Do I insist or let my 82-year-old husband make his own decisions?

As to the eye. I had a vitreous separation with scarring that makes one of my eyes quite worthless. I do well with one eye. This can be addressed but only 50% chance of better vision and they suggest it NOT be addressed unless I were to lose vision in the other eye. I am 77.
As to the teeth. Many people do well with just gumming food, and unfortunately some parts of our country are almost without affordable dental care; that said the INFECTED tooth must be addressed, because the infection could go systemic.
I think you are playing the odds at some point. I wonder about going all out with many visits, much pain, with dentures at this point, so might let him make that decision, as well as the decision about his eye. However, the infected tooth? That's gotta go. IMHO.
You are really going the extra yards to try to figure out what is best for HIM, and so good of you to do so. Good luck. Give us an update when you have time.

I certainly would not go with the teeth extraction. Soon to fall out? What the heck does that mean? If there is an infection, with a suspected abscess, then that does need treating; but to be honest I think I'd ask another dentist. One with a more curator-like approach, ideally.

With the eye - how long has it been in its current condition? And if it *were* to deteriorate, what would be the signs and what would the specialist then do?

I'm not one to be over cynical, and in spite of everything I do still have faith in licensed healthcare practitioners to put their patients' best interests first - no, really, I do, mainly, on balance - but apart from the fee what has been the aim of reviewing this retinal tear every four months?

Dad is 90, his teeth started to break off at the gum line 5-6 years ago. I should clarify, that is when his front teeth started to break off, I do not know when the back ones started to break.

Dad does not have dementia.

After much pushing, he agreed to go to the dentist. He had 3 abscesses and at that time had those three teeth pulled as well as some of the broken roots. Dad has a heart condition and there is a link between dental infections and heart problems.

It was a painful procedure over a few appointments. He probably should have the rest of his teeth pulled, as more have broken off since he last went to the dentist. If they break below the gum line the odds of infection are higher. But Dad refuses to go back. He eats softer food, hamburger, not steak, cannot eat fresh leafy greens anymore. He is not at all interested in dentures, nor does he care how he looks with his broken teeth and missing teeth.

Wait, the dentist did not prescribe an antibiotic or anything to clear up the infection?

That is a huge red flag for me and I would recommend seeing a different dentist.

My dad had to have all of his uppers removed and my dentist said because he is on coumadin and elderly the safest route would be an oral surgeon, the procedure took like 45 minutes from waiting room to walking out the door.

If your husband understands, I think he should be allowed to decide what will be done to his body.

I would address that infection though. Maybe he can gargle with colloidal silver and heal it up without antibiotics. I would try that 1st, I would not trust the dentist if he didn't address that infection, period. That is criminal in my opinion, oral infections are extremely dangerous.

I am 63 and just dealt with an infection after root canal. It was nearly a month ago and I still have a lump under my jaw and numbness with my mouth. It took several types of antibiotics and had to go numerous times for draining. At one point the side of my face was very swollen. I would not hesitate if there is an active infection. Once it gets into the bone life is miserable.

If he’s happy at home and so are you due to the difficulties re mobility and continence - then I’d leave it be. As long as infections are treated - as you say - heart and teeth health are closely interrelated. But you might be able to get antibiotics prescribed by your doctor next time rather than try and get him to the dentist. If antibiotics don’t work he may need an extraction.

Have you made it clear to all the specialists how difficult it is to go there especially if he has an incontinence accident etc? It might be easier for a nurse to visit to test and send results back. Or they might decide it makes sense to treat the retina rather than monitor given your circumstances.

There are home visiting podiatrists who could attend rather than you struggle to take him to them at 80.

i sometimes wonder at the crazy set up for care we have that does not truly take into account all contributory factors.

The infected tooth needs to be addressed but only with careful oversight from his main doc. I do not believe the dentist will treat the infection without first removing the tooth as it may reinfect.

Two things:

1) by friend's elderly dad was on blood thinner and went to have a tooth pulled. His doc knew and his dentist knew and he then had a stroke. This is the danger.

2) Be careful of what antibiotics the dentist gives you. My mom had a course after a root canal and she developed a reaction to it that cause a great deal of swelling in her feet and legs. I can't remember the name of the drug...starts with a "c" I think...clindamycin? But not sure.

Does you husband know he won't be able to enjoy a large assortment of foods anymore? This may tip the scales in his decision. Good luck you dear, sweet trooper!

