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By Mr Bags
I'm trying to find out how best to ask the GP of an elderly mother, if she has dementia - or will the Dr/patient confidentiality prevent that from happening?

As a family, we would like to know, but have no idea as to how to find out, or even how to breach the question with our mother, who is terrified of having the illness as our father had it before he died and we know what that was like - it's a bit of a taboo subject - we don't even know if the GP has told mum if she does or doesn't have dementia.

We have seen a change in our mother over the past few years, and knowing one way or another would certainly help - it's easy to get frustrated with someone due to their behaviour, but if we knew why her behaviour is as it is, it would help hugely, especially with some family members who just think she is being difficult and perhaps making things worse for her with the way they interact with her.

If someone does have dementia, does a GP have a responsibility to let the next of kin know, DVLA, local social services etc?

Thoughts much appreciated.
Mr Bags wrote:I'm trying to find out how best to ask the GP of an elderly mother, if she has dementia - or will the Dr/patient confidentiality prevent that from happening?

Frank will know more than me, but it's a massively difficult issue. You need to talk about Power of Attorney ASAP it's much easier when the patient is competent to agree to it.

Having it will make it much easier to deal with issues when they arise, but at some point the conversation will have to be had as even with POA patient consent (if they're able to give it) is still required. They have a right to confidentiality, even if in reality, it's not in their best interests.
I don't know whether I'm breaking the rules..... My Mum can make decisions, but can't put those decisions into action (dealing with tradesmen, buying things online etc.) so I put her ideas into action and have a credit card with my name on, but is her account.
MrBags I was in a similar situation with my late mother. For several years I dealt with her financial affairs using the authority of an Enduring Power of Attorney (EPA), the validity of which was not dependent on her losing mental faculty, and the EPA did not need to be registered with the Court of Protection / Office of the Public Guardian until that loss of mental faculty occurred. LPA rules are different.

However an EPA did not cover her health welfare. A simple letter from my mother to her GP practice authorising me to act fully on her behalf and to have full access to her medical status was sufficient, and worked well, including full discussion with me of her eventual deterioration due to vascular dementia. Perhaps that would suffice for you, if it's not too late.

I wish you well; not a good path that you may have ahead.

Rich V
Mr Bags wrote: we don't even know if the GP has told mum if she does or doesn't have dementia.

Mr Bags . I know exactly what you are referring to and if it helps ; it isn't quite as clear-cut , or as black/white as that .

I believe that there are different degrees of dementia . It won't just go from being the old mum that you always knew on one day , to some distant and confused old lady who hasn't a clue who you are on the next day .
My dear old mum passed away 18 months ago at 89 . She had always been very on the ball , and still was when she went . But I did notice just one or two characteristics in her that didn't quite tally . For example , I remember chatting on the phone quite normally when she asked ; "what's your wife's name again" . But otherwise the conversation was completely normal . Another time was when she was talking about the war [WW2] and said quite normally that ; "Daddy was always telling Roy [her brother] to get back into the air-raid shelter". She just said it in a way that she wouldn't normally have done in earlier years.

But otherwise , her conversation was quite co-ordinated. But like yourself , I did suspect that she was starting to become a little bit deficient in certain areas , but not seriously so .

The only real clue was after she died and I was sorting out her paperwork with my sister and came across leaflets entitled ; 'Dealing with Dementia'. I found this mildly humorous because she had a very similar sense of humour to my own , and I can just imagine her laughing and saying ; 'at least I know I'm mad'.

An important aspect of this is [ mercenary as it may seem] is all her 'paperwork' all sorted ? If it is , then just be there , make sure she is happy , you can do nothing else .

Whatever you do mate , maintain your own rationality and humour . Because none of us get out of this alive .
You can't make an enduring POA now. Only Lasting POA which do need to be registered are available
Back to the OP's issue, I'd suggest having the POA conversation sooner rather than later. You have to register it but can only act with Mother's consent until she loses capacity. You have to understand that someone is not deemed to have lost capacity just because they make a decision that you might think is a bad decision.

With regards the memory issues, you are really going to have a conversation with your Mother - the GP (or any other health care worker) should not tell you a diagnosis without her consent (even with a POA).

Good luck.... it's difficult.
As everyone else has said. Have the conversation now! My Dad has very early dementia and type 2 diabetes. I was concerned about his blood sugar management and he couldn’t remember what blood tests he had. I drew up a simple letter to the surgery and he signed it. The doctors can now discuss his health with me. As soon as the specialist decided he had the condition, DVLA was informed and he has to be reviewed and renew his driving licence every 12 months. While we were “in the mood” I had my mother sign a similar letter so we are prepared.
Flyingfemme wrote: I had my mother sign a similar letter so we are prepared.

Not against Ff , but that’s the phrase that worries. There is a risk of exploitation that the law addresses if done properly. Little local arrangements may be challenged by banks, health authorities etc.
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Jim Jones wrote:There is a risk of exploitation that the law addresses if done properly. Little local arrangements may be challenged by banks, health authorities etc.

You could argue that such “little arrangements” *should* be challenged. Setting up POA is a little of a faff, but is robust and legal.

That said, it depends what FF’s mother’s letter said. If it was just about a single subject to a single place then it may be ok but still entails that difficult conversation at the outset.
A difficult subject close to my heart!

Every patient has an inalienable right to confidentiality which only can be broken under very specific circumstances - being a worried family(member) is not one of those.

There is no way around this but broaching it with your mum and discussing the concern with her, and then make an appointment with her GP and go and discuss these concerns with him/her.

When a family member attends with a patient there is implied consent and it makes clear to the GP that there are concerns and what those are. The sensitivity to pick up something as early stage dementia is much better amongst relatives than medical professionals:

a) we spend only a short time with patients and concentrate on the presenting problem,
b) the tests available in clinical settings such as a GP practice are not very sensitive.
c) there is a lot less continuity in first line medical practice with people working in larger practices and many more health care professionals involved in delivering care - less of a problem where it comes to easily measurable parameters a lot less so when it comes to picking up subtleties.

Hope that is helpful
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And that is exactly what we did. Wrote and signed the letters and then saw the doctor together. Only medical issues are covered but, since I try to go to specialist appointments etc anyway, we are all happy with the situation. My mother has added me as a joint account holder on two bank accounts so I have access to her cash if she needs anything paid. With Natwest the account “appeared” on my online screen immediately. I accept that not all parents/children would be comfortable with this but it works for us.
We looked at a “proper” power of attorney but my parents are worried by lawyers and frightened of the charges. I don’t want to push things past their comfort boundaries all at once.
FF, I really think you need to get at least the financial stuff "protected" with a POA wrapper. It's not difficult and always there when needed. There's any number of ways that the current arrangement could go wrong in the future.

You don't need lawyers.... just an independent friend (of your Mother) who can countersign to say that Mother isn't being coerced.
I think that 2 things come out of this thread:-

1. Difficult conversations sometimes have to be had.

2. Do the POA thing sooner (when it's easier to do) rather than later.