Aging Parents And The Problem With Doctors
If there is an aging loved one in your life, chances are they’ve got some chronic medical conditions. Heart disease, high blood pressure, respiratory disease, and other common issues bring them to the doctor. And the primary care doctor makes referrals to specialists. Each specialist focuses on their area of expertise and prescribes medications to treat what they see: keep it from getting worse or prevent crises caused by the condition. Before long, your aging parent is taking a dozen or more pills a day, sometimes three or four times a day.
Is this a problem? Definitely yes, from my retired public health nurse’s point of view at AgingParents.com. I distinctly recall visiting my many elderly clients at home and checking to see what they were taking. I sometimes found shoeboxes full of medication bottles, some the very same one prescribed by two different physicians. The client was taking twice the recommended amount of it and did not realize it. I found some that caused side effects so serious that they interfered with the person’s daily life. I found some that were no longer necessary but the pharmacy kept renewing the drug and the elder kept taking it. It was scary. I wondered how many other aging folks were doing the same. They trusted their multiple doctors and did as they were told, but no one was paying attention to the big picture of their health.
The problem persists today, and is even more dramatic as medical research increases specialized understanding of treatment of various diseases. More drugs are on the market. More are prescribed by highly knowledgeable specialists. But the specialists are not talking to one another. Few specialists look at the aging person’s overall health conditions in combination and most importantly, no one is considering the elder’s quality of life.
The exception to this trend is the aging adult specialist we call a geriatrician, an MD who specializes in looking at the aging patient from a wholistic perspective. Unfortunately they are rather rare in medicine. The number being trained in this specialty area in medical schools is declining at the exact same time the need in our aging population is increasing. It’s about how much physicians get paid by Medicare. You can imagine why a new MD will choose a higher paying specialty than geriatric medicine, relatively lower paid than numerous other specialty areas of the profession.
For those of us with aging parents or other loved ones, there are some important things to consider. One is the issue of how long you want an aging parent with something very difficult, such as advanced dementia, to live with becoming less and less able to function. One can treat their heart disease, asthma, high blood pressure and other conditions or you can choose to refrain from treating those things and concentrate all efforts on pain relief if there is pain and simply keeping the elder comfortable and in a dignified state.
This may sound radical to some but there is no mandate to live as long as possible with poor quality of life, inability to communicate, and inability to perform any daily function independently. When most of us do our estate planning and fill out or have the lawyer prepare the Advanced Healthcare Directive, we say we don’t want to be kept alive by “artificial means” or futile treatment. There are exceptions. Some people want everything done, regardless of the benefit, as long as they’re still breathing. But for most, the idea of aggressive medical interventions when we’re on our way out of life does not make sense. Multiple medications for someone who can no longer enjoy life at all due to disease is indeed being kept going by “artificial means”. Treating pain is quite different from trying to change the course of where nature is leading us. We need to stop pretending that there is no end to the physical life cycle.
If you have an aging parent with multiple chronic conditions, especially advanced dementia, ask yourself how long you want to watch that loved one’s quality of life disappear. When the person can’t speak, can’t recognize anyone and can’t even feed himself or walk, what quality does that person have, if any?
Decisions need to be made about all those medications. Imagine that you are a decision-maker on an aging parent’s healthcare directive. When you, in cooperation with at least one caring physician, decide to withdraw all those medications except pain and comfort meds, and allow nature to take its course, you are acting in the best interests of your loved one. This does assume that they, like most, don’t want to be forced to stay alive by artificial means.
What does this take? I recommend three things.
- Visit and make a list of everything your aging parent is taking every day. That includes physician-prescribed things from the pharmacy as well as over the counter remedies.
- With appropriate permission (Healthcare Directive or “HIPAA Release”), make an appointment with a reliable and accessible MD or nurse practitioner to review the medication list to determine the necessity of every single thing on it. Ask about the appropriateness of continuing all meds that might be just futile or no longer needed.
- Advocate for your aging parent. Quality of life is a very important consideration which seems to be missed by many medication-prescribing specialists. They are focused on their own “turf” rather than how it is for the patient to keep living with so many progressive diseases that only get worse. This is most significant for any elder with advanced dementia. Never be afraid to question a doctor or a prescription. You may be the only one who does.
If you’re not at all sure how to approach a medical provider and ask questions, get professional guidance from us at AgingParents.com, a nurse-lawyer, psychologist team. Call 866-962-4464 or contact us online.
By Carolyn Rosenblatt, RN-Attorney, AgingParents.com