Question: My mother and father, both in their early 80s, recently began going to a new doctor since their primary care physician of many years refused to accept Medicare. Dad has been getting more forgetful, but is managing and seems very happy. Mom has a number of physical problems, including osteoporosis, but she is pretty sharp mentally. They still live at home, she drives, and they seem to be doing OK. My husband and I live about three hours away, but neighbors look in on them regularly and call us if there is a problem.

Mom called the other night in a panic because the new doctor wanted to put Dad on a medication for his forgetfulness. Mom said she and Dad only spent five minutes with the doctor and, according to her, the doctor never explained to them what he was going to prescribe or the side effects that could happen because of Dad’s blood pressure medication. She said she tried to call back, but could not get the doctor on the phone. I then tried to talk to the doctor, but his receptionist would not even connect me even though I am their only child and Mom says that she signed for me to be able to get information. The receptionist cited “privacy” concerns. None of this sounds right, and my mother is beside herself.

Answer: We agree that it does not sound right at all, and it appears there are three separate issues involved in your question:

First , it is unfortunate that some physicians are opting out of the Medicare system, but as we have reported in the past, with reduced reimbursements authorized, more and more seniors are going to have trouble finding doctors to treat them. At least your parents have found a primary care physician.

Second, if your parents signed privacy releases that allow you to secure information from their medical providers, there should be no privacy concerns. Many individuals think that if they sign advance directives, they have then satisfied the “HIPAA” regulations; however, since advance directives (living wills and health care powers of attorney) take effect only when an individual is incapacitated, signed advance directives generally will not satisfy state and federal privacy requirements.

Third, while there are no “cures” for Alzheimer’s disease, which is one of the specific conditions that causes dementia, there are five medications that have been approved by the Food and Drug Administration to treat the cognitive symptoms of Alzheimer's disease. None of these medications can cure the disease, but they may temporarily slow the progression of memory loss.
Of the five, the most often prescribed are Aricept, Exelon, and Namenda, and each comes with its own side effects that affect individuals differently. For that reason, and because these medications may also adversely interact with other medications being taken, more than an “off the cuff” prescription is essential.

In our view, the physician should explain not only the potential benefits of taking the medication and why that particular medication was chosen, but also the length of time in which a result should be expected and what, if any, effect the drug will have on both prescription and non-prescription medications.

In truth, Alzheimer’s disease can only be diagnosed post-death by autopsy, so be aware that while signs may point to the disease, memory loss may well be attributable to other conditions.

Taking the NextStep: We suggest that you ask your mother to make an appointment with the physician. You should then take the three-hour drive to be there, and make sure your mother and father both sign medical releases in the form preferred by the physician. Also, plan to be there at the next visit before any medication is given to your father. For more information, you may wish to visit http://www.alzinfo.org/ or click herewhere a lot more information about Alzheimer’s disease and medications is available.