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Posted: January 29, 2007

Do Doctors Give Up on the Elderly?

Fighting for a Fighting Chance

Geriatrician Dr. Rob Stall likes to tell this story when speaking about health care for older adults:

A 90 year old man name Henry went to see his doctor about his sore right knee.
“Well, Henry,” said the doctor, “what do you expect? You’re 90 years old.”
Henry replied, “But doctor, my left knee is the same age as my right knee, and it feels just fine!”It’s a cute story, but the underlying message is not as cute. It implies that many of us -- doctors included -- view old age as if it were an untreatable disease. According to the Alliance for Aging Research, “Evidence has been mounting to suggest that, at all levels in the delivery of healthcare, there is a prevailing bias – ageism -- that is at odds with the best interests of older people.”

It’s a cute story, but the underlying message is not as cute. It implies that many of us -- doctors included -- view old age as if it were an untreatable disease. According to the Alliance for Aging Research, “Evidence has been mounting to suggest that, at all levels in the delivery of healthcare, there is a prevailing bias – ageism -- that is at odds with the best interests of older people.”

Contributing to this bias is the acute shortage of physicians specializing in geriatric medicine. There is only one geriatrician for every 3,000 elderly in the United States. And, things seem to be getting worse: out of 145 medical schools in the country, only five have geriatric care departments.

Doctors untrained in geriatrics may overlook underlying conditions, such as depression and malnutrition, which contribute to health issues in older adults. They may also overlook the question of drug dosage and interactions in older patients, whose bodies are less able to tolerate the “cocktail” of multiple medications that have been prescribed for them.

While the bias against aggressive treatment for elderly patients is real, there are also valid treatment concerns, such as the physical and emotional states of the patient, and the assessment of risk relative to the probability of success for a treatment, which must factor into decisions.

So, how do we know when to encourage our loved one to pursue treatment, and when to back off? How do we know when to accept a condition as part of the natural aging process, and when to probe further? And what if you think the doctor is not giving your loved one’s care his or her best effort?

These aren’t easy questions. But the better we understand our loved ones, our own motivations, and our options, the better equipped we can be to help our loved ones get the best care for their individual situations.

The Reluctant Patient

My own mother was a perfect example of what is known as a “reluctant patient.” In her mid-70’s, she developed symptoms of Alzheimer’s disease. When family members expressed concern, both Mom and Dad dismissed her short term memory lapses as “normal old age.” When we reminded them that Dad didn’t have similar memory problems, they became defensive and angry.

Mom took thyroid and blood pressure medications, and we suspected that she might suffer from depression -- all of which can cause symptoms that mimic Alzheimer’s. The family wanted Mom’s doctor to investigate the possibility that drug interactions or depression were contributing to her condition. But Mom and Dad refused to talk to the doctor, minimized the severity of her symptoms, and even denied them altogether.

The Reluctant Doctor

Eventually, the family contacted Mom’s doctor directly, and asked her to probe further during their next visit. Unfortunately, the doctor also labeled Mom’s symptoms as “normal old age” and told us that there was nothing wrong!

At that point, we felt helpless: Mom and Dad were in complete denial, and the doctor acted as if we were interfering in a situation that was none of our concern. Today -- five years later -- Mom is living in the Alzheimer’s ward of an assisted living facility and no longer recognizes her family. Whether earlier intervention would have made any difference is something we’ll never know -- but will always wonder.

The Fighter

Dad was the opposite of a reluctant patient. After his stroke at age 81, Dad’s bladder did not function and he had to wear a catheter. After numerous tests, his doctor told him there was nothing that could be done. He cited Dad’s age and his diminished physical capacity from the stroke as factors in determining that the risk of attempting surgery was too high.

We decided to get a second opinion. The second doctor believed that he had a good chance of correcting Dad’s problem through surgery, and was willing to operate. For several months after surgery, Dad was off the catheter. Unfortunately, his bladder was not able to function properly over the long term, and he eventually went back on the catheter.

Making the Best Decision

Was it worth it? It depends on your point of view. On one hand, the first doctor turned out to be right. On the other hand, Dad wanted to fight, and the second doctor believed he had a fighting chance to improve the quality of Dad’s life. Although surgery ultimately didn’t solve his problem, it was important to Dad to know that everything possible had been tried.

Each situation -- and each individual, family, and doctor -- is different. Even so, certain considerations will help you do the best you can to feel confident that your loved one receives the best possible health care in any situation. Here are eight steps that can help:

  • Find a geriatric physician or a doctor with a good reputation for working with older adults. The website for the American Board of Medical Specialists (www.abms.org) allows you to find geriatric specialists by searching on “added qualifications in geriatric medicine.”
  • Ask the doctor to take a holistic approach to your loved one’s health by considering emotional and psychological issues in addition to physical ones.
  • Encourage your loved ones to stay involved in life as much as possible. Let them know that they have a right to feel good, no matter how old they are.
  • Involve loved ones in conversations about their healthcare and their options. Take the time to explain things to them fully. Or, ask the doctor or nurse to explain.
  • Ask questions! In addition to what the doctor tells you, do your own research on the internet or at the library to educate yourself and your loved one about the risks of various treatment options.
  • If your loved one is a “reluctant patient,” try to insist on being included in conversations with the doctor. Let the doctor know that the patient may not be providing all the relevant information.
  • If you think your doctor is not fighting hard enough for your loved one, follow your instinct and get a second opinion.
  • Respect your loved one’s decisions. If your loved one is legally capable of making their own healthcare decisions, you must ultimately accept and respect that, even if you do not agree. The most important things are that your loved one feels encouraged and supported, and that you feel you have done everything possible to make the best choice in the situation, no matter the outcome.

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Melissa A. Goodwin is the assistant director of the Foothills Caring Corps program in Carefree, Arizona, as well as a freelance writer and photographer. She can be reached at cc.melissa@earthlink.net

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