Doctors want my husband with moderate dementia to have a colonoscopy because of a severe drop in iron. Any experience with this or alternatives?

I would not authorize a colonoscopy for my Loved one with dementia.
First doing the prep would be a nightmare for both of you.
(Is he continent now? If not even more of a nightmare!)
Getting him to drink all the prep solution in the time necessary would be difficult. And if it tastes bad even more of a problem.
Then we get to the twilight anesthesia. Anesthesia is a problem in general for people with dementia. Not to mention once home you will have to deal with someone that may have balance problems for a while.

Now I will ask the hard question.
What would you do if the results came back indicating that there is cancer? Would you opt for surgery? and possibly chemo? radiation?
If the answer is no to these possibilities why would you have the colonoscopy done?
There are tests that can be done in home stool samples. Easier, less invasive. But that may give you a false positive or negative result (don't cha just love the ads for that test) but if the doctor is looking for blood in the stool that is a way to start. But again getting back to the questions above.

So...I would not have the colonoscopy done on my loved one.. (And I didn't my Husbands doctor asked, she said it was due and I declined and said with his dementia a colonoscopy was unnecessary and she agreed)

A very wise geriatrician told me years ago, "if you not going to do the treatment, don't do the test".

PLEASE:

I ADVISE AGAINST IT.

Of course, I don't know your husband's situation.

BUT seriously:

those tests have RISKS.

When you're elderly, it's unnecessary to go through such tests/risks:

1) If they find something, I guess you won't operate? So don't do the test! Whatever they find, you're not going to go through with the operation (even more risky; can die; can cause accidental tissue damage during the test or operation).

2) The test your doctor wants to do, normally means your husband will need anesthesia. PLEASE don't do the test. Anesthesia has many risks. Can create EVEN MORE dementia.

3) At some point, one has to die of something. I decided for my sister (who was very grateful later), not to go through with the test. Her "bleeding ulcer" (it's not sure there was an ulcer) turned out to be totally temporary (caused by the hospital, strong medications). As soon as she went home, the bleeding/symptoms stopped. The test would have been totally unnecessary anyway (of course we could not know that). We had already decided, not to do the test no matter what. If you must die, then die at home (it's what my sister wants), without having gone through dangerous testing (for which anyway, we would never have operated after, if there was indeed an ulcer).

4) Of course every case is different. But we can still learn from each other. (My sister was/is very lucky. She's at home, very healthy.)

5) Iron levels low? There are iron supplements (they also have side-effects). My sister is home. Our private doctor is reducing the iron supplements (from the hospital), slowly, slowly to zero, while increasing iron-rich food.

6) Find a good, competent doctor.

7) My thread might help you, or not.
https://www.agingcare.com/discussions/im-only-venting-no-question-stress-worry-sister-in-hospital-473532.htm

I am a firm believer in not putting a person under any anesthesia, who is experiencing any signs of dementia.

In Nov. or 2018, my bride of 28 years (at the time) went under general anesthesia for surgery. At the time we did not know she was experiencing dementia but we were seeing signs of confusion. About 10 months late the confusion, delusions and hallucination should up, literally in one night. The switch flipped and she is now in full blown Alzheimer's Disease.

It wasn't until I was in a caregivers support group that I learned that anesthesia is a definite progessor of dementia.

I agree with the other comments. Why put your husband through this?

Prayers and blessings to you and your confidence in your decision!

Firstly, I presume other lack of iron reasons have been ruled out (ie dietary, anemia, blood conditions).

Secondly, the Doc must have a strong suspician he is losing blood from the bowel internally to warrant a colonoscopy (as apposed to gut or other).

Ensure that is correct before proceeding just in case there is other less invasive tests that can be done.

If that was the strongest area of concern (after other less invasive options), I'd probably go ahead if my LO. The scope may be a bit tricky at the prep stage but is not usually painful - although any procedure does carry risk.

For any special needs a colonoscopy could be done as an inpatient (but may cost more) - so the prep (white diet or similar) & effects are managed by staff. Then anaesthesia will take care of the procedure itself.

