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93-year-old mother is supposed to do follow-up visit for blood work 2 weeks after a medication change, and have appointment with her PCP to discuss the findings at her doctor 4 weeks afterwards. The problem is she refuses to or doesn't understand the importance of why she needs to go. Appointments are made and she will cancel, either due to she will say she doesn't feel well or her feet hurt. The follow-up is important as she is on medications which affect Blood Pressure, Liver and Thyroid. PCP made a change in the way she is to take the pills and of course she isn't understanding why there is a change. She is hard of hearing, refuses to get hearing aids although she does have the finances to get. It is wondered if her hearing is causing issues with her ability to comprehend things so she just nods as if she understands, this is very common with those with hearing deficiencies, or if there is something underlying. Not being able to get her to go to her PCP is hard enough but we want to get her tested for possibility of dementia just in case it is not just her hearing that is causing issues, but her refusal to go to get her basic tests and cancelling appointments for extended period of times. She went 18 months last time she had blood work done, the only reason she went to the PCP was due to the PCP refused to refill her scripts until she came in for blood work. The biggest problem is her driver drives 3 hours, takes a day off work to ensure she makes the appointments, but it is not until the driver arrives she informs that the appointment was cancelled. What she does is she calls the doctors office when she is pretty sure the driver is on their way down and cancels. It has been asked that the PCP will call her Medical POA if the appointment gets cancelled, but, they don't cooperate. HELP please

When my dad got dementia he started acting like that. Saying I'm not going...acting like 2 yr old basically- Even after I'd take off work to take him. I'd just give him a choice either get in car or I'm calling an ambulance & we are going to hospital. And on 2 occasions we ended up in hospital but he was checked out and put back on right meds & did better for a while. It's tough on you mentally too but rest assured you are doing the best you can & what's right for them.
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Reply to Makinmecrazy
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There is something I want to add. I know old people present us with horrible problems that make us nuts. There are different views of looking at this problem. You can try to fool them and that way get them to appointments but that will work just so often. Or you can gently 'physically' restrain them so they will go even if they don't want to - verbally talking toughly to them or taking their arm and leading them to the car. Or, you can do the unthinkable........you simply accept their stubbornness and their lack of mental judgment and you leave them alone. If they are so stupid and stubborn, what comes as a result is their problem, not yours. I know this could cause you to lose them but at least they are doing in their final time what they want things to be.
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thingsarecrazy8 Jun 16, 2019
You are correct in the fact that older people do things that cause us to go nuts. I have done the fooling thing over and over again and it is not failing. I also don't want to be accused of Elder Abuse by physically restraining her. She is committing self abuse, however, our state does not seem to follow their own guidelines of what is considered in these policies. It sounds that you have been through this or have a different light. Thank you
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You tell the medical office from now on YOU are making the appointments and only YOU can cancel them. Then make arrangements to take her yourself or hire someone to go and get her who will NOT allow her to get away with NOT going. You do NOT allow her to have anything with appointments - just ignore her and let the office know she must and will get there no matter what she says. Speak with the doctor. And get a Power of Attorney if you don't have one - you will need it.
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thingsarecrazy8 Jun 16, 2019
Power of attorney medical does not do anything here as far as making her go to appointments, have spoken with the doctor and she won't make issue as she will continue to let Mom call and cancel, the doctor continues to provide her with the prescriptions for her thyroid, blood pressure and liver, without following up with the testing necessary. It seems that the medical system is failing her and nothing that is done seems to change the doctor position. After all Mom is 93, she has had a good life type attitude. Guardianship would be necessary to get mom to the doctors, but without the doctor support that won't happen.
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Play the fib card from the deck, "Mom - we're going for ice cream, pizza, et al."
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thingsarecrazy8 Jun 16, 2019
Been done several times, she no longer will even leave the house during the time in which the doctor office is open unless she has decided that she wants to go. I do understand her not wanting to go out in the winter months as they are brutal and I can also understand her not wanting to go when it is raining heavily, but on days where the sun is shining and it is not extremely hot and she has all the supportive measures to get her to the office, walker, wheelchair, transportation.
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You say below that your Mom is not incompetent. Then I would explain the dire things that can occur with her current refusal, including falls, breaking bones, hospitalization and placement in assisted living or rehab. You mother may be deciding she does not want medications anymore which are preventative. She may wish to have palliative care, no meds, and take the consequences of that, which may be rapid at her age. But this may be her wish. If your mother is competent there is little you can do.
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thingsarecrazy8 Jun 16, 2019
So true on your statement about things, too bad they are not open about things. I guess because I am so open about my desires with my children I have a difficult time understanding why she isn't. I do know it is a different era and she had a much more challenging life and had to be very independent when raising us kids. I hope that I can get something out of her so that at least if she doesn't want the care the continual frustration of her actions could at least be put to rest. Knowing maybe hard but not knowing is worse.
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Well. I wouldn't claim it fits entirely within ethical guidelines, but how about you book the PCP appointment to suit the driver and don't tell your mother about it? If she doesn't know it's in the diary, she can't cancel it, can she.

