Letter to GP about mother?

[LozzaChops101]

Hello everyone - just after some advice about sending a letter to my mother's GP. This might be a bit garbled as my brain is completely fried at the moment, apologies.

My mother (74 now) tried to bring up cognitive impairment to her GP when I accompanied her to an appointment after she had a heart attack in early 2018. She thought she was becoming "forgetful" due to her heart attack, but I had been seeing signs for several years. Her GP was extremely dismissive, saying if she knew where she was and hadn't left the gas on then there was nothing to worry about. There was definitely something to worry about then, and it's obviously got worse since. I need to somehow get him to take it seriously as I'm now struggling to cope with her on my own. Another problem I have is that my mother is (has always been) quite difficult with me, and this is only getting worse as she gets older - she gets furious with me, then stops speaking to me for weeks if she feels slighted, which includes any suspicion that I might have noticed that she's done something a bit batty. I don't know how she remembers that she isn't speaking to me when she forgets everything else(!) but I really would like her not to know that I've been in touch with her GP about her.

We've got to the stage now where her friends are bringing it up to me, and each other. She can't remember any appointments, or that she's meeting friends, she struggles to follow conversations, and she completely messes up her (vast array of) medication; forgetting that she's already taken it, or forgetting to take it at all. We have the same conversation literally dozens of times a day, each time can be within a minute or two, and she won't remember. She can't remember very recent events, eg. last night I helped her fill in an online form for an imminent asthma assessment, the second she pressed "submit" she said "Oh, I think have to do a form about my asthma somewhere, but I don't know what that is." She is also now becoming very belligerent with her friends for little/no reason and then can't remember that she's done it. She's cut off completely two friends that she's known for over 60 years without explanation to them.

Her own mother developed vascular dementia in her late 50s, but this feels different, and if a stranger spent a few minutes talking to her they might not notice. She's also physcially quite active, she can garden all day, has pilates weekly (that she almost always forgets to attend now) and volunteers to go leafletting (then obviously can't remember where she's been) etc, so she doesn't fit the average image of an old lady with dementia to outsiders.

TLDR!

A) Can I write to mother's GP re. concerns about dementia/cognitive impairment?

B) If not GP, who, if anyone?

C) What should I include if I do?!

I think this is probably a garbled mess, apologies.

Thanks for reading! Yours in mild desperation, etc.

I'm in a similar position. There's definitely stuff going on with my mother but to everyone outside of the family she seems fine.

I was advised to do just this by a specialist at a dementia charity.

Could you approach adult social services- that’s what we did with my aunt.

I'm a GP. Letters that say 'I'm worried about mum, please don't tell her I have written' put us in an impossible situation. I'm not clear if she is concerned at the moment about her memory or not?

Firstly, without her consent, I can't even reply to a relative and confirm if the patient is registered with us or not
secondly - what on earth do you want the GP to do, if we can't reveal that she you have been in touch?

Make a GP appointment and take your Mum to see the GP.

Thanks for the reply and it's great to get another perspective.

I know in my case if I was to make a GP appointment for my mother, it would enrage her.

I know in my case, my mother isn't bad enough yet but there's some behaviours that's not right. She's also neglecting her health now sometimes. I encourage her to make a GP appointment now and then. She went a year without any GP appointment. She was sick last week and ignored making an appointment. She did eventually go.

I am concerned about dementia. I think what I will do in time is to prepare a document for printing with all of my observations. I attended the same practice as my mother. I think what I will do is make a GP appointment for myself and ask my mother for help to come with me and blow my symptoms out of proportion to my mother and pretend to be every vulnerable and ask her to help me go to the doctor. And once in there, talk to the GP separately and maybe my mother could be called in.

Isn't one of the symptoms of dementia, denial though? My mum would be enraged too, if I even suggested concern about it. I appreciate it puts you as a GP in a difficult position, but sending a letter is what some of the rhe charities recommend. I think it's in the hope that the surgery will offer a wellness check.
What should we do? Is it really a question of waiting till the wheels fall off? Most of us here are simply trying to protect our loved ones, even when they are being extremely difficult, but we come up against dead end after dead end if nobody will help 🙁

So I offer a wellness check, which is easy to do
I say - any concerns about your memory
The patient says no

what then if I can't say that a member of your family is worried about you?
charities can be great but actually they often say things without consulting with the people affected.

Thank you for your reply @letsgoskiing . Is there anything else you can suggest or are we all as bound as each other by the mental capacity act?

