It’s not all doom and gloom treating the elderly, says GP Dr Chris Fox, and it also adds valuable insight into our own lives.
As GPs we see patients of all ages but, if you stay in one place long enough, the appointment book fills up with lots of elderly patients with complex problems. We see them quite often and become familiar with their histories, their personalities, their foibles.
If we’re doing our jobs well, they place trust in us and we become an essential support in their lives, particularly as they become frailer. And that’s a salutary reminder that we’re all on the same chronological conveyor-belt.
So it makes sense to treat our elderly patients as we would like to be treated.
Our youth-obsessed culture tends to view ageing as a descent into infirmity, ineptitude and irrelevance. Government health departments and medical insurers have a tendency to quantify the cost of the ‘Aged’ in monetary terms. If we look at the cost of health care in an average person’s life, the bulk of it is concentrated in the autumn years and even more so in the last few weeks of life.
We’ve all seen elderly people who see themselves as a burden to society. It’s hardly surprising that depression is relatively common and we, as GPs, need to be careful that we don’t confuse it with cognitive impairment.
And yet there’s a tendency for some elderly people to try and hold on to the past with a thoroughly natural yearning to retain all the vigour and relevance they can muster. This can translate into a fear of change leading to a reluctance or refusal to comply with treatment regimes.
We’re all well aware of the rising tide of geriatric Baby-Boomers but it’s important to acknowledge that every ageing patient is unique. Clear communication with a healthy dose of empathy is absolutely indispensable, particularly when we have to strongly suggest that having a driver’s licence may not be such a good idea.
I’ve worked in palliative care with Silver Chain Hospice for many years and it has strongly influenced my work as a GP.
Here’s one story that’s instructive. A woman in her 90s with dementia was referred to the service. She was living in an aged-care hostel, her family was distressed to find her continually agitated and she felt that no-one really cared about her.
A few years previously, she’d said that she wouldn’t want ongoing treatment if the quality of her life had diminished. Consequently, the family wanted us to cease her medication and allow her to pass away peacefully. The only trouble was that with the support from our service and the residential staff she brightened up considerably. She became more engaged, was clearly happier and ended up being discharged from the hospice.
And that leads me to one of the positive aspects of our job as GPs. Sometimes we’re able to tell an elderly patient that they’re doing fine and just go out and enjoy life!