Call your Area Agency on Aging and see if there are any services to help you get him to these doctor appointments. Ask his primary doctor to order him HH so he doesn’t have to go in as often. They can do blood work from home, bath him and provide physical and occupational therapy depending on your insurance. They could also do his INR testing for the warfarin. Do you have Traditional Medicare? It’s worth checking out these services for someone as compromised as your husband.
A geriatric primary would be good to switch him over to if possible. They might know of a dentist you could get him into that would take care of that one tooth and advise him on the others.
If it weren’t for the possible infection, I would be tempted to leave him be but he has a lot to be managed to stay status quo.
Try to budget for an aide on the days you have to take him out. If something happens to you, what will happen to him?
Call the Area Agency on Aging and see what you can find out. Let us know how things are going. You are amazing to handle all of this. He is very lucky to have you for his bride.

At this point, I think your husband should still have a say in his treatment. If he doesn’t want his teeth pulled, leave it be. Also, that Dentist should’ve given him an antibiotic for the infection.
If some of your husband’s Dr. appointments are absolutely not necessary, maybe you could cut back on some them? My mother in law is 81 and it really seems some of her Dr.’s keep her coming so often just for the money!

Sounds like a good income earner for the dentist, have a chat with your own Dr and see what he advises knowing all the pros and cons - it may cost a consultation fee but at least you will have an opinion on now and the future. If there is an infected one Dr can write you a prescription for antibiotics for that which will cure the problem for at least a while and maybe for years.

My 92 yo mother, with dementia & immobile, had similar problems with teeth...most fell out ..& some infected..I take an Aide with me who can transfer manual from wheelchair to dentist chair. Mom has top denture for years and all that’s left on bottom is one half tooth in back ..oral surgery said it’s more difficult to extract with local anesthetic..& she would need intravenous...not crazy about at her age & the dementia...he said if it don’t bother her...leave it alone. I thought about denture for bottom, but it’s too involved with drilling & posts implanted & several visits back & forth. Also they have to be maintained & cleaned ...with dementia, very difficult to even get her to rinse her mouth. I suggest if his teeth that bad, a hospital has dental department with oral surgeon ..if he needs intravenous anesthesia..he can have it done there & they can help with transfers, etc.

As far as eye, talk on phone with ophthalmologist and ask him his advice ...see if there’s drops he can prescribe. My mother also has glaucoma & macular degeneration & went last year to retina specialist...it’s very stressful since it takes about 3-4 hours...I decided I’m not shlepping her there anymore & she continues with the same eye drops prescription.

It’s too stressful for you to shlep him everywhere. Also general Internist can come to house.

I hope you have or get some help with caregiving?

Hugs 🤗

He needs an antibiotic for the tooth infection. It can rapidly become very serious. That type of infection can go to the heart muscle. Address that situation first.
Some decisions have to made for them without taking away their power over their bodies.

If he is No "Quite Gone" Yet, Yes...You will Indeed Upset his Happy Apple Cart, No Doubt about it.
Go with his Flow, I do think One Day, You will be able to Make all of his Decisions down the Stubborn Mule Line and at the Same Time...Miss HIM.xx

My mom (late 70's at the time) had a tooth that needed to be pulled. They didn't take her off the Coumadin first. They didn't give her an antibiotic first as a precaution. She bled out and died. They killed my mom. Make sure they know what they are doing. As you know, dental health is so important but if you get bad service it can kill a loved one even faster. I had called them and told them about the bleeding. They said to have her stop swallowing the blood so it would clot. Even took her back and was told the same thing. She died the next day.

As a side note... after her death they kept sending her/me notices that she had appointments coming up. I went there in person asking them to stop. I was told they couldn't help it, they had so many patients they didn't have the time to go through all the pre-printed cards. I blew up. (I had been quiet up to this point). Yelled at them that their poor practices killed my mother and if I got one more card from them I would see them in court. It got so bad people got up and left. They threatened to call the police. I told them to go ahead and while they call the police I'd be calling the local news paper. I finally left and never got another card from them. Amazing how they "now" could go through their pile of cards and get my mom's out of the pile.

I had the same dentice and of course changed dentices. My new dentist and the one doing a root canal for me, helped me file paperwork on them. They were made to show their paperwork for the next five years showing they were finally being compliant on checking their paperwork when working on patients. (Mom's had that she was on a blood thinner.) . If nothing else, we probably stopped them from killing anyone else.

