Dementia Caregivers: 14 Reasons to Call the Doctor

Doctor on the Phone with a Dementia Caregiver
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Not sure if you should just wait and watch your loved with dementia, or call the doctor? This question for caregivers can be difficult to answer, especially when caring for someone with Alzheimer's disease or another kind of dementia who may have difficulty expressing how they feel.

A call to the doctor is warranted under some circumstances and will benefit your loved one's wellness. Consider these suggestions for when to make the call.

1. Your Loved One Has a Fever

A fever can be a sign of an infection, and infections can trigger delirium. Infections such as pneumonia and urinary tract infections are particularly common in older adults and without treatment, they can cause more serious illnesses such as sepsis

2. An Open Wound Just Won't Heal
If your loved one has a sore that just won't heal, you should call the doctor. Wounds such as pressure sores can cause significant pain, infection, and a decline in functioning if they're not treated. With vigilant treatment, many of these sores will resolve.

3. Your Loved One Has Shortness of Breath or Prolonged Coughing

A persistent cough that won't go away after a few days or shortness of breath should be reported to the doctor. While these symptoms could simply be due to the common cold, they could also be related to influenza or pneumonia, both of which may benefit from treatment, often an antibiotic.

4. You Notice Signs of a Urinary Tract Infection

A urinary tract infection (UTI) can cause increased confusion, pain, and a general decrease in functioning. Often, an antibiotic can help fight a urinary tract infection. 

5. You Notice Increased Confusion That's Different Than Normal

Although your loved one has dementia, you still might see those times where their confusion is more prominent or severe than normal.

This could be related to a medical condition that's treatable, so it's important that the reason for this cognitive decline is investigated by the physician. It is often helpful to the doctor if you're able to provide and example or two of the cognitive decline/confusion, rather than just a statement that "they're more confused."

6. Your Loved One Shows Signs of Pain or Discomfort

Be vigilant about looking for signs of discomfort or pain. This is important for all caregivers, but especially for those who are caring for people with dementia because of their word-finding difficulties. Pain may be demonstrated by anger, irritation, resisting care, yelling out or increased restlessness. Adequate pain control is important for your loved one's quality of life.

7. You Notice Behavioral Challenges That Are Distressing to Your Loved One or Yourself

Even if you're committed to using non-drug approaches to your loved one's challenging behaviors, you should also keep the physician informed about what those behaviors are and what's been working for reducing and responding to them. While non-drug approaches should be the first strategy, keep in mind that if distressing hallucinations and delusions are common, psychotropic medications are often a key to decreasing that distress.

8. Your Loved One Is Experiencing Sleeping Problems

If your loved one is up much of the night, and thus you are too, you may need to discuss possible treatments. Medications that help with nighttime sleep often do increase the risk of falls, so again, non-drug treatments are more desirable. However, you may need to address the situation with the doctor if it continues on an ongoing basis.

9. There Are Sudden Changes in Condition

Changes that warrant a call to the physician include a facial droop, difficulty in waking up the person, a decline in the ability to speak or interact as compared to normal, or other noticeable changes in functioning.

These all may be indicative of a more serious condition that requires medical attention.

10. There Is Unplanned (Unintentional) Weight Loss or Gain of More than a Few Pounds

If your loved one is putting on the pounds or losing them without a noticeable change in diet, this could be a cause for concern. While excess pounds can indicate things like hidden snacking, hoarding food or water retention due to congestive heart failure, weight loss in dementia has been correlated with a general decline in condition and should be investigated.

11. There Are Significant Changes in the Ability to Eat or Swallow

As dementia progresses into the later stages, your loved one may forget how to chew food well or be less able to swallow well. If he's pocketing food in his cheek or coughing or choking when eating, be sure to discuss these symptoms with the physician.

12. Your Loved One Has a Fall (Depending on the Symptoms)

For people living with dementia, the risk of falling is increased. While some falls don't cause any injury, other falls can cause concussions or head injuries, hip fractures, or neck injuries. If your family member with dementia hit her head or neck in the fall, lost consciousness, can't move her arms or legs, has significant pain or can't bear weight, you will likely need to call 911 for medical evaluation and possible transport to the hospital.

13. Medications Haven't Been Reviewed by the Doctor Recently

Too many medications can increase confusion for some people, so it's important that each medicine is actually needed and still remains appropriate for the person's highest possible functioning. Especially if the person's functioning has changed- either improved or declined- the medications they receive should be evaluated.

14. Antipsychotic Medications Are Being Prescribed for the Person With Dementia

If your loved one with dementia has been receiving an antipsychotic medication that hasn't been reviewed for six months to a year, this should be evaluated.

For example, if your loved one was in the hospital and started on an antipsychotic medicine because she was hallucinating, it's possible that her hallucinations were related to a delirium caused by an infection. Now that the infection has been treated and has resolved, it may be appropriate to decrease and eventually discontinue that antipsychotic medication. This is important because this class of medication has the potential for many negative side effects which could be eliminated by removing the drug from her regimen.  

Talking With the Doctor 

Keep in mind that in order for physicians (or their medical staff) to speak with you about their patient, they will typically require either verbal permission from the patient to do so or a copy of the medical power of attorney for healthcare decisions.

Additionally, make sure that you have provided the physician with a copy of the living will if one exists so that the treatment decisions reflect your loved one's choices that they've previously made regarding their care.

Sources

Merck Manual. Fever in Adults.  https://www.merckmanuals.com/home/infections/biology-of-infectious-disease/fever-in-adults

Sutter Health. Palo Alto Medical Foundation. When Should I Call My Doctor if I Have a Cold or the Flu? http://www.pamf.org/flu/doctor.html

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