Mom is 93 and in assisted living. Would a gerontologist be able to serve her every need better than her GP?

I'd recommend getting her to a gerontologist when you can. They will review her medications and may make a referral to a neurologist for a mental evaluation.

Due to a recent change in insurance, I changed my mom's treating to a gerontologist. He completely understands her life wishes and it's been a godsend to talk with him regarding my mom's treatment plan which is no treatment plan. He has put in place forms that will allow my mom's wishes are carried out and has provided me with valuable advice on what I should do and should have on my person when mom is hospitalized.

She is becoming forgetful and the filters are off, so it's an interesting place we're in now. It's difficult getting her to the dr, so I have to select what appointments are needed and which are not; again, based upon her wishes.

It's not easy, I know. You're not alone. This site provides valuable perspectives and advice.

Is your mom only on Medicare with no supplemental coverage? Docs today don't really want to spend time on "those" patients since they don't get reimbursed as much as with private pay patients.

A gerontologist will be better at figuring out any medication interaction. The pharmacist can also look at what she's taking and flag any interactions but can't make any suggestions to change her meds. When was the last time she was checked for a UTI? It can worsen dementia symptoms but can clear up with antibiotics. Wishing you peace as you help her.

Possibly if you can find one working in the community as opposed to academia. However as she clearly has some problems that are expected to simply get worse as they do in the elderly, I personally would leave her with a Dr she gets on with and who is likely to be taken more notice of by your Mum and who knows her better. If you have doubts about all her meds ask Dr to have a sit down and run through - if he prescribed them he should be able to give you information on need there certainly is a tendency to add extras in rather than make them alternatives or look at the whole picture.

The gynecologist is refilling and not seeing her? That’s not exactly practicing good medicine. We just changed my dad from the internist in the NH to the gerontologist and he took dad off some meds and changed another. I saw dad yesterday and he was much more alert and conversational. So I’m hoping that’s due to the medication changes. When they are on too many medications you run into problems. The elderly don’t metabolize them as well either. So yes I think another pair of eyes is always a wise idea. It can’t hurt and might help. You are her MPOA, I assume so you want to do what’s in her best interests. Incontinence goes hand in hand with dementia as it advances. I would not advise putting her on medication for it as those are further implicated in dementia development.

I would definitely take her to a gerontologist for a complete evaluation, especially of her medication. My mother suffered for almost 2 years with multiple broken bones resulting from 9 falls in her assisted living apartment. After being evicted from her facility for being too much of a liability because of her falls, we had to find a new facility and new medical team for her. The new gerontologist was horrified by the types, dosages, and number of different medications my mother was taking. The doctor adjusted her medication to align with current treatment protocols for the elderly. It appears that some of her medications were interacting with negative effects on her, and some should never have been prescribed for the elderly, and were most likely the cause of the balance problems that caused her falls. We saw almost an immediate and dramatic improvement in what we thought was an inevitable decline in her cognitive abilities. And, after almost 3 years with her new gerontologist, her balance and other physical abilities have improved so much, that at 90 years old, she has a new, happier and more active life. Please have her and her medications evaluated by a gerontologist. A second opinion is always valuable, if not for changes in treatment, at least for peace of mind.

Incontinence indicates the need for a nursing home and is beyond what assisted living can provide.

Bless your heart! Isn't keeping up with the medical care part of elder/dementia care challenging? ( I'm there with you in caring for my mom. ) I think your mom is super blessed to have you, as well as a caring medical team.

I agree that yes, it would be wise to see a geriatric specialist if possible. (Maybe you could do a one-time consult then still see the GP your mom loves, if your insurance allows?) I'm no doctor, but based on our family's own experience caring for my mom, it sounds like your mother may have a UTI, which can dramatically affect mental clarity but fortunately usually responds quickly to antibiotics.

When my mom lived alone, she used to also see her regular GP and RNP, who were wonderfully caring but prescribed lots of meds. When she moved in with us in a different town, we started her with a regular GP (who basically did the same thing, just refilling scripts).

Then we switched to a PCP(primary care provider) board certified in geriatrics. Aha! This doctor knows elder care. For example, many meds affect the elderly differently than younger patients (some meds have little benefit but heavy side effects), so the doctor ordered lab work then cancelled several of my mom's meds; UTI's are common among the elderly, who may not notice burning, etc., but caregivers will notice increased mental confusion, and a quick UA (urinalysis) can confirm if a UTI is the reason; eyes, teeth, and feet are critical to watch, especially for elderly diabetes patients; and she (the doctor) refers out to specialists as needed, including the neurologist, who handles the memory meds. Mom sees doctors often, 2-5 times/month, but so far she can still live with us. We also speak often with the pharmacists at the local pharmacy which handles all mom's meds, especially if a med gets missed or we wonder about an OTC drug.