She can still refuse to go of course... But then the driver could call the doctor's office and apologise, if she really won't be persuaded.

Changes in medication.... You might like to tell her of a conversation I had with my medically qualified Ex about a letter from my mother's cardiologist that I hadn't understood - I rang him to check if this was really as urgent as they'd made it sound? He cleared his throat and said calmly: "if it's increasing her potassium, it will stop her heart. I think she'd better go."

They need to check various levels, and unless she doesn't think living is important she'd better let them.
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Reply to Countrymouse
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I have to comment on hearing aides. My husband is 72 and has worn them almost 70 yrs.

This is what a person goes thru to be fitted for hearing aides.

First an exam by the doctor. Sometimes, there is a lot of wax and removing this helps.

Next you see an audiologist. She (DHs are women) puts you in a sound proof room that reminded me of a walk in freezer. You are sat down with earphones put on ur head. Simple questions are asked and ur repeat. Then sounds are introduced and the person has to use a figure to say which ear they hear the sound in.

Next is ordering the aids. When they come in u come back for fitting and adjusting. This is done with a computer. The person has to be able to follow directions, like "is this too high or too low". Then, will they be able to know that the mold is too tight or uncomfortable. My husband had his shaved down. Then its putting them in and taking them out. My Mom pulled on the tube and broke hers. The little wheels for volume and background are small. Hard for elderly to turn.

There are now rechargeables but my DH has not been offered them. My DHs Union BC/BS pays for a new set every 3 years. Medicare does not cover hearing aids. One for my DH is at least 2k for just one ear. He is deaf in the other. Expensive to not wear them or lose them. Or like a man I knew whose wife wanted to warm hers up so she put it in the microwave.

But, it really wouldn't hurt to have Mom checked for wax build up. It could make a difference.
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caroli1 Jun 14, 2019
JoAnn, if your DH joins AARP ($19 or less/year), he can get a discount on hearing aids through HearUSA *if* there is a HearUSA office near where you both live. There isn't a lot of choice, but I do know that in range of correction that I needed, both over-the-ear and rechargeable in-the-ear- canal were available. I understand that your DH can get the hearing aids he needs through his insurance. Through AARP, could get rechargeable ones if that would be easier for him. I don't know what his co-pay is through his union-subsidized BC/BS is, but it might be worth it to compare the two.

I might add tht some primary care doctors will clean out wax, which could be done when your DH is in the office for other reasons, saving one of the trips you listed--and which I also have experienced. It Is a lot of trips!
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Yes hearing loss has been implicated in dementia. My dad didn’t get any until he was 91 and they made a world of difference and he adjusted to them. The elderly can be so darn stubborn!!
But definitely you need to be sure you have HIPPA permission and Medical POA at the very least as she goes down the slippery road of aging.
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thingsarecrazy8 Jun 14, 2019
HIPPA and Medical POA is in place. This was updated about 3 years ago when eldest brother passed away. Yes, it is a slippery road and raising us was all in her hands as dad passed away while we were young. Non of us have been able to convince her that hearing aids would help her. Can't force her to buy or to wear them.
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My answer is long. I have a good deal of experience with this subject and am having a hard time netting it out.
Your mom might qualify for Medicare provided home health care. Call a HH Agency in her area to see. She would need an order from her doctor but the HH Agency could help you with that if they think she qualifies. It sure makes life easier.
She’s a home bound senior who needs less than full time nursing care is part of the requirement. HH can do the blood work in her home and fax it to her doctor. And it’s insane to me to have to go back to the drs office for results. I would find another PCP. Try to find a geriatric primary. I do agree that 18 mo is too long. I took my elders every 12 mo. whether they needed it or not.
My aunt (92 with mild dementia) is on BP, Thyroid and other meds. The thyroid meds require a blood test to make sure its the correct dosage, the HH nurse couid do the blood work and the HH nurse would track her BP and also do full blood work before a routine annual appointment.
If we get to the doctor and additional blood work is needed, it’s done either by HH later or while we are at the drs office. Hasn’t happened but once.