Hi Happy,
Sorry for the length of my post.  IMO that amount of appts seems excessive.  My Mom has glaucoma and we visit every 6 months.  The last appointment she could not participate in one of the tests.  The Dr was stumped on what to do.  I said we just forgo it, she can't do it.  Dr said I guess that will be fine.  We'll just monitor another way.  And why a different eye Dr for both of your husbands conditions? Two wallets to fill?  I'm sorry but I am cynical.  I would find one who can monitor/address both. You can only do what you can do and what makes sense.  Could a visiting nurse come to the house to check Coumadin and sugar levels?  I know of someone that monitors Coumadin levels at home with a meter and calls in results to Dr who then instructs to increase, decrease, skip a day, etc on the meds.  My Mom was scheduled for a colonoscopy.  I did some research on risk vs benefits and had a discussion with her Dr.  He said that with her history and current mental status, he agreed to forgo that test.  I had another Dr that wanted Mom's blood work checked every 3 months.  We did this for a couple of years.  A new Dr said that this was absurd.  No issues, why every 3 months?  I had a recent experience with my Mom.  She was light headed and falling.  Dr said this is what happens as dementia progresses.  I did some reading on blood pressure meds and found out if you are on a cocktail of 3 meds, take one in the AM and 2 in the PM to alleviate the dizziness.  I implemented, it worked, and Mom is fine.  Dr never suggested this and once I told her what I had done she said, great, glad that worked.  We know our loved ones, we can see their symptoms and changes.  The quality of life must factor in with our caregiving.  My Mom is also diabetic.  The Dr would say NO sugars for her.  She is diabetic.  I say, SOME sugars for her is just fine.  I do this while keeping her sugar levels in check BTW.  She is only on metformin, no insulin.  Speaking of metformin, my Mom wasn't taking her med years ago because she couldn't comfortably swallow it.  It's a large pill.  I spoke to Dr about it and he said cut in half.  My Mom still had an issue and Dr has no suggestion.  I spoke to the pharmacist about this and they told me about a liquid form of metformin which Mom now uses.  Dr's don't know everything is my point and continue to advocate.  I wish you and your husband the best and he is lucky that you are looking to improve his quality of life not simply extending it.  Lastly, your quality of life matters too! Sorry for the length of this post but thought my experiences might help you or other readers :-)

First of all, your husband is very lucky to have such a supportive spouse. In regards to the dental concerns, could the dentist give him an antibiotic for the infection? The bigger concern though is the fact that he has mild dementia. Has your husband and you as well executed a durable power of attorney for health care and advanced directives? This is an important document to have especially for when the dementia progresses and he no longer can make decisions. If he isn't in pain and he can eat with his own teeth, I would let him be. After all, getting dentures is an lengthy process.

There are dentists nowadays who specialize in dental implants, which the advertisments say can be installed in one day, including extractions. The implants are screwed into the jawbone which has been drilled and threaded for the teeth, and they are permanent. Whether they are suitable for old jaw bones I don't know but it may be worth exploring as an alternative to conventional dentures. But looking down the road, the ability to eat and chew food is important for survival. The Coumadin is a problem because if he is on it as a blood thinner it needs to be checked frequently (lab work) and if it gets out of range it leads to internal bleeding which is very bad. If his blood work is stable the doctor visits could be stretched out, I should think. He could be weaned off the dose of Coumadin by weekly reduction of strength. Does he really need it? If he is happy and not bothered with pain why not let it go for six months or so and then see how things are. One thing though is to get a health care POA for you to act in health issues when he cannot or is not willing to. As one old guy to another you don't need all that doctoring when you are over 80, because you have outlived all the "baddies", as I was told by a doctor who said he didn't need to do a digital rectal exam, because the cancer if there is one would outlive me! (And Medicare would not pay for it anyway.)

He should be able to make his own decision based on informed consent. If his teeth aren't causing pain and he isn't interested, let him be. I would also consider a second opinion. If that tooth is infected, one choice would to be to pull just that one. If his upper teeth are worse, perhaps just replacing the uppers might suffice and leave the lowers alone. At his age, less is more.

About the infection, that can make the dementia seem to progress more rapidly. Address the infection and memory/behavior will improve.

I would be leery of any dentist recommending pulling all the teeth! I had one that wanted to pull 4 out of my DH's mouth and he was 96. Through their own stupidity, we wound up across the highway at another dentist who said there was no reason to pull any teeth and he rebuilt the 2 that were a problem.

Needless to say, we never went back (more to the story but now is not the time). It would have cost $1500+ for the teeth to be pulled and it cost $500 to have 2 rebuilt. Do the math. And get another opinion on his mouth/teeth. You cannot even imagine the pain of pulling all the teeth.

And yes, too many doctors does get tiresome.

