Sad and Lonely – Part 1

There’s been some comment in the press recently, concerning the plight of the elderly under the NHS, following on from a report by the Audit Commission.

Random Reality recently posted a story, Patientside, concerning the loneliness of an elderly lady. A situation which is becoming all to common in a society that aspires to the noble sentiments of caring for the elderly in their own homes but which, in reality, is condemning many of them to solitary confinement.

I got a call the other day to assist a colleague who was with an elderly lady complaining of being ‘generally unwell’. One of those vague calls where the symptoms can all too easily put down to ‘getting old’. My colleague had decided that A&E was not really the place for this patient and had requested an ECP visit for an assessment and a possible referral to a more appropriate unit. When I arrived he was still there and together we discussed with the patient what was ‘wrong’. She was still in bed and complained, amongst other things, that she couldn’t stand and that her legs ‘wouldn’t work’. At my prompting, she then proceeded to demonstrate all manner of movement, including a double leg, straight-leg raise. No mean feat indeed, particularly in one whose legs are now, apparently, not functioning. My favourite question at these times is to ask how she coped with going to the toilet. As expected she confessed that she could get up and walk to the bathroom. “so your legs do work then!

In the end it all seemed to boil down to depression. She was a proud and independent lady but now, due to arthritis and cancer, was confined to her own home. Most of her friends had passed away and, apart from the odd neighbour who popped in from time to time, she had no one to talk to during the day. She had a son, who now lived with her and was her main carer, but he went out to work and she was left to her own devices for 8 to 10 hours at a time. She felt she was becoming a burden on him and the more she thought about it the worse she got. He, meanwhile, was also finding the going tough. As he was the only source of social interaction she had, she had started becoming increasingly resentful when he wasn’t with her. He told me that if he was late home from work, even by 10 minutes, she’d be on the phone demanding to know where he was. On his days off she insisted on going with him in the car , no matter where he was off to. He was beginning to feel bitter and resentful that his mother was now depriving him of his own life.

As it happened, I did find something medically amiss with this patient. I persuaded her to get up and provide me with a urine sample, which I ‘dipped’. It came up positive on quite a number of indicators. My thoughts where now heading down the UTI route, however, there had been mention of a possible kidney problem from an earlier operation, all very non-specific but enough to put a question mark on that diagnosis. So I rang her GP for a bit of advice and to let him know what was happening. I'm pleased to report that, on this occasion, he was extremely helpful. As he put it “she is, medically, an extremely complex person" and, given her medical history, it was probably prudent to have her admitted to hospital for further assessment. He was kind enough to make the necessary arrangements for me even though I am allowed to undertake direct medical referrals to the local hospital myself.

The ambulance arrived whilst I was still writing up the notes and, after it had departed with the patient, the son asked me to stay and 'have a chat' with him about the situation. Now, being a counselor is not one of my strong points, but I was saddened by how depressed this relatively young man was becoming. He was soldiering on alone, as his mum’s primary carer, with virtually no support from social services. This situation allowed his mother to remain at home, just what the government wants. Yet in this instance, instead of treating our elderly with the dignity and respect they deserve, we’ve ended up with two potentially depressed patients, both of whom are stuck in a cycle of despair and don't know who to turn to for help.


12 Responses to Sad and Lonely – Part 1

  1. alice says:

    Do you ever suggest these clients get in contact with various support groups? Age Concern often have day centers that would provide this lady with the social interaction she requires. They can often provide transport.

    Obviously there are loads of services that various clients could benefit from, so as a catch all, why not disperse the leaflet of your local PALS service and suggest clients call them to help find a support network.

  2. Magwitch says:

    Thanks Alice. I do suggest day centres and stuff but historically the ambulance services have always referred patients back to their GP for this type thing. Now of course we’re trying to supplement the GP role so we’re sort of learning as we go along.

    We don’t carry any PALS leaflets. Don’t know where you get them from to be honest. Might be a start though. I’ll make some enquiries when I’m next on duty.

    Blimey, this blog’s already helped me out with a new initiative. Wow!

  3. CarLa says:

    Sad, but true. We (I was an acute hospital nurse until recently) try to keep people in their own homes as long as possible to keep them out of hospital so we can empty A&E and meet all the Access targets. Unfortunately we often forget what the carers go through so as not to be thought uncaring. My mum-in-law has been worn into the ground looking after her Mum, who has advanced dementia, and now the hospital want to send her back to them. Thankfully they have the Psych on board and she should get referred to Residential.
    I look forward to more of your musings Magwitch – my part of the world (also South East) is exploring the use of ECPs – maybe our paths will cross . . . . . .

  4. CarLa says:

    Thanks to Tom at Random Reality for directing me to your site – have you caught up with MArk at NeeNaw??

  5. scott says:

    good start. i have been a daily reader of random reality (hi tom!) for quite some time now, and neenaw (tho i do wish he would post a bit more), among others on your list. while i do not work in your field, or even in your country (lol US here) i have always been somewhat enamored of both this line of work and your country. good luck, i shall be returning!

  6. Craig D says:

    Hello Magwitch,

    Here in NZ we have an interesting service in St John (which, over here, provides the majority of primary ambulance coverage, so drop those perceptions 😉 called Caring Caller, where a volly calls up people like that and just has a chat for a while.

    This means:
    A) If they die they aren’t left decomposing at home for a month
    B) They get a little bit of companionship each day.

    Not a bad idea, methinks.

    Looking forward to hearing all about the ECP job.


  7. PJ says:

    As a 911 dispatcher I run into this in the Staes all the time. Just the kind of thing you describe, nearly word for word. It’s becoming increasingly difficult to let this kind of thing roll off my hardened exterior. Especially as I am approaching old age. The rest of you guys may not appreciate this now, but as you get closer to 60 this kind of thing really gets under your skin. Don’t wait. Care about these people now. Don’t wait until you’re looking back on all the ones you let slip away without leaving a mark on you.

  8. UnLtd Blogs says:

    Wanless And The Future Of Social Care

    Following on from my semi-articulate post on the cost of caring, the Guardian carries an overview of the Wanless proposals for expanding basic social-care services to elderly people. Wanless calculates that the social care spend needs to triple to around

  9. Happystance says:

    The coverage must vary throughout the UK but there are lots of support groups for carers that would be able to provide either day visits to a centre for an elderly person in this case , or who would be only too willing to talk with the son on a regular basis. I run voluntary workshops in laughter and resilience for carers, and I know that many of them have never been told about what is available, and it has never occurred to them to look because they didn’t know they existed or thought that they wouldn’t be eligible.

    I was annoyed that the recent Wanless report spent so much time discussing the costs of social care for the elderly and proposed some useful ideas but made little reference to the needs of the carers.

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  12. Jackson says:

    Great post. Hope to see more excellent posts in the near future.

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