What Am I Forgetting?

Elderly woman looking concerned and confused.

My mother is almost 82 years old, and she has been worried lately about how often her memory fails her. She once had a great memory for names, events, places, etc., but now, she's losing track of time, people, and social engagements. The other day, she was sitting down to lunch at her assisted living facility, when she looked over to see my brother and his family coming in the front door to visit her. She had known about the visit for over a week. She had spoken to him, in fact, the day before regarding their visit and had placed her lunch order with him so they could all eat lunch upstairs in her room.

What was initially a little embarrassing to her, soon turned into something quite concerning. She was worried that dementia might be nipping at her heals, and she wanted to see a neurologist. Again.

She had last seen her neurologist a little over a year ago when was beginning to worry about forgetting things, losing track of time, etc., but after a good six months of normal and mostly normal (age factors aside) test results, the only thing left was to have a "follow-up" appointment to discuss next steps. She didn't see a point. A "follow-up" appointment to simply tell her that she's aging normally seemed not only pointless, it created all kinds of logistical and safety concerns that didn't make the trip a measured choice.

Now, however, she's forgetting more, and the caregivers in her facility attest to her increasing memory loss and her "slowing down." It was time to call the neurologist again, only, this time, we felt it prudent to request a neuropsychological (neuropsych) test. According to The Cleveland Clinic  a neuropsych screening "tests for a range of mental functions, like reading, language use, attention, learning, processing speed, reasoning, remembering and problem-solving, as well as mood and behavior."

Though many reasons exist for have such a test, my mother's reasons include not only her recent cognitive issues, but also the knowledge that her father died of Alzheimer’s disease in his 80s. Doctors often administer neurophysch tests to detect Alzheimers's disease and/or dementia.

She spends most of her time in an electric wheelchair, as it's increasingly more difficult for her to spend much time on her feet. She uses a walker to navigate her small apartment, but mostly, she relies on her chair. Subsequently, her limited mobility makes traveling to doctor visits difficult, especially if they are in a neighboring town. A disability taxi service can meet her needs in the town where she lives, but traveling outside a 10 mile radius or more takes planning and money.She didn't see a point. Transporting her was difficult back then, but her lack of mobility now will make the trip that much harder.

The call to the neurologist did not, however, go as planned. The first response I got was that the next available appointment with her doctor was July (it was currently the last week in February). Obviously, that wasn't going to work. She's worried now, the concern is now, and now (or within the next few weeks) seems to make more sense that waiting five months. I told the nurse as much. I explained her age and her health concerns hoping the nurse would be able to search for an earlier appointment.

Person holding an elderly person's hand.

The conversation went back and forth, and she finally agreed to talk to the doctor and call me back with (hopefully) a better plan. Not so.

When she called back, she had even worse news than before. Sure, she could book an appointment as soon as the end of the week, but she would only be able to see a physician's assistant, not the neurologist, and that appointment would still be just a "follow-up" from the previous year's experiences. She couldn't make an appointment for the test until she had an appointment to talk to the doctor (or physician's assistant in this case) about the test. Furthermore scheduling for the tests went out over a year in advance.

At this point, I started to turn red. How in the world, I asked the nurse, does it make sense for an almost 82 year old woman, whose father died of Alzheimers's disease to wait over a year to determine if she's in mental and cognitive decline. Again, we went back and forth. I finally agreed to schedule the (worthless) appointment, an appointment that will cost us over $200 just for transporting here there. Don't get me wrong, I don't begrudge her the money. The reality is that traveling itself is a chore for her, as is toileting away from home, and just generally getting around. The experience is stressful and tiresome for her, so the fewer trips we can make, the better. Taking the trip for the test makes sense. Taking the trip to sit in a room with NOT a neurologist only to be told "yes, looks like we should schedule a neurophysch test..." is ludicrous.

Handicapped accessible van

Healthcare is a mystery to me. With our increasing elderly population, what is the medical community doing to facilitate quality and timely care to non or partially ambulatory patients? Many older folks today struggle to get to the doctor, and health care providers do precious little to accommodate those who can't easily visit their clinics and hospitals. So, they go untreated. How can they, in good conscience, tell an aged patient that a test they need because of their age might take a year or more to administer?

The message is clear to me. They don't matter...enough. I'm not saying they won't receive care, but I am saying the medical community seems overall uninterested and unmotivated to work in the best interest of the elderly patient. Health concerns, mobility, and urgency seem to be of little concern.

So, I cancelled the appointment. I will look closer to home for a less popular neurologist, but for one that she may have less difficulty getting to. After all, at this point, time seems to be of little issue or concern to her provider. I'll keep working towards a better solution, but I'm not holding my breath in this current healthcare environment.