About decision making... There are different types of dementia that affect different functions of the brain, some of which the general public is unaware. If the frontal temporal lobes are affected, memory is quite intact. Social diplomacy and decision making skills are impaired. Your Husband can use a guiding hand hold. Infection can reap horrors for seniors including cognitively. This is most important you put on your hat of intelligence and compassion.

Is your husband a veteran? If so the VA offers in home primary care for homebound Vets ( vets who no longer go out on their own) . That won’t help with the dental appts but could make the follow up easier. The VA tends not to offer these extra services until caregivers are at their breaking point. As for pain; insist on pain meds. An 82 year old is not likely to become addicted and, really, so what if he did?

My mother-in-law was also on coumadin. At 90 years of age, her dentist wanted to do two implants to replace a permanent bridge. We sought a second opinion. The partial denture was a good solution for a long time. The heparin injections to replace the coumadin were shockingly expensive and complex. They also were for an extended time, not just a few days. The complex process for the more invasive dental work would have been a nightmare for all of us. I encourage you to get some real help finding a less extreme solution. Good luck and God Bless--none of this is easy or obvious.

Treat the infection, leave his teeth. I am 81. I had all my teeth pulled four years ago and I'm still trying to get things in my mouth back to OK. Let his teeth fall out if and when they will. I don't mean to be crude or unsympathetic, but I'll bet his teeth last longer than he does. As we grow older we have to begin thinking that way. Doctors and Dentists want to do everything they can to "fix" a problem, but the often look only at the problem, failing to take the consequences of going after the problem into consideration, not only in the life of the patient but the lives of all around them. They can easily fail to see the problem in the context of a patients entire life, including life prospects.

Yeah, poor guy is burned out with doctor visits. Sad. I guess you could seek a second opinion before making any decisions.

Best wishes to both of you. Hugs!

I would have the infected tooth removed, after a round of antibiotics. And he absolutely must have his Glaucoma checked regularly. For the rest of the appointments, you should call his general practitioner about in home visits or if it’s ok to stop them completely. I know podiatrists make house calls. At 80 years old, this far too much for you to handle. An appointment once in awhile might be ok, but eliminate as many as you can. We don’t want you to end up injured and unable to help him at all. Try to take care of yourself first, he needs you to.

My Husband was non compliant at the dentist.
My Husband had dementia.
He had broken teeth.
I made the decision NOT to have any work done because I did not want to have to deal with open wounds in the mouth that I knew he would not leave alone. I did not want to have to deal with the after effects of anesthesia that he would need to have.
Also the fitting of dentures is tricky and with weight loss the teeth made now will not fit after weight loss. If there is a chance he will have to be placed in Memory Care there is the great possibility that the dentures will be lost.
There is also a good possibility that if he has just a partial it could be aspirated or swallowed should it become loose.
If he has an infection treat that.
Continue good oral hygiene either you brush his teeth if he is not doing a good job. An electric toothbrush that has a quadrant timer is good so you know you have covered each area.
The use of Tooth Swabs or stiff foam brushes is also good after each meal to clear food debris from between the cheeks and gums.
cut back on sodas and juices stick with water, flavored is fine.

It is a tough decision but you have to balance what is best. A Benefit VS Burden check list might help. And does the dentist fully know the dementia diagnosis? That also might change his or her treatment plan.

My husband was the same way and I let him make his decisions
I know it hasten his death, but it was difficult for him to get to medical appointments

Get a second opinion on the "possibly infected tooth." If it does turn out to be infected, that is going to be a multi-faceted approach with the Warfarin, which I assume that his cardiologist dosed him with. The 2 doctors need to communicate. As for him not wanting to go to the retinologist, why is he waiting? He doesn't get to decide since his vision is a critical sense. The second opinion dentist can tell if he has to have most of his teeth extracted. TBH, the dentist that he went to may be money hungry. Plus if the tooth has to come out, he should be on a course of antibiotics 10 days prior.

MY dad had all kinds of work on his eyes done at 89 dad HATED IT! But it was his idea I just took him to all his appointments only because he could not see to drive lol otherwise he would of gone by himself...But we could NOT MAKE MY DAD DO A DAMN THING IF HE DID NOT WANT TO OR NEED TO, but he did know the danger of an infected tooth or of any kind so I hope you can coherse him to get antibiotics and just pull the darn tooth ...dr. will adjust his comden properly AT LEAST GET YOUR GENERAL PRACTITIONER TO PRESCRIBE ANTIBIOTICS TO CLEAR UP INFECTION ..
if hubby wont go you did what you can