Skip to main content

More on dementia and mammograms


We recently discussed a study that described the common practice of obtaining screening mammograms in women with dementia. We considered how mammograms are very unlikely to benefit these patients, but have a substantial possibility of doing harm.

Paula Span, on her New Old Age Blog at the NY Times has a wonderful post on this article. She imagines what it would be like to be a frail older woman with cognitive impairment, being undressed for a mammogram, for reasons she does not understand.

But what is most instructive about this post are the poignant comments from adult children of persons with dementia. A number express the sentiment that they had to protect their loved ones from a health care system that seemed to insist on performing all tests and ignoring goals of care such as the desire to focus the care of their parent on comfort and quality of life. Several reported having to fight to not have screening mammograms done.

I am sure the health providers who tried to order these procedures, or convince family members of their necessity, had good motivations, and wanted to do the right thing for their patients. But what is remarkable from the family comments is the anger this has left in them, still present years later. It seems that one of the most awful outcomes we can have as health professionals is leaving our patients' families with a belief that they have to protect their loved ones from us.

It is instructive that sometimes doing a procedure for a person does not leave family members a sense that "everything" is being done for their loved one. Rather it leaves a sense of bitterness that no one is really listening to them or their wish to protect their loved one from unnecessary pain and suffering. Perhaps we need to spend more time listening to these perspectives.

Comments

Dan Matlock said…
This makes me think of one of my favorite quotes: "Don't just do something, stand there!"

I use this all the time when trying to make the point that sometimes, less is more.

Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Survival from severe sepsis: The infection is cured but all is not well

Severe sepsis is a syndrome marked by a severe infection that results in the failure of at least one major organ system: For example, pneumonia complicated by kidney failure. It is the most common non-cardiac cause of critical illness and is associated with a high mortality rate.

But what happens to those who survive their hospitalization for severe sepsis? An important study published in JAMA from Iwashyna and colleagues provides answers and tells us all is not well. When the patient leaves the hospital, the infection may be cured, but the patient and family will need to contend with a host of major new functional and cognitive deficits.

Iwashyna examined disability and cognitive outcomes among 516 survivors of severe sepsis. These subjects were Medicare enrollees who were participants in the Health and Retirement Study. The average age of patients was 77 years.

When interviewed after discharge, most survivors were left with major new deficits in their ability to live independently. …