I hope some of this is helpful on your journey with your mom. Please keep us posted.

Hugs and prayers for strength and wisdom each step of the way... for you, me, and all of us on this challenging path. 🤗🙏❤️

Thank you everyone for your input. It has given me new incentive to be bolder with her doctor. I am going to check into the one-time consult with a gerentologist to try to put "new eyes" on the problems too. This website has been a steady sounding board and information source for me for the past 4 years. Bless us all.

HI! Just wanted to let you know that enlisting the help of a geriatric specialist has been the best thing we could have done for my grandmother. in your original post you mentioned having someone look at your mom's meds to see if she needed all of them. That's exactly what my grandma's new gerontologist did, and she found that not only did were some of the meds not helpful for Gramma anymore, but they were actually exacerbating some of her decline. She took her off of some meds, changed others and brought Gramma to a much better physical state with better overall clarity of thought. Not to say it restored Gramma to her earlier functioning, but she's definitely got more time when she feels good and can communicate and participate at a higher level. Trying to get my parents to change to this doctor before they are in desperate need. My thought is that having an aging specialist on the front side of aging might help prolong independence and overall wellness.

Good luck!

I see nothing wrong with checking with a specialist in old age problems. If they can help, fine. But this woman is old and getting older and I doubt there is much anyone can do to change what is happening. It is simply a fact of life - we get old, things change, and then it ends. But it is worth a try for your peace of mind.

Your profile says that your mother has dementia. Have you discussed the prognosis with a doctor who treats patients with dementia? What is the goal? It was important for my LO to avoid extensive testing, doctor and ER visits, etc. so, we saw Palliative Care, which was to keep her comfortable.

My mother's dr is almost as old as she is. Very late 70's, possibly 80+. He's nice, that isn't the problem, he is just too darn old to be an effective dr any more. Sister works in healthcare and got mother an appt with a highly rated gerontologist---and initially, as usual, mother agreed to go and then YB refused to take her, so she stuck with her old GP who barely looks at her. She needs better, more appropriate care, and this old guy is barely making it through the day himself.

One thing is that she has the 'old doc' completely snowed about her encroaching dementia. You talk to her longer than 10 minutes and you know something is wrong--a new doc would pick up on that.

I have no say in this, we 4 sibs who cannot get near her anymore just leave well enough alone. Until she has some major fall or health issue, we decided to let it go.

I would not take her to drs anymore...it’s too stressful for you and her. Just keep her clean & comfortable. I’m sure there are doctors at the facility to check on her...like vital signs.

The suggestion to perhaps have a one-time only consult would be a good idea. There are so many medications today and many interact, either causing more problems or negating the benefit they might provide. A pharmacist should be able to look at all the medications and provide some advice about the medicines themselves. The doc could reassess mom and maybe determine what she needs/doesn't need.

As for UTIs, I was a skeptic when I joined this forum. After the first UTI while in MC, I became a convert. Mom had classic sun-downing, becoming almost a raging beast late afternoon into early evening, demanding to get out, had guests coming, needed to go home and get things ready!!! However, more recently we've been having bed-wetting episodes and other "accidents". This was not normal (although it could be part of the progression.) She would refuse to get up at night and decline assisted trips to the bathroom during the day (some recent non-injury tumbles has resulted in refusal to walk, but she will "scoot" herself along with the transport chair and head to the bathroom.) Previously her accidents were because sometimes she couldn't undress fast enough. We took all her undies away and leave disposables instead, which has helped. Anyway, they tested her and sure enough another UTI! No raging this time, but hopefully treatment will resolve the bed-wetting!

I would, along with getting the consult, check for a UTI. Typical symptoms don't apply for those with dementia. It just might contribute to her having more of an issue with incontinence. For that matter, not everyone gets the "typical" symptoms - my doc called in an Rx for me once, years ago, after a physical, telling me I had a UTI - really???

Getting a consult from a geriatric physician could possibly help. Not know what kind of facility your mom is in, hearing loss often can cause confusion. Geriatrics have a better understanding of effective and not effective drugs. Drugs may also have been effective, but are no longer or may be interacting. Have her ears checks as well as check for that ugly UTI (that will make anyone crazy). Good geriatrics can make a difference.

