Elderly hospitalized patients often experience an abrupt and permanent mental decline, many research studies have shown. What can you do about it?
Intensive cognitive rehabilitation – think of it as akin to physical therapy for your brain – has been shown to help. But the first step is convincing doctors that you have a problem.
Consider an example in which a doctor told an elderly woman’s children, “Don’t worry, your mom is perfectly normal in language ability – she scored right in the middle, in the 50th percentile, so she’s well within the normal range.”
Were they reassured? No, because they knew that before she went into the hospital, she probably would have scored in the 90thpercentile or higher. Without any official tests on file, though, the family was not able to convince their mother’s care providers that this result reflected an abrupt change that warranted an intensive rehab program.
This reality leads me to a recommendation that most people would consider unusual today: even if you have no concerns at all about your present cognitive functioning, consider getting a neuropsychological evaluation when you are between the ages of 60 and 70 so that you have a baseline against which your mental functioning can be compared in the future.
The gold standard for such an evaluation is testing by a neuropsychologist. Typically, these specialists require a referral from your primary care doctor. Here you may run into some challenges: generally, for doctors to justify ordering such testing, they need to suggest a diagnosis. The obvious diagnosis in this case would be a decline in mental functioning.
But you don’t have a decline in mental functioning; you just want a baseline. Our health care system is not set up to support this sort of advance planning. And if your primary care doctor and/or the neuropsychologist gives you a diagnosis that indicates cognitive decline, the implications can be problematic.
For example, if you are applying for admission to a type of retirement community (that doesn’t exist in Prescott) in which monthly fees are the same regardless of whether you are living in your own apartment/casita or in a skilled nursing unit, you may have to release medical records. If those records show a diagnosis of mental decline, the retirement community may not accept you as a resident. If you are trying to buy long-term care insurance, you may get a similar result.
If you do succeed in getting a referral without such a diagnosis, your insurance company may decline to pay, and you may be stuck with the bill.
Each person has to weigh the pros and cons and make a choice. I made mine, have baseline results on file, and plan to be retested once a decade.
