What kind of specialist should I be pushing my dad to see?

August 10, 2014 1:51 PM

I recently saw my father for the first time in 2 years and over that time his balance and mobility have sharply deteriorated. I'm on the opposite coast and there are limits to what I can do to help, but one thing I had thought of was trying to go back and do a round of doctor/specialist visits with him. YANHD, but I would love to hear of ideas about where to start.

My dad is 78, and lives on the opposite coast from me in an isolated area without a whole lot of medical resources around. When I saw him a couple of years ago, he was starting to have some balance issues. Now, over the past couple of years, he's gotten significantly worse. He's dependent on a walker and cane and says he falls a lot. He's got some arthritis in his hands as well. He says one doctor told him he was just getting old; he has a new doctor but it's unclear whether he's gotten referrals to anyone or what the new doctor told him. He lives with a long term partner but she's had difficulty getting him to go see anyone or do anything about this. He drinks a lot and has done for years, and smokes as well. He stopped drinking for a month and says it didn't help, however. (He also needs dentures, but that's a different question.) I've got lots of longer term issues about whether and how much and how I can help, but my immediate question is what kind of care/referrals/specialist visits should I be pushing? Is this a neurologist, a cardiologist, or just a good internist to start with? Or something I'm not thinking of? History of heart disease and cancer (pancreatic) in the family if it is relevant; history of high blood pressure for him.

posted by Cocodrillo to Health & Fitness (8 answers total)

Best answer: Loss of balance could be a symptom of many, many things. He needs to see a good GP and get referrals to whomever the GP thinks is pertinent.

Oh, and if the GP tells him he's "just getting old", find a new GP. My grandfather was 94 when he died and never had any balance problems.
posted by Specklet at 1:56 PM on August 10, 2014

Best answer: A good internist or doctor specializing in geriatrics would be good. This may be helpful.
posted by cecic at 2:05 PM on August 10, 2014 [1 favorite]

Best answer: Gerontologist. Our GP happens to be one of these, but someone who specializes in aging.

My Dad's balance is shit, he's 77. It's an inner-ear problem and it's not something that can be addressed, but we all know about it and he's careful when walking with his cane. But it helps to know what's going on and whether it is just aging or if it's something else.
posted by Ruthless Bunny at 2:38 PM on August 10, 2014

Best answer: Seconding gerontologist. My 95-year-old mother was perfectly happy with her GP of 40 years, but he never noticed her dementia until I pointed it out on a visit, and then only gave her a prescription for aricept. When she got agitated over a big life change (being moved to an apartment away from her husband), he gave her lorazepam, which exacerbated her dementia. Then he left her on it for seven months. It turned her into a sundowning vegetable with hallucinations who fell down all the time and took swings at her caregivers. Part of this was due to a UTI, which also went undetected for who knows how long.

When I got her in front of a gerontologist, the doctor adjusted her meds and sent a speech therapist (to help with memory issues), an occupational therapist, and a physical therapist to visit her right away. The improvements in her attitude, clarity, memory, balance and movement were apparent inside of a week.

In my opinion, the difference a gerontologist makes is not just that they understand the medical issues of aging, they understand the aged. They know how to overcome the barriers elderly patients may have to getting treatment.
posted by caryatid at 3:09 PM on August 10, 2014 [7 favorites]

Best answer: In addition to a gerontologist, he might see an ENT who specializes in balance issues. I had terrible persistent vertigo for a while and I saw an ENT at a balance clinic.
posted by KathrynT at 4:36 PM on August 10, 2014

Best answer: Nthing gerontologist. Look into physical therapy referral which could be useful regardless of underlying cause of the issues. Look into improving the safety of his home (no throw rugs, no obstacles on the way from the bed to the bathroom, safety rails in bath/next to toilet, etc) - small things can go a long way to preventing a serious injury in a fall. If he's on any blood thinners (aspirin, Coumadin, Plavix, etc) make sure he addresses this ASAP with his physician to discuss the risk vs. benefit and that they are aware he falls a lot.
posted by treehorn+bunny at 7:10 PM on August 10, 2014

Best answer: One other consideration: see whether he would be willing to set you up as a healthcare proxy for him (and power of attorney, while you're at it). You will likely want to get more involved in knowing what's going on with him, since you seem to care a lot about him, and it's better to be proactive than wait until he's seriously ill. I'll just say that it's possible that he's reached the age of 78 and his only problem is high blood pressure (if he's a very fortunate and healthy gentleman), but my guess is that he has at least 10 other diagnoses you don't know about, especially if he's a longtime drinker and smoker.
posted by treehorn+bunny at 7:14 PM on August 10, 2014

Best answer: I'd agree that a geriatrician would be the best option if your father doesn't have a diagnosis. However heavy drinking causes permanent balance problems (that don't go away when you stop drinking), and you should consider that it's entirely possible that your father's existing doctor has told him what the problem is, and he just isn't telling you.
posted by tinkletown at 2:36 AM on August 11, 2014