It is a good idea for a gerontologist to be on board with her care as a one-time consult.

An involved family member and a truly great doctor (even a osteopath or nurse practitioner) of any type is more important than their degree specialization.

I hope my mom’s story can help you.

My mom became (gradually) severely over medicated following hospital stays for various problems over a number of years. Doctors just kept adding on this and that prescription drug.

It was Mom (and Dad) and also Mom’s cleaning lady (Mom did not live with me at that time) who all jointly first alerted me to the problem. Mom said, “They just keep giving me more medication and I feel much worse - I think all the medications are making me sick”- (she also told her doctors this). Dad said, “This is ridiculous, I asked them to look into the medications before prescribing-this is too much for any one person to take, but they won’t listen” and the cleaning lady called me and said, “Your parents keep complaining about all this medication and they are probably right. This seems like too much.”

Mom’s reactions to these medications became so severe that she mentally and physically declined to the point she didn’t know time or place and even lost the ability to recognize us. Dad had to hire help to care for her. Visiting nurses, OT, and PT started coming out twice a week. Everyone said the same thing: cognitive decline, dementia. The medical charts suggested Alzheimer’s. The doctors visits were frequent, but short. Mom started having difficulty ambulating and couldn’t follow directions or score well on a mini mental. They basically wrote her off. She was seeing 5-6 doctors very regularly. They were all asleep at the wheel.

Dad was imploring all of them for help and explaining that Mom was over medicated. The doctors would just nod and not truly listen to him.

When Dad lobbied me, I’ll admit, I didn’t react as quickly as I should have. I did go there and look at the medications and think, this does seem like a lot to take. But she was elderly and her decline was typical for someone her age. Her doctors were highly credentialed medical professionals.

I decided to check this all out-to just give Dad the peace of mind and attention he needed.

I went to the pharmacy Mom used and got a complete set of those “stapled-on” lengthy print outs. I charted out the warnings, side effects and interactions I looked up the recommended dosages and researched the drugs on the Internet. I spoke to old friends who were in the medical profession.

Some of her dosages were suited to much larger people. Most of her drugs had side effects that corresponded with her most worrisome symptoms (dizziness, falls, confusion). Several of her drugs had cautions that they should not generally be prescribed together.

Luckily her primary care provider was on vacation when I went in, armed with conclusions. She probably would not have listened. Her “sub” who had never met Mom did listen, however. Mom had to be gradually weaned, and carefully monitored by physicians and family. The total weaning (and medication reduction) took about two years. Some changes were made that day, others had to be gradual to prevent her body from going into shock.

Visible improvements were immediate within a week.

Mom conpletely came back. For me and Dad it was a miracle. She lived for many additional quality years, always recognized us, felt better, enjoyed life. She started walking and within several weeks, was able to build up to walk for two miles, without a bench break- no falls, dizziness or confusion. Dad was frequently crying tears of joy and gratitude.

Visiting nurses and doctors were grateful for this experience and later communicated that Mom’s story helped them help other patients and families. I have written about this on this forum (and strangely, some individuals have sent me hateful messages).

My parents are both gone now, but this was one of the true miracles I have experienced in my life and one of the reasons I visit this site.

Yes that’s a good idea to have your mom check out by all those medical doctors. My mom is 86 I’m going to have her check out by a geriatrics doctor also, she’s been taking certain medications for years lots of blood pressure medicine and her pressure reading r so low I feeling she’s just going to slip right on out at times. The primary doctors have her on to many medications. She also had a stroke in 2009 but now that she is 86 she has really really slow down I believe she is still taking medicines like when she was in her late 50s and 60s she still taking the same medication so her body has really slowed down now has changed I keep stressing it to the doctors but they say oh no she still needs to be on this medicine and that medicine but I’m gonna take her to geriatric doctor and have all the medications checked over again because I feel like The doctor is just primary doctor is not listening to me and just want to keep her drugged all up my mother she can’t really walk anymore for some reason and then she just have slowed down so I’m kind of worried about her but I’m and I feel like maybe it’s a good thing that you are having your love one checked out in all those areas so you’re doing the right thing thank you and God bless you .

Please take her to a gerontologist. They are specifically trained in issues of the elderly. They have experience and knowledge that gp's and other specialists just don't have.

daisy and ACaring: The OP posted this thread in late August. Thank you for your added comments.