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Is dementia diagnosis necessary for someone very old?

Carol Bursack of Minding Our Elders

Dear Carol: Is a dementia diagnosis always needed? I can understand younger people needing to know what kind of dementia is present, but my dad, who is 89, has declined cognitively over the last five years. His doctor has him on some dementia drugs that are supposed to help. They don't seem to do much but they don't seem to be hurting either, so we decided that it's worth whatever benefit he can get. The doctor says that Dad is really doing OK for his age, and we both hate to put him through a lot of tests just because his memory is poor.

He's in assisted living and when he worsens he can go to their memory care. The facility is good and I see him several times a week. He seems content. Should I be doing more? - KP

Dear KP: One primary reason to obtain a diagnosis is so that a person can receive whatever treatment may be available and will not be given medications that may have negative effects for certain types of dementia. The other primary reason is so that people can plan for their own future and that of their family. If someone is 65 years old and beginning to have symptoms, then that person needs to put plans in place for the future while he can still count on his good judgment.

Eighty-nine years old is different. Most people of this age are aware that they are not likely to live a lot longer and have already taken care of planning. If their medical care is good, as it seems to be with your dad, I'd agree with you that enough is being done. I am not a medical person, so understand that I'm only presenting my own opinion.

Your dad is content, which is more than many people are at 89. He has a doctor who seems to understand him and is taking care that your dad receives the available medications that might improve his quality of life. Your dad has a place to live that he enjoys and there is a plan for the future. I agree that there really isn't a need to upset him with more medical intervention.

A thought to keep in mind is that some studies have shown that, after a certain point, continuing to provide medications that are intended to stave off the worst of dementia symptoms can begin to backfire, often causing side effects while no longer offering any benefit.

You might want to discuss this possibility with your dad's doctor so that you can both be aware of any negative changes that could be the result of side effects of these (or any) drugs. Age makes it harder for most people's bodies to eliminate drugs from their system so as we age, generally, less is more.

You are taking good care of your dad, so I'd encourage you to keep doing what you're doing. Love him as he is and help him enjoy life.

Carol Bradley Bursack is an established columnist, blogger and the author of a support book on caregiving. She hosts a website supporting caregivers and elders at www.mindingourelders.com. Carol can be reached at carolbursack@msn.com.

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