Expert: Michalene Peticca - 9/26/2008

Question
Hi Michalene,
My mother just turned 83 and has had Alzheimer's for at least 7 years.  She has been incontinent of urine for at least a year or so.  She has recently had problems with incontinence of bowel movements.  Even though this could be a progression of the AD, it seemed to follow a bout of diarrhea.  She still has loose BMs, but has had for years.  She is not always incontinent, but is at times.  Her doctor did all the stool testing to see if she had any infections, etc, and they came back normal.  He said that the next step is a colonoscopy.  I hate to see my mom put through this.  I doubt that she will willingly take the prep because she doesn't take her oral meds very well.  I also don't see the point....if she has a cancer, I doubt that she would have any treatment because of quality of life concerns.  I had my father raise all these questions when she had an appointment with the surgeon that will do the test.  I expected him to agree that the test wasn't warranted.  Instead, he told my dad that she was OVERDUE for the test since she has never had one!!  The surgeon set up the test for next Friday with the provision that they would give her the prep through a feeding tube!!  The more I think about it, the less I want her to have it...I have read some of the pros and cons of having the test done in the elderly, and I still have my doubts.  What is your opinion on this?

Answer
Hello Sue,

Thank you for writing and bringing up a very good question about quantity of care vs. quality of care for our Alzheimer's diseased loved ones.

This question does arise from time to time and i open my discussions by exactly what you wrote "if she has cancer, i doubt that she would have any treatment because of quality of life concerns".  

For each of us, quality of life means many different things. And, i strongly urge you to follow what your mother would deem Quality of life.  Was she the type of individual that wanted Full CPR? Full life support, etc.?  If so, then i think you have some decisions to make.  If not, then i think you should follow your mother's wishes.

My own mother is 83 and just recently had to undergo an emergency colonoscopy...so this is interesting timing.  However, my mother does Not have Alzheimer's disease and yes, it still was extremly uncomfortable for her.  Combined with Alzheimer's diease, i'm sure they will give your mother a relaxant while the procedure is occuring.  

Don't be too harsh on the physicians, they have taken an oath to offer and provide EVERY means of medical care available to keep someone alive.   They have to make those options available to you and your family.  Whether you choose to go that route is a personal choice.

I know you will make the best decision for your mother Sue. And, even if you do not choose to proceed with the colonoscopy, i would suggest including a dietician or nutrition specialist in your mom's care to aide with decreasing the loose stools.  Additionally, please make sure she is toileted or changed often to avoid skin breakdown and infections.

Hope this helps focus and ease your mind.

Best Regards!
Michalene Peticca, M.A.