Does patient with severe dementia need to be under psychiatric care? - AgingCare.com

Does patient with severe dementia need to be under psychiatric care?

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My loved one, who is 63 and in a Memory Care Unit, has advanced dementia. It's Vascular mixed with AD. She is wheelchair bound and double incontinent and requires that everything be done for her, except she can feed herself and she can propel her feet to move around in her wheelchair. Her memory last only a few seconds. The only name she knows is mine. She is verbal and can answers questions, though mainly in a yes or no manner. She makes few comments otherwise. She can hug and say she loves you. She can't button anything, turn on a remote or open a gift, etc. Most things I have to tell her what they are. Such as she doesn't know what to do with a sock, unless you explain it goes on your foot.

For most of this past year she has been on Cymbalta for anxiety and pain. She has arthritis as well. It has been a huge help and she has very little if any anxiety when on the med. Her GP prescribed it. She is content most of the time. I have confirmed this with the staff.

Is there any reason for her to see a psychiatrist? Someone told me that you have to be under psychiatric care to stay on this medication. Is that true?

I just don't see the point of starting her with a new doctor. I know they require regular visits. She already has to see her medical doctor about every couple of months for Type II diabetes.

The psychiatrist is not in her town and she will have a two hour round trip for the visits. She can't recall what happened 1 minute ago, so I don't see how talk therapy would help her. I have researched the medications for dementia and do not feel compelled to try them at this stage.

Is there any benefit to her seeing a psychiatrist? Can't the GP monitor her for the Cymbalta meds? I would appreciate anyone's input.

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I feel the same way. I have no intention of her having any procedures, but, if she has a condition that is causing blindness, then I'll have to evaluate how fast that could happen. I know that laser treatments can be rather uncomfortable. I had one and it was disturbing. I don't think she could tolerate it. However, it's a tough call. Plus, she doesn't know right or left. It will be a challenge.

I did end up calling the director of the Memory Care facility and discussed the psychiatrist issue with her and she agreed. If it's not broke, don't fix it. So, that settles it. What a relief.

I appreciate all your input.
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I was at the eye doctor recently as they were trying to examine a dementia patient in the next room. Can your LO follow is trucking like "look to the left, right, up down"? Even with physical cueing, this nice old lady couldn't do it.

Is he sending her for an exam for a particular problem or just because we should all have an eye exam each year? If there is a particular, easily treatable issue, that's all well and good. But I'm not testing mom for anything that requires treatment that would cause discomfort or pain, not at this point.
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Oh, at her last visit last week, he recommended her have an eye exam. Well, I guess that's okay, but it just seems odd for someone who is in the advanced stage of a terminal illness. I agreed, because if she needs to preserve her vision, then I think that would bring her comfort. And comfort is what I want for her.
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Sunny, it sounds as though you are both really polite people. I would be more direct and ask him "is she hospice - eligible at this time?" and "I would like you to tell me when we can start hospice care".
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I appreciate your responses and they are in line with what I have been thinking.

First of all, I met with her GP BEFORE I chose him for her care. I did it after significant research of doctors in the area. There is no MD near her facility and they don't take blood at her facility that I know of. I met with him and provided him her history and explained that PALLIATIVE care was what I wanted for her and that I wanted to avoid numerous doctor visits. And that I wanted to keep her comfortable. Oh well, we'll see. I can't complain too much if he will monitor the Cymbalta, since the drive to the GP is only about 30 minutes. He did set her next visit for 3 months from now, so, maybe we are now on a better track.

I have thought about Hospice. When we saw that she had dropped some weight, even though she eats well over the last 3 months. (I think it's 12 pounds in the last 4 months.) I asked her GP about her decline. I said please tell me what I need to know about her decline. At a recent doctor visit while waiting in the lobby, she told me her parents were doing fine. (Her dad died in 1993 and her mom in 2004.) He said no. There was nothing for me to know. So, I took it that she didn't need hospice.

How would they help?
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Sunny, is it perhaps time to think about Hospice? I wonder if that would change her care in a significant way for the better? We are going through this disvussion right now vis a vis my mom, so I'm interested in your thoughts and anything that you find out.
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Seeing a psychiatrist would not result in talk therapy. Psychiatrists are medication managers. Since you are comfortable with the meds she is on, I don't see any reason to consult a psychiatrist at this point in the journey. (Talk therapy is conducted by therapists, counselors, social workers, psychologists ... just not psychiatrists.)

It makes no sense to have an a1C test more often than every 90 days. And I can't think of any reason that couldn't be done in-house. Why should she go out to a doctor's office if blood can be drawn right where she is and sent to a lab. Then if it it appears to be worsening you can take her to her doctor, or the in-house doctor could address it.

My husband's geriatric doctor kept track of his a1C and told him he no longer had to monitor his blood sugar daily. If it was worsening she'd step in. She also told him to eat whatever he wanted to. He understood he had a terminal disease and whether he had a piece of chocolate cake or not was not going to make any difference in his longevity, but it might make a difference in his happiness.

Too bad mom's doctor doesn't really understand palliative care, and apparently doesn't quite get that she is dying. Dragging her around to more doctors is not the answer.
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Agree. She does not need to see a psychiatrist to be on Cymbalta. As far as the frequency of doctor visits and the frequency of doing the blood work remember you have the right to refuse. Sounds like your doc doesn't really understand what you're wanting regarding care for your loved one. Perhaps it would be a good idea to sit down and have a talk with him or send him a letter explaining what your care goals are. We had the same problem with my Mom. Our goal was to keep Mom comfortable but the doc kept ordering all these lab tests and follow up visits. Nice guy but our family treatment plan and his never could come together. We changed docs and it's been great. Now for the first time since we started on this dementia journey with Mom our family goal and the medical treatment plan are all on the same page. It was a great relief. Now we're all doing what's best for Mom.
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She does not need a psychiatrist. Continue the Cymbalta as ordered by the MD.
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I agree with you both. I have sought palliative care for her and don't see the point of hauling her out for an additional two hour commute. Even though her GP said he understood palliative care, he still keeps scheduling her more than I would expect and doing lots of blood tests. Her A1C is excellent, but the blood test keep coming. But, as long as he will monitor her and we an avoid extra doctors, I guess we'll have to be okay with it.

Since she is doing fine right now, I don't see the need to mess with it. I am open to other opinion and experiences though.
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