When Alzheimer’s Affects Your Clients/Patients/Practice

Posted on January 25, 2012 by Cecily Jennings, DVM

Recently, one of our longtime and dearest clients (Ms. W) was diagnosed with Alzheimer’s disease. The news has been very upsetting to all of us at the clinic, as we’re concerned not just for Ms. W, but also for her pet dog, Stevie.

Stevie was diagnosed with diabetes almost five months ago. He lives with Ms. W and her elderly daughter (who has health problems of her own), and they are treating him with daily insulin injections.

When Ms. W’s daughter was admitted into a hospital for several days, she instructed her mother to board Stevie at our clinic until she was able to return home and help care for their pet. When Ms. W dropped off Stevie, she told us he was not eating and felt he was having a hard time getting around. Over the next 24 hours, we administered his insulin and arthritis medication and fed him. He ate without hesitation, ran around the clinic and seemed to sleep comfortably with normal eliminations.

The next day, Ms. W was confused about why Stevie was at our clinic and came to pick him up. I informed her specifically when he had his insulin and when to give it again that evening. Within one hour of her leaving, she called back to ask if he had been given his insulin. When she called an hour later with the same question, we asked her to bring Stevie back and offered to board him at no cost until her daughter returned.

These incidents have brought up many concerns that I foresee we will need to address in the near future:

  • When and how do I step in and express the concern that Ms. W may not be able to take care of Stevie the way he needs, especially if she is left alone with him?
  • How do I discuss my apprehension with her family about allowing her to drive; should social services be contacted at some point?
  • I know that the human-pet bond provides many real and measurable health benefits for people and would not want to limit her from this, but at the same time I have a responsibility to my patient. There is always the fear that she may forget to give insulin or give too much/too often, she may forget to feed him or give him an overdose of the arthritis medication.
  • Is part of the reason we are having difficulty regulating the diabetes due to the effects of the Alzheimer’s and her ability to care for him?
  • Is she legally able to make any medical decisions for her pet anymore?
  • What if her family refuses to help care for Stevie?

More and more of us have family or friends who have been touched by Alzheimer’s and other health problems that cause very real concerns in terms of these pet owners’ ability to care for themselves and their pets properly. You want what is best for your patient, but do you tackle the invisible legal/ethical/moral boundaries to address those uncertainties and, if so, when and how?

The only answer I have is that every situation is unique, requiring the utmost compassion, communication and documentation.

For more information on Alzheimer’s:  http://www.alz.org/



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