If a few nasty polyps are the cause they can be delt with quickly, iron problem fixed & your DH will be feeling much better quite quickly. If however, something more ominous is found, you can take your time to weigh up the burden/risks/benefits of more treatment/surgery.

Of course, you know your DH best. What would be his pre-dementia decision be for a common routine medical procedure to investigate?

Or if required (I hope not) more invasive surgery?

How old is your husband? If you dont want to do the procedure ask doctor about giving dad iron supplements to boost his iron levels if you don't do the colonoscopy.

I highly recommend proferrin iron supplements. You can buy them on line or the pharmacist can order them in in a day or so. They do not cause stomach upset as they are not metallic.

The proferrin really works.

The reason for the colonoscopy is to make sure your husband doesn't have colon cancer. The anemia is quite obvious. Iron supplements won't help if he has colon cancer.

Has the test been done to look for occult blood in stool, and was it positive? Can you tell me your husband's age? If your husband were positive for colon cancer would you treat him with surgery, possible colostomy, and chemotherapy?

These are all things to ask yourself. My own father had similar results in his 90s and he did no testing after discussing with MD what he would do if postive. He had some weakness, who knows whether of age or iron poor blood. He died in his easy chair at 94.
There are other blood tests to be done to rule out other possible reasons for this drop. You could also wait and retest in 6 months.
I myself an 80. If I had this result I would not treat any condition unless obstructed. In that case I would have an MRI.
Colonoscopies are not complication free in and of themselves and I have witnessed, as a nurse, death after perforation of the bowel. This complication will be discussed before the test, in fact as a pre op warning about possible complications.
I am only saying I would not take this, but there are many things I would not including CPR, vent, dialysis, feedings by PEG or NG. I guess I am saying I am ready to go.
Your husband cannot make his own decisions, and you I assume are his POA and will have to. Make the decision for him you think he might make, the one you think best for him. That's the best you can do. I wish you both good luck and hope you'll update us.
Meanwhile do some internet research on reasons for iron-poor blood, etc.

Profile says DH is 74. Its not recommended to have a colonoscopy after 75. Perforation of the bowel is more likely as we age because the lining becomes thinner. I agree, I would not do it if the person has Dementia.

I just had my first, at 72, and looks like my only colonoscopy. I did the home test and it came up positive. The Doctor found nothing. The blood in my screening was probably from a hemorrhoid. Really! I thought they were suppose to be able to tell the difference between cancer blood and regular.

I took pills, 12 if them with water following them. I was suppose to take the rest of the water after finishing taking the pills. Then 1/2 hr later more water. I sip everything I drink so diwning this much water was hard. It did not take the pills long to work and I was throwing up the water while I was on the toilet. My stomach cannot hold that much liquid at one time. That was about 12 I think. At 8 pm I had to take another 12 pills, this time I spaced them out taking a little water ea time. Then, I just kept sipping water until bed. (Okd by the doctor) Those pills were horse pills.

I do not see someone suffering from Dementia going thru this. From beginning to end was maybe an hour for the actual procedure. Anesthesia problems, I think, depends on how long your under. I am so surprised when Drs recommend these type of procedures for people with Dementia.

I decided against a routine screening colonoscopy for my Mom at age 75 with mid stage dementia. Talked with her Dr about the risks of anesthesia and treatment we would not due if cancer was discovered. Maybe some iron supplements would help your husband vs a procedure that could make dementia accelerate. Good luck with your decision.

I would increase the iron in his diet, spinach, beets, liver, etc. and retest in a few months.

Low iron can make you just feel crummy and exhausted, so getting some in him naturally should help avoid the side effects from supplements like headaches and constipation.

I am a firm believer that we should not chase symptoms if we aren't going to pursue treatment for whatever is found. At 74, they always find something, it's part of the sickcare system.