My aunt also has an aide (private pay) who takes her bp, pulse and O2 on a daily basis. Your mom may not need that much daily care. It was the thyroid that alerted me that aunt needed help with her meds. She had stopped taking them. So I get how important the right dosage is and why she needs the follow up blood work (but not the visit).

Yes, not hearing is a problem but at 93 I don’t know if hearing aids would ever work. They are difficult to adjust to. But it would depend on the person. I do think if she does have dementia it would be very very difficult to adjust to hearing aides just watching the hard time my husband with no dementia has had at 67.

Again if she were motivated she might adjust easily.

The easiest way to handle the doctors appointments would be to take her phone number off the record and put yours along with a message from you that your mom is on her way. She sounds pretty sharp to me. Who is her driver? I take it that you are not going to her appointments with her? Is her pcp near her or near you?
I drove three hours one way weekly to check on and provide care for my mom. When she had a dr appt I picked her up early and we got home late but we wouid see two drs, get her pace maker checked, have a couple of meals out and do the six hours of driving together and 12 hours for me. Her doctors were in the city rather than her small community. We could get more done in less time and have the best doctors.
I did NOT leave anything to chance on appointments.
My mom did not have dementia and if she had done that to me (cancel) there would have been heck to pay.

Don’t tell her when there is an appointment or that the driver is on the way. Show up and pick her up and off you go.
While she is competent to make her own decisions so are you.
You can let her know that you will not be playing games with appointments.

But do listen carefully. She may need a transport wheelchair. She may not feel well but what better place to be than at the drs office if she doesn’t feel well. My mom had congestive heart failure. Towards the end she would say she might not be able to make the trip. I would tell her if she felt bad we would stop at a hospital. Let’s go. We always had a good time but it is hard at that age and we were both very tired the next day.
I read recently that in 2020 Dr on Demand will take Medicare. That will really help a lot of people. I also know that Urgent Care in my aunts area will do thyroid testing so when I suspect aunts is off, rather than fool with getting dr orders for HH, I can take her to the Urg Care and then let the dr know if her numbers are off.
You have to impress upon your mom that she isn’t the only one who matters here. That you are doing your best to see that she gets good medical care and she needs to make it easier on you.
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Reply to 97yroldmom
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Does Mom have u on her HIPPA form so u can talk to the doctor? See if there is a company that comes into the home and draws blood. I realize the doctor prefers to see her, but that is not working. Ask if you can be called with findings since Mom does not hear well. If its serious, then u will try to get her in otherwise, if its just an adj, can that be called into pharmacy. You will see she gets lab work 2 weeks after.

If ur not on HIPPA paperwork and Moms not forthcoming, maybe telling her it may mean no doctor visits if she allows u on.

At my age, 69, I am tired of the annual Dr visits and mammograms. So I can sympathize with a 93 yr old. If she is mentally sound, she can do what she wants. She is 93 and still here. Maybe the doctor being stricter about prescribing her meds. 18 months seems a long time. In my state, u have to see a doctor every six months to refill a prescription. They can get around it with some Meds but not DEA controlled ones.
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I finally had to leave my job and drive 215 miles one-way to make sure that my mom went to the appointments, then repeat that for the results, until she finally had an "episode" at a resort where we were vacationing (15 minutes after we checked in!!) which put a stop to all of that.  She was evaluated, and I became her POA and court appointed guardian after that.  I am now the one who does everything and follows up on everything, so there is no "I am NOT going to do this" any more.  Good Luck!!
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thingsarecrazy8 Jun 14, 2019
She has not yet come to that episode which although the family has discussed about her not taking her medications or following up on her doctor appointments and we have sat down with her doctor with the same thoughts, but since Mom isn't considered incompetent we cannot get guardianship for her medical. I already have her financial guardianship. What is sad is that I see that until she gets hospitalized or dies, that is when someone will step in, even with all of us gathering together to do what is right by mom.
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