Caregiver Questions for Neurologist Daniel C. Potts
Daniel C. Potts, M.D. is a neurologist, author, educator and champion of those with Alzheimer’s disease as well as their caregivers. Dr. Potts communicates this dedication by being accessible to those of us who represent family caregivers, so I took advantage of his willingness to help by asking him some common questions that many family caregivers face.
CBB: Dr. Potts, unfortunately, there’s still a stigma attached to cognitive problems. My first question is how can a spouse or adult child convince a reluctant family member to see a doctor for memory issues?
“This is a tough one and really represents a judgment call,” Dr. Potts said. “If the child or spouse senses their loved one may balk at the idea, or may be in denial or not recognize their cognitive issues, then I suggest that they focus on potential medical reasons that a visit to the doctor may be needed. You could say, ‘Dad, you really need to get that back pain checked out. I have heard you mention it several times, and I feel it is affecting the quality of your life. Why don't you make an appointment to see your primary care provider? While you are there they can also check your blood sugar and cholesterol. In the meantime, the concerned spouse or child (provided they are on the HIPAA release) can contact the provider and let him or her know about the cognitive issues.”
CBB: Dr. Potts, I hear from many caregivers who have found that their loved one gets confused when he or she has a urinary tract infection. Could you please educate us about the frequency and severity of UTIs in elders?
“I think there may be several reasons for this,” Dr. Potts said. “First, older adults are relatively immunocompromised compared with younger people. In other words, they are less capable of fighting off infections. In addition, bladder function can be affected as we get older, so that the bladder does not empty as well. Some conditions that affect older adults, such as diabetes and benign prostatic hypertrophy, can affect bladder emptying, so that some residual urine remains in the bladder after voiding. These are some of the issues that might predispose older adults to more frequent urinary tract infections, and make them more serious if they do occur. And certainly it is true that urinary tract infections are one of the most common causes of acute confusion in the elderly, especially if they already have cognitive impairment.”
CBB: Dr. Potts, how do we convince an elder to take prescribed medications? Can you suggest any tricks that can help if they refuse medication necessary for good health?
“I think it is important to realize that maintaining independence is an important issue for older adults, and to have the sense that they are not dependent or a burden,” Dr. Potts said. “So it is important not to belabor the point of taking medications. If cognition is normal, I think gentle reminders, and nudging, with suggestions that the family is concerned and wants them to be in the best health possible are good ideas. Reminding them that taking their medication as directed will help them maintain independence and health and enable them to be there for the younger generations can help. If there is cognitive impairment, then I think that's where the tricks may need to come in, like slipping in a pill with food. But it is important not to force the issue, as this will breed agitation and resistance.”
CBB: I’m sure you hear this often, Dr. Potts. One area where family caregivers seem to feel at their wits end is the driving issue. How do you help families when they feel that their loved one is a danger behind the wheel?
“This is a huge issue,” Dr. Potts said. “First of all, the family should rarely if ever be the ones who force the issue with driving or try to take away the keys. This is just too hard on families. If there is cognitive impairment or infirmity that would otherwise affect driving ability, as judged by the family, then family should either accompany the patient to the doctor visit or contact the doctor outside the visit and make the driving concerns known. Then ideally the doctor can order a driving evaluation per physical therapy, which will give an objective assessment of driving skill. A pre-test of cognitive function as relates to driving is usually performed which will tell if the patient is safe to even complete the assessment. Then the report is sent to the physician, who can make the final determination about whether to restrict driving. In cases of cognitive impairment, often it is helpful for the physician to write a letter to the patient clearly stating that driving has been restricted, and the family can then show this to the patient repeatedly, if needed. But the bottom line is that this should be done by the physician, and not the family. It is too hard on the family.”
CBB: This is my last question for this round, Dr. Potts. What do you tell families who have little choice but to place their loved one in a nursing home, but the nursing homes in their community are poor quality?
“Well, that is a tough one. If there are no other options, then I would choose the best nursing home of the bunch, and then contact the local ombudsman for that nursing home at the first sign of neglect or care that is less than optimal. I also think that families should make their expectations known to staff at the beginning, and they should be perceived by staff as being very involved in their loved one's care and should ask frequent questions. I think it is also a good idea to tell staff as much as possible about their loved one's history, likes and dislikes."
Dr. Potts kindly thanked me for asking him these particular questions as he also considers them important. A physician who has a deep understanding of family caregiving as well as his patients is of enormous value to us all. I thanked Dr. Potts for helping family caregivers. Doctors like him are deeply appreciated.
Below is a brief biography of Daniel C. Potts, M.D.
Daniel C. Potts, M.D. is a neurologist, author, educator and champion of those with Alzheimer’s disease and other dementias and their caregivers. He was chosen by the American Academy of Neurology as the 2008 Donald M. Palatucci Advocate of the Year, and has been designated an Architect of Change by Maria Shriver. A Pocket Guide for the Alzheimer's Caregiver (www.alzpocketguide.com), written by Dr. Potts and his wife, Ellen W. Potts, is recommended as a resource by The American Academy of Neurology, The Alzheimer's Association, and Maria Shriver. Inspired by his father’s transformation from saw miller to watercolor artist in the throes of dementia through person-centered care and the expressive arts, Dr. Potts seeks to make these therapies more widely available through his foundation, Cognitive Dynamics (www.cognitivedynamics.org). Additionally he is passionate about promoting self-preservation and dignity for all persons with cognitive impairment. He lives with his wife and two daughters in Tuscaloosa, Alabama.