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Mom is 92 with moderate Alzheimer's (we think) - but def dementia (vascular).
She cannot make good decisions for herself anymore.
She brushes her teeth with hand lotion if we are not watching her... so...
She has a DNR in place, and I am her POA.
She (or I) have been advised to take her to a kidney specialist, as her kidney levels came back a little high which means they are working too hard.
Mom says she feels fine and doesn't want to go.
Again, she IS 92, and with moderate dementia, the future ain't looking too bright anyway... but should I try to trick her into see the specialist (i.e. get her in the car and "stop in" to see him?) I feel like I'm in a Catch-22.

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A wise gwriatrician told me "don't do the test if you're not going to do the treatment". Call the doctor and ask what he's trying to find out.
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When my mom was in her mid 80s and in rehab, "suspicious spots" were found during a thorough exam. When she was out of rehab and went to her regular geriatrician the doctor brought it up. "Would you like me to arrange for further testing?" she asked.

Mom: "No. I've lived a good long life. I'm going to die of something. If it is cancer, so be it. But I won't take treatment, so there is no point of doing the test."
Doc: "I understand. Many people your age feel that way. I will respect your decision, but I am obligated to tell you that if you do have cancer there are treatments for it, and the treatments have improved in recent years."
Mom: "But I will not have treatment. If I have cancer I don't want to know."
Doc: "Jeanne, how do you feel about that?"
Me: "I think it is Mother's decision. I will support her either way."
Doc: "I will accept this decision and record it in my notes. If you get to thinking about it some more and change your mind just call the clinic and I will arrange more tests."

Babalou, I guess in this case it was the patient telling the doctor, "I won't do the treatment, so don't do the tests."

Nikki, as others have said, look into what the options would be if she does have the tests and something is found. What would the treatments be like? Would they be advised for someone in her 90s with dementia? Would your mother be likely to cooperate with them?

