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On this board, a recurrent theme seems to be that general practice MDs won't help caregivers getting elders "committed", and won't give a firm diagnosis of AD and 'dementia' and are loathe to sign papers that will hasten an interaction with Social Services. They're supposed to be patient advocates, as I understand it. I've run into this with a GP. Are they worried about liability, lawsuits, other time-consuming legal involvement, actual medical issues, or what? Because this is the interwebs, you don't need to be an MD to answer, and your speculation is welcome ;-)

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First of all, a GP is hardly the type of doctor you should be visiting if your loved one has a dementia (there are many types). Neurologists are the doctors who make this diagnosis along with EEG testing (brain wave), an MRI (imaging of the brain), physical exam, and the standard short and long psychological exams. There is much to making a correct diagnosis, so it is not a simple task. It would also take probably a psychiatrist and a neurologist testing results to convince a Court the loved one is a danger to himself/herself and others. I don't know who you are trying to commit, but if the loved one is in imminent danger, then adult protective services can be called. No one will give you a definitive answer that the person has Alzheimer's disease until after they are dead and a brain biopsy is performed. They will give an insurance ICD-9 code of 331.0 which is Dementia, Alzheimer's type. I am a nurse, and have been dealing with my husband's dementia illness for over seven years and know more than I want to.
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Without getting into detail, dads Dr killed him basically...by not signing the order, dad had already endangered mom per his(DR) own statement she had finally been picked up found in her own waste on the floor of their home, and taken to a facility and he would only release her to me. was taking minor spills, cut n bruised, he was hallucinating and thought we were trying to harm him and break into his home he was so sick n frail, flooding the home, leaving gas on attemting to drive, already having had a recent accident, etc... this was all documented and presented to the DR Anyway we contacted the lawyer prepared paperwork and he refused to sign! THe lawyer had a previous telephone conversation with him stating he would sign anything needed to help us but when we got to the meeting with the paperwork, he said he would not....that my dad should just rely on his family and social network and stop all this nonsense! We battled the system for a month (on our own APS didn't help us either, no kidding) until he went missing one day and was found in hospital suffering from severe lithium poisoning...he OD'd on his own prescription.
3 weeks later he was dead! I went back to that DR and told him dad was dead, face to face, I was so furious with him.. He had the nerve to tell me well that is unfortunate but one can OD on Tylenol...I told him oh no, you will not go there this time...Lithium is toxic medication and dad did not release us to have his records so we did not know what he was taking...it was your job to follow this thru...you dropped the ball...it was your damn job to know a demented hallucinating patient on a toxic med is in danger!!! To this day I hate that man just for his stupid cop out! anyway...I wonder now maybe the attorney never did get a positive response from him we weren't in on that conversation, maybe he just took our money! I swear I don't trust any of them so called PRO'S dr or lwyr!!! anyway I rant but yes he was a coward to go to battle with my dad idk why but he would not do it. but SURELY my dad is dead because he did not, and it was not pretty, he suffered!!!
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For most MD's, their whole training is all about cure and doing whatever is necessary to cure a condition or a disease. And if it cannot be cured by medications then surgery. That is how medical training is done. Dementia - being a terminal disease - doesn't enable that. Most MD, unless they are gerontologists or work within a gerontology practice - like a neurologist often does - are totally not synched or trained to evaluate and treat any terminal diseases. So that plus the fact that there are many dementia's AND that diagnosis can only truly be done by an autopsy of the brain, makes them incapable of being able to ever adequately & definitely say and treat a dementia patient. Or do the paperwork to have them committed or declared incompetent.

You really need to have your elder evaluated and become a patient of a gerontology practice in order for them to get the best treatment plan for their specific type and stage of dementia and have them tested so that the gerontology
guys can have them declared incompetent and have the results to back it up. If family is squabbbling about $$ and control, a good lawyer will destroy easily a GP's credibility. You have to have a whole gerotology practice work up to do a incompetency if family is at odds on this.

