it away and didn't really think about it. When Dad was seriously ill in hospital, I realised I might need to use the POA so contacted our solicitor to ask what I had to do to invoke it and he said nothing! It was already registered and I just needed to produce the paperwork I had when asked. Is it possible that your POA is already registered? What does the paperwork say?

If not, and you do need a letter from a doctor, what about the hospital doctor who approved taking away the car keys? Tbh, I'd be really hacked off at your mum's GP for refusing in the first place - it seems obvious that the POA would be to her benefit and it's not as if you're only just applying for it you, you already have it! Would it be worth going to the senior partner in the practice to see if they'll agree to produce a letter? Although I get that you don't necessarily want to rock the boat at this point.

Another option might be to make your mum's bank account joint accounts with yourself or your brother? Not sure how this would work in terms of your mum's capacity ( but if the doctor says her capacity isn't affected enough for a POA then it must be okay to give consent...?!) I've done this with Dad's accounts (he recovered after being in hospital and I've never had to produce the POA paperwork to anyone) and it means I can use internet banking to keep an eye on his accounts.

A call to Alzheimers Scotland might throw up some other options as well. You're in a really difficult position and I wish you all the best.

bouicca21

My mother’s dementia was only diagnosed once she was in hospital and they gave her an MRI. With hindsight she had been deteriorating for many years but so slowly that we didn’t pick it up ourselves.

She was quite passive so organising stuff for her was easy in that she did not object, but difficult to put together. Between lunch clubs, carers, meals on wheels and our own visits we kept her out of a nursing home for as long as possible. We also turned off the gas and took over her finances (yes, she got scammed by a couple of men knocking on the door saying they were from the water board).

From what you say, I think you need a hospital to tell the gp what’s what..

poppy10_2

Tammer wrote: »

With that in mind, I'm keen to invoke a PoA that she put in place a few years ago (and has no recollection of now). To bring it into effect, I need her doctor to write a letter saying she has lost capacity.

Skibunny40 wrote: »

When Dad was seriously ill in hospital, I realised I might need to use the POA so contacted our solicitor to ask what I had to do to invoke it and he said nothing! It was already registered and I just needed to produce the paperwork I had when asked.

There's a difference between the old "Enduring Power of Attorney" and the newer "Lasting Power of Attorney."

EPAs need to be enacted/invoked before you can start using them, which is done by registering them with the OPG once you feel the person has lost capacity. LPAs don't need to be invoked; they are normally registered as soon as they are made (while the person still has capacity) and then the attorney can simply start using whenever they feel the person has lost capacity.
In either case you don't need medical evidence of incapacity. For EPAs you sign a declaration stating that you have reason to believe the person has lost capacity, for LPAs you don't need to do anything.

If your mum made a PoA after 2007 it is almost certainly an LPA rather than an EPA, and doesn't need to be invoked.