Don't do the tests if she won't do the treatments.
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Mom can't really make a decision about dialysis or not... but we had my dad's brothers on it, and I can tell you it was not fun... yeah it extends life, but to what end? She puts on her clothes over her nightgown, she's agitated most of the time, unhappy, angry, and depressed. Yes, we are working on the right behavior/mood meds for her, but other than that, I know she would not go for dialysis even in her right mind at the age of 92. I think I need to get her there. I know kidneys are nothing to play with; but if they say 'dialysis', then it would literally take a herd of wild horses to force her into that, and I won't force her, if I have any say...
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My mother is 74 and living with vascular dementia - she has absolutely no quality of life. Due to the side effect of a medication required to treat a medical condition of hers for years, this medication has caused her kidneys to weaken. She's a DNR (both cardio and respiratory) and I'm her POA. She will not be getting kidney dialysis if it were to come this - because she has no upside to her situation as it stands now and her life will only get more miserable by being on dialysis. At your mother's age of 92 "ish", how realistic will kidney dialysis benefit her if she were to need it? Sure, it may be her some time but I guarantee you, she'll have very limited quality of life, if any; in fact, she'll be be miserable. Have you researched what dialysis does to the body and its potential complications - again - it's going to be even more difficult for these complications on a 92-year old. Traditional doctors are trained to look at the labs and treat the disease at all costs - not to think about quality of life of the patient. The only doctors who have any semblance of putting quality of life first are the doctors working in hospice care. Don't blindly assume that your mother's doctor is looking out what's best for her. You need to do your research now on kidney dialysis and decide now if this is something you want for your mother and if you don't - tell the doctor no kidney consult. Don't let him/her bully/persuade you differently. We're all going to die from something...Who wants be in misery in his/her last years?? I've learned painfully the hard way when it comes to aging, it's about quality of life and NOT quantity of life.
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I would say yes. Trick her, lie, manipulate, whatever you can do to get her to see a kidney specialist. This isn't anything to fool around with, regardless of how she feels. And you know that with her dementia, she might not even be able to detect anything amiss, but the bloodwork and other tests a kidney specialist would probably perform would be insightful to determine if something is amiss.
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I'll start by saying I know nothing about kidney problems (thankfully).
I think your GP could give you a little guidance here, ie what would the treatment options be that a specialist might recommend? If we are talking about some tweaking of meds is it something that the GP could handle? If we are talking about possible dialysis would mom even be willing to consider it?
I believe there is no point putting you mom or yourself through the hassle of travelling to probably multiple appointments if you would probably not go forward with the treatments offered, but that is a judgment call you need a little more info to make.
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Dialysis is no picnic and can leave you feeling just plain awful. I would take a good hard look at all the medications she is on and ask the pharmacist if any one of them or the combination of them is compromising kidney function. Pharmacists know more about meds and interactions than a doctor.
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Well, you received so many great answers. IF taking your mother to a dr is like giving a cat a bath---that's when you have to use your common sense and humanity to make decisions FOR her. Most drs look at the numbers on the paper and treat accordingly--and they don't often thing "whole patient"--just what the "numbers" might mean. I wouldn't force my mother to go to the dr., I would talk to her PCP and see WHY exactly they felt the need to look further into something. It's no delight to trick an elderly person into a dr's visit. I remember my FIL hating his oncologist's visits, b/c half the time we'd wind up going right from the office to check him into the hospital. He got to the point where he'd practically fight me about going-"Is he going to admit me? I don't want to go!"
I'm sure this is a conundrum for many. How much do you do for someone who is really unable to decide what kind of care they want? If it's the start if kidney failure, I know in Mother's DNR, she does not want interventional care for that. Go read your mother's DNR and see what she chose. It may make your decision for you.
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careisgiving says "The only doctors who have any semblance of putting quality of life first are the doctors working in hospice care." They definitely do, by training and by the philosophy of the program. But I have found geriatricians to also be exempt from the "cure at all costs" mindset. Elders should have geriatricians as their PCP, just as children should have pediatricians.
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I respect what jeannegibbs is saying because this is her experience and we all have different experiences. This is my experience: Doctor specialty demand is based on location and money potential and the amount of debt/cash against medical liability insurance required to sustain the business at a healthy profit; some doctors are okay with a reasonable amount of profit, some doctors want more profit. Today's medical students are not rushing to specialize in primary care medicine because they're wanting to specialize in the higher paying specialties, like anesthesiology, oncology, radiology, surgery, etc in return for the years of medical school debt, low pay in residency, and years of higher income potential as we're all living longer. Geriatric doctors are PCPs with decades of work under their belt, not looking for a huge profit margin, have taken a few additional courses in continuing education credits to see what's happening in senior medicine, and then call themselves geriatricians. There's no medical residency for "geriatric medicine". How many practicing geriatricians are under the age of 55 years old? Not many. We live in a major metropolitan city with no geriatrician. We live down the street from a city widely nicknamed "Snowbird City", and there's not on geriatrician practicing there, just a handful of PCPs. Do some of them put quality of life first, first. Sure. But not many of them. Kuddos to anyone who can find a geriatrician but sadly this isn't the reality in many localities. And with all the changes and cuts to Medicare, PCPs don't want to take on many elder patients and the ones that do balance out the low pay rate reimbursement from Medicare by increasing supply of "younger" patients who have higher insurance reimbursement rates. It's so important to really think about quality of life instead of quantity of life. How many PCPs ask the patient's family something like "Let's talk about quality of life..." Not many. A lot of the PCPs just look at the labs, write scripts, write orders and then just push the patient on to the next doctor, who'll do the same thing. I love my mother so much and it's because I love her that I don't want her to suffer just to prolong her life. This is absolutely cruel in my book. As caregiver, as POAs, we need to be vigilant in advocating what's best for our loved one for their quality of life because 99% of the traditional doctors won't do it as it's not in their training.
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