Yeah I know if you are out in the boondocks, your care is limited. But you can find a practice affliated with a medical school or a free-standing gerontolgoy practice and get them into that and have the testing done so that the right meds can be prescribed it will be a godsend. By & large the dementia's on their own are a long decline and pretty manageable until the final phases with the proper medication. If they don;t have other diseases to any real extent like CHD or diabetes or a cancer and they have Lewy Body Dementia - like my mom does - they can be quite cognitive for ages although not competent. It could be a decade plus of diagnosed dementia till they are not capable of their ADL's at all.
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Thank you so much for understanding...it does mean a lot coming from a medical professional!! and your words are graceful and comforting! it amazes me how fear of malpractice can override decent common sense and the oath to serve a patient...but Im no expert...
I do know the last night of dads life an angel was sent to me in the form of a nurse....it wasabout 10pm sunday nite, 3 days after he was transferred to "3rd floor", I was getting ready to go back to our motel for nite and a nurse pulled me aside wrapped her arms around me and said..."im not saying this but what are you really gaining here..i sed dr yesterday said 50/50..she shook her head and said honey you need to be brave and just let it go, he is not coming back! after that I had a long talk with my dad begging for guidance and to just let go if need be, "oh dear god. whoever you are, I don't want to make the wrong decision but I am compelled to confront DR first thing in AM"....I was beat and went to hotel, showered, hopped in bed and ringy dingy....they sed things were changing we mite wanna come back and we did...dad was gone by sunrise! I will forever be thankful to this nurse, who I have no idea who she is but was the only one willing to give it to me straight....she will forever be an ANGEL OF MERCY in my life!!
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I was just reading about this condition, and it seems that since there is no speciality, primary doctors are hesitant to make the diagnosis, in my opinion, they do not really understand the condition.
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Jujbean, you have every right to blast us with the details. That is a horrendous story. Your dad did not recieve the care he needed and you were left helpless to do very much if anything about it. In the name of preserving individual freedom the system failed to take of someone who simply could not make the decisions needed to take care of himself, and what possible reason that particular doctor would not sign off is certianly a mystery to me. Was Dad threatening to him? If so, surely he should have seen through that and acted accordingly and proceeded with doing the right thing instead of succumbing to the temptation to avoid conflict. If I could validly apologize to you on behalf of our entire profession, I would.

I am not sure what I would have done if the pscyhaitrist and the primary docs at the assistive living had not given me the letters certifying mom's being unable to manage for herself which offically activated the DPOA I had in hand...running around to get second opinions is not easy, especially with an uncooperative patient.
And you can bet I was angry about mistakes and lapses in my mom's care, which happened, fortunately none of them with disastrous consequences, just aggravating to her and to me. I am sorry not just for your loss, but that you have such bad memories and the knowledge that it could have been handled so much better...you have every right to express your heartache here.
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They don't want to be sued or get caught up in a family squabble. Too often the complaining relative is simply trying to get control of financial assets. The only way to get the person committed is when they are violent and the police (independent, third party, authority) have them hauled away to the county psych center.
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Physicians, either MD or DO, unless they have special interests or special training, just don't have the inclination or the expertise to do social work or serious geriatrics! Most will not even know how to do an MMSE (mini mental status exam) and are easily fooled by a little "show-timers" and will even miss the early cogwheeling tone that happens in Parkinson's and with antipsychotic drug side effects. They (ok, we) generally tend to avoid things that are going to take a lot of time and coordination efforts, and also could be fearful about the possibility of being the middleman in a family conflict over driving or competency...they would be rightfully concerned they would not have the tools to distinguish someone out to steal money versus someone out to keep an elder safe from scammers or living at home alone when they really can't. I really recommend geriatric specialists or some neurologists to properly diagnose dementia; please note while you'd LIKE all the docs who serve as attending or primary physicians in nursing homes or assisted living facilities to be geriatricians or geriatric experts, most just aren't. And espcially if you and/or your loved one don't overtly look like you are about to fall apart, you will have to ASK to get a visit with a social worker who might really know how to help.

One of the better things I did for my mom was to get her to a fairly comprehensive visit at the Benedum Center in Pittsburgh, and I got my hubby into our Longevity Center clinic here, though now he is back with a good family practice doc instead and it is working out OK, but then I often have to be in on it to nake sure he actulaly tells the nice doctor or the PT what is actually going on.
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oops guess I did get into details...I get so darn passionate!
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I think we are living in a society where medical advancement has been a blessing and a curse. We have individuals that would 15-20 years prior died of cancer, heart failure or some other medical problem and they are living longer and many times it is like dealing with zombies because while the body is still going, there brain is gone.
And it is all the families fault.
My FIL has been found with a gun held to his stomach and it was reported not only to the visiting nurses but to the police. He cut himself on the abdomen over and over with a knife when he did not get his way and lied to the nurse and was told, "ohhhh....that's okay honey, we get to feeling that way when we are dying." Problem is? He isn't dying. In fact, Hospice has been called off. He is in rehab and physicall stable.
We are told he is depressed (2 anti-depressants are doing squat), he has a paranoid disorder and that he has excessive sexual fantasies (he is 86). He has seen a psycharist and we are told to just dismiss all of it because he has a touch of dementia and to not be shocked by his outlandish behavior. The problem is, we have told them he has had this behavior for decades, has been committed once before (for one year) and they just sit and smile and say, "okay now...what are you going to do about bringing him home?"
No one takes us serious so since we can't get him committed, there is the next best thing -- long term nursing home care. We don't care if it takes all his assests, his house and pension, let someone else deal with his "issues."
So no...they will not sign for them to be committed because they want to blame the family. We are not understanding enough, we should spend more time, quit our jobs, mortgage our home and live on the street. Oddly enough, I don't see these doctors doing the same thing...
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