I used to contact my mother's GP if I had any concerns about her health. They always invited her to the surgery for a routine appointment. They never told her I had spoken to them, and she was always please that they looked after her.

Ps sorry @letsgoskiing do you think there could or should be better ways of going about diagnosing dementia, or does the current system work in the main?
I do have friends who's parents are concerned about their memory and could or have been diagnosed. Is it the few with parents who have perhaps always been 'difficult' who fall through the net?

This is a fantastic post and reply.

I can't talk for anyone else here but I genuinely see changes in my mother that are concerning me. I observed for months and months before I even approached a GP. This post really explains it very well. We are in an impossible situation seeing changes and pure stubbornness and anger and other changes.

A referral to a geriatrician. If that can't happen a wellness check every 6 months. Until something shows up.

A referral to a geriatrician saying what? What am I going to say to the patient about why I'm referring them, if they say they are fine, and I can't tell them that the daughter has been in touch?

and what is "a wellness check"? As a one-off, fine, I can say 'we need to check your blood pressures' - but every 6 months?
who does it?
what is in it?

completely agree and I have been through this with dementia in the close family, so I get it from both sides.

In the end, as a relative you have to just tell your parent/whoever that you are concerned and you're going to contact their GP.

It's a subset of the fact that the NHS has been deliberately underfunded for well over a decade and is falling to pieces. We need more access to GPs in general, and to memory clinics, and to every other NHS service. But with a govt who won't move from their proposed 1.9% increase to GP funding for next year, nothing much is going to happen. And Labour isn't much better - Streeting is clueless about the NHS.

I know one of my observations about my mother is that she is ignoring high cholestrol. I don't know what her numbers are. Her GP has mentioned it at least twice to her . She refused meds in favour of sorting it through her diet. I now know she will never sort it through her diet. Ever. She doesn't have the comprehension to understand that aspect of her health any more. Her GP should have picked up on it.

Maybe other people are dealing with similar when it comes to their aging parents. Some aspect of their health being neglected and if GPs are afraid to move forward with suspicions surely something could be found for a referral to a geriatrician.

But what actually happened? Did she agree with your concerns? what were they?

If she has the mental capacity to make her own decisions then she has the capacity to make bad decisions.

For primary prevention (if she's never had a heart attack or stroke), you've got to treat 200 -300 people for high cholesterol to prevent one vascular event in any case.

surely something could be found for a referral to a geriatrician.

you do realise that when I refer to secondary care for a valid reason, my patients wait up to a year to be seen? And you want to clog up clinics with meaningless referrals, so that those who need to be seen wait even longer? What exactly is a geriatrician going to do about the fact that your mum doesn't want to take a statin?

Something that is part of dementia is that you can't reason with them. I find this now all the time. I am not able to reason with my mother and that strengtens my suspicions further and further. We are in an impossible situations. I can't talk for others her but I know for me I am not able to say to my mother that I have concerns. It would enrage her. Utterly utterly enrage her. Even though that's not my intention.

If you think she has dementia then you need to own that concern, make an appointment with her GP, GO WITH HER and say in front of the GP that you think she has dementia. If she disagrees and still has mental capacity there is nothing that you, the GP, or anyone else can do. If she disagrees but the GP thinks that she lacks capacity, then there are sometimes things that can be done. But don't send a letter saying 'please sort my Mum out but don't tell her I wrote to you'.

In the end, if you're too frightened to enrage her, then how do you expect someone else to do it?

Ig ring cholestrol is just one observation that I have. There's many many many more. Episodes of no speech or conversation, odd behaviours - snooping, eavesdropping, stealing, easily angered, over reactions, intense angers, unable to adapt to any change without explosions of anger, limited diet, paranoia, my list is endless. It is endless.

My mother is not right and there is no help.

one option is to write a letter to her GP like on this thread. Or another option is to trick her to go to a go where I will likely be handing over a written document of observations anyways.

Is it truly a case of ignoring this until the shit hits the fan?

It’s very hard. I wrote to the GP and nothing happened, and yes it had to wait until we had several crises for something to happen. It’s like watching (and being in) a very slow car crash.

I suppose I felt by writing to the GP I had done “something”, and we’re pretty powerless in these circumstances.

If you can get powers of attorney in place, please do so. My mother refused to give me one for many years, and by the time she relented I couldn’t get anyone to give the necessary capacity certificate.

Thank you for this 💐