This really puzzles me, but perhaps I just don’t have the medical knowledge. I’ve had low iron levels, and boosted them with iron tablets (doctor prescription). The suggested dietary supplements (spinach etc) are good, but don’t pack as much punch as tablets if there is a real deficiency. (I knew a guy with large blood loss through haemophilia, and the doctor tried to be kind in explaining to me firmly that spinach wasn’t the answer) I’ve also had about 6 colonoscopies (polyps, family history etc), and the prep is not much fun, much worse than the colonoscopy itself. At 74, I’m not having another. I’ll just stick to stool tests.

What puzzles me is how a lot of blood can be lost in the bowel without ANY of it being detectable in a stool test. If a lot of blood is passing from the bowel internally into the stomach cavity, would a colonoscopy be the only/ appropriate way to check – and where would the blood be going if not into the bowel, or into a detectable swelling in the abdomen? Plus are there other potential causes for low iron besides blood loss?

Unless you can find medical support to explain this coherently, I’d be asking for a second opinion before even considering a colonoscopy. Good luck!

They're likely looking for internal bleeding, not cancer.

My mother had severe anemia (and dementia) misdiagnosed by her doctor as "she needs more exercise" (My #1 reason for getting off Kaiser, but that a whole other story). She ended up in the hospital, not the gym, and they wanted to do a colonoscopy AND an endoscopy. She refused to drink the prep after a while, and they couldn't force her, so she wasn't cleaned out all the way. The doctor did it anyway, and the results were inconclusive. (They suspected a bleeding ulcer.)

They gave her five blood transfusions, and the problem went away.

I wouldn't recommend doing it.

Seeker12: Heredity factors, e.g. family history (blood relatives) with colon issues/diseases should be addressed also before proceeding with a colonoscopy or other less invasive colon screenings.

You REALLY have to have a good reason to do this invasive procedure on someone who is over 75. My SIL is a GI doc and he is always very wary to do colonoscopies on the elderly, the bowel lining is so thin, a perforation is a real risk.

Also, with dementia, he probably can't make the decision to say yes or no to such a procedure and the prep would be horrible.

I have low iron anemia. The first thing they do is check you for internal bleeding. Usually that would be a colonoscopy and an endoscopy.

Statistically an iron deficiency anemia in the elderly is considered to be caused by a bleeding colon tumor (cancer), unless proven otherwise by a colonoscopy. If course, the procedure s risky in old people. The question are: What will happen if he has indeed colon cancer? Bowel resection surgery, chemotherapy and radiation? Perhaps that will kill him right away.

Is his smear of stool test positive for occult (hidden) blood?
Are his stools dark and tarry looking?
I would do this according to whether you are going to treat or not. If they find a problem would you want him to have surgery at this point is the question? Would you treat him for cancer?
If the answer is no, then it is unimportant.
My Dad in his 90s faced this exact thing. They said he had anemia and he was pretty tired. They asked him if he wanted treatment if they found something and he replied no. They didn't treat it. He died suddenly some two years later, like a dissecting aneurysm, as we knew he had that as well. Not even time to say "ouch".
For me, I wouldn't be doing this. If you wish to, they will give him light sedation, and the worst will be the prep for it with the severe diarrhea.
I wish you the best in your decision and hope you will update us.

If you suspect a bleeding ulcer, an endoscopy will reveal that. DH would be sedated for an endoscopy which is much less potentially harmful than a colonoscopy. Such a procedure can be done on an out-patient basis, normally, just like a colonoscopy.

I wouldn't try to put him through a colonoscopy with dementia at play. Way way WAY too much to go through, imo.

This post is from March, folks. I'm sure the issue has been resolved by now.

thanks to everyone who took the time to advise/warn me of possible problems with a colonoscopy. I am 73 years old, so moving into that "at risk" group. My PCP (new) advised one because I had told her that when I had the first one (about 10 years ago) the doctor did remove some polyps. I'm most likely going to forgo the experience also as I have a referral at a hospital I don't trust at all, + I'd have to get someone to accompany me and I've had experiences with that (being robbed by the "caretaker" who accompanied me, per the law (recounted in previous topic). Also, anything "invasive" I'm not wild about, especially if it's elective.