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.