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.

So ask them. As a GP, I get the letter. I call your Mum in on a pretext of a health check, check her blood pressure, cholesterol, pulse etc. Ask her if she has any concerns, any issues with her memory. She says no.

What do they expect me to do then?

I've been there. I've confronted a parent with no insight. It's shit. I get it. But if you can't bring yourself to deal with it, you're expecting a lot from a 'don't tell anyone I wrote' letter.

Gosh - that's bit harshly expressed. Not necessary really.

I have worked for the NHS in the field of dementia care and can understand the OP's quandary - she wants to do the right thing by her parent, but does not want to overstep the mark. The Alzheimer's Society are very well respected and will give her the chance to talk it all through with someone who has experience of the problem - which many other AC face. I think that will be very helpful.

I'm in the exact same position as the op and I am also considering a letter to the GP.

My response and reply was in relation to another poster who's writing on this thread saying that she's a GP and a letter to the GP as a family member with someone suspecting dementia and asking to remain anonymous is useless. There's a GP arguing against letters to the GP.

A dementia organisation would only advise you to write to the GP.
Yet there's a person here on this thread claiming to be a GP suggesting against a letter.

It's not that I don't understand why you'd do it.
It's just that it puts us in an impossible situation.

I say again - I get this letter, get your mum in on a pretext, ask her if everything is ok, any concerns about memory, she says 'kind of you to ask doctor, all is fine'.

what then?
if I can say - well your daughter was concerned enough to write to me - that might move things along

without that, I can do nothing

Writing a letter means that if someone ends up having a fall or similar, it hasn't come out of the blue. It may give some kind of timeline - concerns first raised by family at point x, etc.

Would it be so hard to do the MMSE or the MOCA as part of a check up?

I didn't know what the tests were called, but yes, these are what I imagined a GP might do if they'd received concerns in writing from a relative.

Well, our GP did help.

The Gp that came out was concerned mil still had capacity, so the memory clinic declined the referral, as she'd already refused to go several times.

GP, re-referred after discussion about capacity & the cmht sent a cpn out. She reported back to a consultant, who dx mixed dementia.

This was the very best solution to an intractable problem. Mil wasn't disturbed too much. Nothing much had changed but we are now known to the cmht & have access to the local dementia coordinator.

A dementia organisation would only advise you to write to the GP.
Yet there's a person here on this thread claiming to be a GP suggesting against a letter.

First of all that may not be their advice - we do not know that. And secondly it is not bad advice. We have one GP against this. There are lots more GPs! My experience is that GPs put the letter into the patient's file and next time they see the patient they will be alert to signs of dementia. That is all good.

What the Alzheimer's Society helpline would do is to provide the OP with someone to have a live supportive conversation with. To talk it through, to express their concerns, to listen to the experiences of others, to get some perspective, to not feel alone in trying to work their way through the problem, to get advice on the next steps. I think that would be very positive. Indeed I know it would be as I have seen this happen.

Likely to be refused if patient in denial and can't refer with no history

My mum was quite happy to do the memory test as she was convinced it would prove that everyone else was wrong once and for all.

I don't know, I'm out in the community and ask a lot of patients to do things to help us rule out any issues, including quite detailed cognitive screening. Or even just recording that they've declined it 'because you'll only get my daughter upset'.

At the very least, giving the patient a bit of info at the start of the appointment (their blood pressure or whatever) and seeing if they remember what it was at the end, and if they do, what strategies they are using to remember it. Not in a judgemental way, but just to have it on the record what's happening at this point in time. God knows we all use memory strategies.

You know all this. I just do believe that it shouldn't be that difficult just to record 'family concerns re memory' on the timeline, if nothing else.

Thanks for the replies everyone, it's much appreciated. I realise it's an awkward thing to ask of a GP, I was hoping they could just flag up that there might be concerns and to keep an eye out in appointments for any signs. I'll take all POVs on board.

Good luck everyone else who's dealing with the same!

It is not awkward.
Gp s are there to serve their community
Elderly should not slip thru net and relatives can alert to declines

Hopefully many gp practices have designated elderly nurse as per my relative. This designated nurse did home visit and knew exactly what to assess and look out for . And called me after to say had visited.

It's not awkward - that's not the problem.
It's just impossible, if the patient says 'thanks for asking but I'm fine', and they have capacity, to do anything further without permission to say that you have written.

It's not writing the letter that's the problem.
It's asking the GP to keep it a secret.

Surely you could trawl through recent medical visits or medial issues and see if there's anything whatsoever that crops up. I know for my mother. She always looked after her health. She's now being very stubborn about some issues and I know from what she tells me she has high cholestrol. There's probably more bits and pieces being neglected too. Surely something could be picked apart and found and used as an excuse for referral onwards to elderly phsciatric or geritician or whatever.

I had some bad few days with my mother. She definitely has the mind of a child now but I don't have a diagnosis. In other parts of the day she is ok-ish. A lot of the time no matter how gentle I approach issues she's very defiant. A diagnosis would be hugely helpful for me so that I can get supports for her and for me too. I find have to babysit her more and more and I am falling behind on so much work. I'm utterly depressed and I feel much much worse than this too with feelings of the big S but I don't want to type it.

In the end we can't refer or do anything without the patient's permission.

Have you been to the gp with your mum to raise your concerns?

That's nonsense. I was sick a few years ago and my GP referred me to the hospital. She didn't ask me but she did it and rightly so but didn't refuse her either.

Yes, my GP knows I have concerns. I haven't attend to the GP with my mother because it's impossible to get her to the GP now.

My relative's short term memory was far gone enough they had no clue anyway....
You don't need to ask gp to keep it a secret ?
Gp s are surely able to use the right words like "just calling for routine check "

ah yes sorry it wasn't in the OP - the thread went on to talk about people writing to the GP but saying 'please don't tell Mum I've been in touch'

(or maybe that was a different thread on a similar subject!)

My mother has dementia and sees a private geriatric doctor in Spain. He doesn't ask "do you have issues with your memory?". What he does is give her memory tests and he sees by himself that she has issues. I write to him with my concerns and he acknowledges receipt. He won't share private information but he certainly uses the info I give him.

I can't understand why GPs can't do something similar unless it's just due to lack of time and money

Do you not think that someone who has no concerns about their memory, or is defensive because they are in denial, might take offence at the first or second question of what is obviously a memory test, and refuse to answer it?

That's what often happens in the real world, unless we can give a reason for doing it.

I think these tests should be done by default after a certain age, just like they do mammograms after age 50 or blood tests at regular intervals. It is very common in other countries so if we don't do it in UK, I reckon it is lack of resources and not any fear to offend the patients

They are done if you have an nhs operation. My mil goes private, so not done.

" hello good morning what did you have for breakfast"
Could elicit a response which may or may mot reveal issues
Ahead of any formal memory test
If you arrange covertly to be there you can then inform nurse or GP which questions were showing short term memory loss

These tests don't come anywhere near meeting the Wilson criteria for being suitable for screening.