Ask Miriam – April 2026
Dear Miriam,
I am taking care of my mother, who is 75 years old and has dementia. She lives with me, and it’s just the two of us. The biggest issue is that I have an older half-sister (my mother’s daughter from a prior relationship) who lives out of state, but who is pretty involved even at a distance. While I generally appreciate her support, we are having a major disagreement. The problem is, my mom also has congestive heart failure, and the medications she is on are not helping as much as the doctor would like to see. He feels she would be a candidate for valve replacement and that she would feel better overall. I am very concerned about the impact surgery could have on her dementia, but my sister agrees with the doctor. She and I share healthcare power of attorney, and I just don’t know how we can resolve this. Please help.
—Fighting Sibling
Dear Sibling,
I’m so glad you wrote in; It sounds like you and your sister are doing the best you can to help your mother experience as high a quality of life as possible, but it’s also very normal for family members to have differing ideas about what is actually the best path to take. Sometimes, there is no right answer, just different options.
Congestive heart failure can be very uncomfortable for the person suffering with it, and there are a broad variety of ways of coping, including, as you mentioned, medications, as well as environmental changes such as limiting salt intake and reducing fluids, and hospital-based treatment such as IV diuretics or surgery.
When making medical decisions, it is important to keep the person with dementia top of mind. Ask yourself, how far has her dementia advanced? What are the other health conditions or physical limitations she has? How independent is she now and to what extent can she cooperate with her own treatment and recovery?
It may be beneficial to consult with another doctor for a second opinion. A geriatric physician can be invaluable in assessing the pros and cons of different treatment options. Anesthesia with surgery can also be a risk for people with dementia – sometimes they do not regain their pre-surgery level of cognition.
Set aside some time for you and your sister to talk over each of your hopes, fears, and expectations of what surgery would accomplish. If conflict remains, you may want to consider a mediation meeting with a skilled facilitator. Try to take care of yourself, too, during this stressful time and balance your caregiving responsibilities with some relaxation.
For more information on managing medical issues in people with dementia, call the Alzheimer’s Los Angeles Helpline at 844-435-7259.
Best,
Miriam
Questions for Miriam can be sent to askmiriam@alzla.org.
