—The government's Alzheimer's advisers want doctors to steer families toward advanced-care planning, including designating a health care power of attorney, as soon as dementia is diagnosed. Montefiore's Kennedy says early diagnosis gives patients a say in how they want to be cared for while they're still capable of making those decisions.
—A health care proxy won't be used until the person is quite sick. So Kallmyer advises also signing what's called a "release of information" allowing the doctor to discuss the person's care with whoever is named right away.
Such steps are important, Kennedy says, because advancing dementia leaves people so unaware of their deficits that they can take family or doctor input "as an affront." He always asks new patients if he can fill in their loved ones, or invite them in from the waiting room, as a way of starting that conversation.
—Doctors can violate patient confidentiality if they believe the person's decisions or behavior has become a danger, Kennedy notes.
McKenzie says her father would never discuss naming a health care proxy and her parents were furious that she'd voiced concerns to their physician. She had to think up non-confrontational ways to get invited back into their doctor visits: "I'll drive you, and then why don't I take notes in case you have any questions later?"
It turned out that McKenzie's father had a non-cancerous brain tumor causing his own gradual dementia symptoms, which started becoming apparent with the phone mix-up, unrefrigerated food and eventually delusions. Finally, she had to go to court to get her parents the care they needed in an assisted living facility near their hometown.
Aging America is a joint AP-APME project examining the aging of the baby boomers and the impact that is having on the communities in which they live.
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