Tuesday, February 21, 2012

Why Getting Old is Really Complicated

Today I would like to take a short break from talking about myself to talk a little about how hard it is to be an old person.

I recently visited my grandparents in Georgia (oops, still talking about myself). My grandfather had just returned home from knee replacement surgery, followed by two weeks of rehabillitation. This was his second replaced knee, and, as with the first one, he took it like a champ. He was clomping around with his walker, not taking much pain medicine, and generally doing well. We celebrated his 81st birthday while I was there.

But watching him manage his medications and instructions really got me thinking about how complicated his medical regimen has become.

For example, he was prescribed a diuretic for leg swelling. He was supposed to take one tablet in the morning and a half tablet in the afternoon. This requires him to remember that the dosing is different for morning and night, and to have the dexterity to pick up the pill and split it in half.  The medication works by having the kidneys eliminate the extra fluid, so he has to hobble to the restroom on his post-op knee even more often. Once in there he (like most older men) has some prostate issues, so there's that to deal with.

My grandfather is still pretty sharp, but I noticed that on this visit his memory is not as great as it once was. It seemed like he was having trouble remembering complex instructions from one day to the next. His eyesight is pretty good but his hearing is abysmal. The terrible hearing means that sometimes he doesn't hear instructions in the first place.

So you can imagine how challenging it was for him, and his physical therapist, to make sure he is doing his knee exercises three times per day. He has to remember the instructions (luckily she took the time to type them out), do the exercises, and then ice the knee afterwards. The physical therapist only comes three times a week. The rest of the time my grandmother has to help position the pillow under his leg for the exercises, and put ice packs around his knee after. Her dementia makes all of this really complicated- if he sends her to the kitchen for the ice packs, she might forget what she's looking for by the time she gets there.

I also wonder about the number of specialists my grandparents (and most older folks) are seeing. There are several physicians writing orders and prescriptions without really communicating with each other. We are really lucky to have my Uncle Sam, who goes with my grandparents to most of their appointments and keeps track of what's going on. He's extremely intelligent and willing to research and ask questions to make sure he understands. But many 80-year olds have children who are aging and who don't have the time or ability (or inclination) to be this involved. I would guess that my uncle spends at least 20 hours each week working with my grandparents to make sure they get to their appointments and keep their medications refilled.

In the hospital, we are really quick to label people as "non-compliant." Sometimes our patients make the concious choice not to make necessary lifestyle changes or follow instructions. But I wonder how many of our patients just didn't hear, understand, or remember what they were supposed to do. Also, if it gets too complicated to send your wife to the kitchen for an ice pack, do you eventually give up on icing your knee? Are we taking the time to ask why the patient hasn't complied?

So long for now, KISS (keep it simple stupid), and don't worry, I will be back to my usual self-centered self in time for the next post!

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