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Alzheimer's Disease
The Doctor's Visit:
Overcoming Resistance
by Doreen Kearney,
RN, C, Care ConsultantNeed for a diagnosis. It can often be difficult to get a loved one to the doctor for a diagnosis or even just a routine check up. Try to restate your position by validating their fears. Agree with their arguments, but also state your position, "I know you are healthy and you don't need to see a doctor, but I would feel so much better knowing that you have a clean bill of health." In many cases, the person is familiar with the symptoms of Alzheimer's, and fears getting an actual diagnosis. You may try to reassure your loved one that there are some treatable conditions that cause similar symptoms to occur, for example, new medications, hearing loss etc. Try not to take your loved one's disagreements personally. The following suggestions may help. Please keep in mind that the tips are given with your loved one's best interest and well-being at heart. Find the right person your loved one will listen to. Sometimes it's the male person or the oldest in the family. Have that person state how not going to the doctor might affect them. Share your feelings. "I won't be able to sleep tonight." Then use the support of other family members. Have the caregiver go as a patient, also. Tell the loved one you need to go to the Doctor. Ask if he or she will come along. The caregiver could get their blood pressure checked, etc. by a nurse. This may make the person more at ease about going. At the same time, the physician may evaluate your loved one.
Ask your loved one's physician to call them to schedule an appointment. Often the doctor's office will work with the caregiver on getting the person evaluated. The office may call and schedule an appointment directly with the person since they have not been in for some time. You may want to make sure that the doctor you select is experienced in diagnosing and treating dementia. Get the doctor or pharmacists involved. The loved one may be told that an evaluation or trip to the doctor may be required to continue a current prescription. Then call to schedule the appointment. Call ahead and explain your concerns. Many individuals in the early stages of Alzheimer's behave well in short social situations, making it difficult for a doctor to pick up on problems without some warning from the caregiver. Call ahead and give a description of your loved one's behavior, or write a letter, hand it to the receptionist and ask the doctor to read it before the visit. Reducing anxiety and confusion is your goal. To do that, it may be best to make an appointment without telling the patient. On the day of the check-up, get in the car for a "drive." Bring along music tapes, snacks, photo albums, etc. To keep them busy both in the car and the office. If they resist when you get there, tell them, "That's okay. Let's go inside and cancel." Once inside they are generally cooperative with the doctor's staff. If they are not you can always leave. Make sure the doctor knows beforehand that this may occur. If the patient becomes angry, do not reason, argue, or insist. Instead, accept the blame…. Reassure… distract to another subject. It's best not to tell the person ahead of time and simplify what you tell them. If confrontations occurs. They may produce anxiety. The patient may sense your distress, but not know how to cope with it. The first step in resolving the situation is to understand that because of brain cell death, the patient cannot control their emotions nor change their behavior or perceptions. (This includes early stage dementia, even though they seem so capable.) Imagine the brain as a toolbox filled with essential implements and hardware. Then imagine reaching into the box and some tools are missing. And next time more are gone. You can't even control your frustration about it because that "control" tool is lost. Don't be tempted into believing the patient is deliberately being obstinate or that you can reason them into an appropriate response. Instead, put on your creative thinking cap and try some new approaches. Reassure them often that you love them and you are there for them. If none of these suggestions work, you may have to put off going to the doctor. As memory impairment progresses, new opportunities arise. Also, given some time, resistance decreases and you can try again in a few months. Sometimes a crisis occurs that allows you to obtain immediate medical help or calming medications. As a last resort If you are still struggling to get your loved one to the doctor, give yourself permission to alter the truth. We were told of a caregiver that wrote their loved one a letter resembling that of the insurance company, stating that the person was due for a physical. Keep in mind; this is for your loved one's health and well being that they must see a physician. The sooner the diagnosis can be made, the sooner other possible causes can be diagnosed, the person may begin a treatment, and future legal and financial planning can occur. In the Later Stages. In the later stages of Alzheimer's, you may experience different obstacles when trying to get your loved one to see his/her physician. Obstinate behavior and acting out may make your trip difficult. Sometimes just getting your loved one out the front door may be a problem. The following suggestions may help your trip to the doctor go more smoothly. Take someone with you. If possible, take a third person along to help in the car while you drive as well as to assist you in occupying the person while you wait. Plan the trip out well. Know where you are going. You may also call ahead and warn the nurse and/or doctor in advance about the person's behavior if you will be waiting for a long period of time. Bring distractions along such as snacks or pictures to look at. Use other physical problems as an excuse. If the person has any discomforts such as a hip hurting, explain that the doctor will give them something to help their hip. A prescription may help calm. If the person is extremely anxious and acting out, a prescription to relax your loved one may make the trip easier for both of you. See if the doctor will do a home visit. It may be rare today, but there are still some visiting physicians. If not the doctor, a nurse practitioner or visiting nurse service may be able to do an assessment and report to the physician - as long as you're loved one's problems are not emergencies. Never leave the person alone in the waiting room. Having you disappear in a strange place can be very frightening for the impaired person and they may get very upset. Look for ways to prevent catastrophic reactions. When the confused person is even slightly stressed or when he has to think of more things than his impaired brain can sort out, he may overreact by crying, arguing, wandering away or even hitting. Analyze the situations and look for ways to simplify what is going on so that it is less stressful for him. Stay calm yourself. This is difficult, but often your tension is communicated to the patient.
Simplify what you tell the impaired person. Instead of saying, "We have to get up early today and hurry with your visit with Dr. Brown; I want him to change your medication," just get the person up with no comment, serve his breakfast and matter of factly help him into his coat. Then when you are almost there, say "We are seeing Dr. Brown this morning." This is not deceit: It is limiting what the confused person must remember. Rather than get involved in an argument, ignore or downplay objections. For example, if the person says, "I will not go to the doctor," instead of saying, "Yes, you have to see the doctor," say, "We will stop downtown for ice-cream." - Try using a visiting nurse or nurse practitioner to do a home visit, they will report back to the doctor.
- If they are having any physical problems, ex: hip hurting use that as an excuse. This doctor will give you something to help your hip.
- Make it a day. Go to breakfast or lunch. Then go to the doctor.
- Look for an opportunity for the individual to go to the physician
.
RESOURCES: Visiting Physicians Association -They assess over all health, mental status, safety, hygiene, diet and other environmental factors that play a significant role in the patient's well being. VPA provides both inpatient and outpatient services within the patient's own home. Clinical laboratory testing and high-tech portable diagnostics, which historically were only available in an ambulatory or hospital setting, can safely be rendered in the home. VPA physicians not only coordinate all in-home care but also closely follow the patient's progress during necessary inpatient stays. VPA-Toll-Free 1-877-HOUSECALLS or 1-877-468-7322. Payment can be through Medicare, Medicaid and Passport Services.
Mobile Medical Office -This service is for seniors who are not able to leave their home. Serves only Westside because they operate out of St. John Westshore. Medicare pays 80%; 20% is the responsibility of the patient or secondary insurance. House calls are made on Monday, Tuesday, Thursday, and Friday mornings only. New patients will get a complete physical, blood work and a cardiogram. For more information, contact 1-440-827-5530 Academy of Medicine Physician Referral -216.520.0110.
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