Jan 30, 2010

Mammograms for Women With Dementia? What is the Right Decision?

Today I read an article about the wisdom of giving mammograms to women with dementia. I think this is a very, very hard decision to make....
By Max Wallack
Researchers found that among more than 2,100 U.S. women age 70 and older, 18 percent of those with advanced cognitive impairment had received a screening mammogram in the past two years.

Sure, it makes sense that we should not torture elderly women who are within three years of death and will certainly be very frightened by not understanding what is going on when receiving a mammogram. But, who is going to make such a decision?

Can we be sure that the decision made by one doctor would be the same if a different doctor were consulted? Are we going to set up committees to decide these things? How much would that add to the cost of healthcare?

Should the family members make the decision? Are family members ALWAYS guided by what is best for a dementia patient?

With dementia, do we really know how long a person will survive? What about medications being developed that could add quality years?

I have seen some of this situation personally. Great Grams was told she needed a special type of X-ray because of a suspicious mass on her mammogram. This was about three years before her death.

She was already having behavioral changes, but we did not know she had dementia. In order to perform the special X-ray test, the physician referred Great Grams for psychiatric evaluation, and she was put on an antidepressant to calm her enough to be able to get through the test.

Someone the family trusted advised us to go ahead and have her do the complicated X-ray test because she was so physically healthy, even at 90. He felt she had the potential of having many more years of life.

Great Grams did go ahead and receive the additional testing, but it was traumatic for her, and the results were benign. Clearly, the test situation did her harm. Her personality changed rapidly during that time period, and only a few months later she was hospitalized for her first episode of delirium.

In retrospect, Great Grams should never have had that mammogram. But who can play the role of God and decide these things beforehand? I don’t know the answer.

I am interested in learning what you think about this issue. Or, if you have had a similar experience.

To read the article go here.

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