We treated a very old woman in the hospital this week. She was nearly 100, but looked ageless, sitting by the window and watching the world go slowly by her. She had gotten unsteady and short of breath at home and was waiting for us to make things better.
There’s something regal about the very old. As a physician, I tread lightly with them. They are survivors, but fragile. The slightest change or perturbation in their care can lead to all kinds of complications, from disorientation or delirium to falls. In fact, preventing falls and delirium in the elderly is a major focus of geriatric practice and research.
Their independence is equally fragile and most people guard it fiercely. The elderly woman’s first question to us was, “Will I be able to go home again?” Answering this question requires balancing safety concerns—is there enough support at home?—with the patient’s need for the emotional security and the comfortable routine of the home environment.
I remember one 98-year-old patient whom I “inherited” from a departing resident. He’d taken care of her for three years. “Your job,” I remember him telling me, “is to get her to 100.”
She had heart failure, osteoporosis, and a touch of kidney disease. When her legs swelled up too much, she’d come in, dressed in her Sunday best, to see me. I’d have her take two water pills instead of one and hope for the best. “Just write it down for my daughter. She’s in charge of the pills,” my patient would tell me, and off she’d go, slowly, slowly, with her cane.
It was a year before I thought to ask: “How old is your daughter?”
“Well,” said my patient, “I was 18 when she was born.”
So we were depending on an 80-year-old daughter to understand medication changes, pick up prescriptions, and care for her mother as she approached 100—a fragile situation indeed.
Fortunately, that patient had a larger family network to support her, but that’s not always the case. Social networks often fray with age and the inability to do simple things—such as grocery shopping and taking pills—herald the end of independence.
We didn’t have an easy answer for our patient this week. To be “safe” at home, she had to be able to walk without much assistance and be able to climb a few stairs. We told her that we’d get her working with physical therapy to improve those things, and she sighed.
“I like you all, don’t get me wrong,” she said. “I just wish I could like you from the comfort of home.” So do we.
(PHOTO: FOTOLIA)
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