Wednesday 01 December 2021

If we live long enough, we are all going to need taking care of

This column first appeared in Malta Today

No one really likes talking (or even thinking about) old age. It’s a grim prospect which faces us every time we look at our reflection and start noticing the telltale signs of ageing. If the mirror does not tell you loudly enough that you’re getting older, then your body will do the job, as you start feeling aches and pains in places you never thought possible. And if that doesn’t drive the message home, a visit to your GP or any doctor is enough to slam down the notion that you are still in your prime with the hurtful words, “well, at your age…what do you expect?”

Ouch. It’s like a dagger, straight into your (ageing) heart. (Come on doc, couldn’t you have sweetened that bitter pill just a little?)

The reality and inevitability of it is brought home to us even further as we gaze at our elderly parents, once so full of energy and vigour, as they slow down and become more frail. More than anything else, I think watching as they become more and more dependent on us is what is so sobering and what clutches at our heart. Physical impairment and a decrease in mobility is always a challenge and can strike a devastating blow to their once independent spirit. But when old age is exacerbated by a debilitating degeneration of their cognitive abilities as a result of conditions such as dementia or Alzheimer’s, then the strain is felt mostly by their loved ones.

It is already heartbreaking enough to realise that your mother or father no longer recognise you, to notice that they are suffering from memory loss or they are forgetting simple words, and that they are becoming easily confused and disoriented (which are some of the most common symptoms of dementia). We have often seen appeals by relatives who are searching for an elderly person who has wandered outside and has not been able to remember how to get back home. In other cases, dementia sufferers also experience psychological changes to their personality which can range from paranoia to anxiety, inappropriate behaviour and a tendency to become easily agitated.

When the condition worsens and relatives are unable to provide the 24/7 care which is needed, the difficult decision often has to be made to admit the elderly parent into a care home. Suddenly, your parents are no longer in the familiarity of their own residence but have been relocated to strange surroundings with people they don’t know. Even in the best case scenario where one’s mind is still all there, going into a residential home for the elderly is a major adjustment. When one is dealing with dementia patients, this change can be bewildering and overwhelming and when at some point they also require hospital treatment, the ensuing problems can multiply.

Within this context, the crucial need for carers, nurses and all health care professionals to have a good beside manner and who are capable of showing empathy towards the elderly, in particular those with dementia, cannot be overstated. While on the whole, we have excellent free health care, sometimes a few bad apples, who do not have a vocation for the work they do, slip through the net to the detriment of those who fall under their care.

A reader this week sent me this account of what happened to her father which I am reproducing verbatim:

“My 90-year=old father was admitted to MDH urology ward 1, on 15th October 2021 After a 5 day stay he was, never put in a chair, he was released yesterday full of bed sores on his heals, leg and buttocks. While visiting I noticed he was still wearing the same socks as when he was admitted. I provided clean clothes, socks, wipes, sudo cream, yet he was sent home with bed sores on his heals, leg and buttocks. His body is stiff from laying in bed in the same position . Shame on the staff to treat a 90-year-old with dementia in this inhumane manner. This ward need an overhaul. My father’s medicine was also not sent home with him, the nurse had to deliver it to his residence as I am his only carer and can’t leave him alone.
This is horrible care and treatment. It should be the charge nurses’ responsibility to examine a patient prior to discharging and not go by what a carer tells them. Just because my father is old, it doesn’t mean that he doesn’t matter, he is still a living human being. Shame on the carers who instead of doing their job they are on their mobile. Shame on the nurses that didn’t care for my father like they would have wanted their own loved one to be treated while under their care.”

I immediately shared her description of how her father was treated on my profile to draw attention to it as quickly as possible. She also sent me photos of the bed sores, but I felt that it would be a breach of the gentleman’s privacy to share them publicly. However, I have no reason to doubt what she said. The response was overwhelming (sometimes FB can be amazing) and many people shared their own similar experiences about their relatives who (because of their dementia) have been neglected, overlooked and not as cared for as others whose minds are alert. When someone cannot speak up for themselves because of their condition it is beyond appalling to just leave them laying in a bed, festering with bed sores, and in some cases not even changing their clothes. I know of cases where elderly people who are not incontinent are put into diapers because “it is easier” for the carers. Why strip someone of their dignity in this way? Why subject them to this ultimate insult just when they need to be cared for the most?

All of this is a breach of the Hippocratic oath, which includes the essential phrase “First Do No Harm”. Frankly, if you are not willing to deal with these patients with the same tender loving care as you would your own blood relatives, please leave your job and go and do something which is not related to health care.

Meanwhile, I have been informed by the reader who wrote to me that she has been contacted by Mater Dei and they are investigating the case. Her father is now under private care where he is receiving medical treatment for his sores and physical therapy to compensate for the lack of movement while at the hospital. But beyond this one incident which has become public, I urge the management at Mater Dei to take a closer look at what is happening in these wards, especially with dementia patients who are at their most vulnerable because they are literally at the mercy of others, since they have no voice of their own.

The stark fact is that we are all heading towards old age, if we live long enough. As we gaze at our parents, we need to fully appreciate that one day, that will be us and there will come a time when we will need to be taken care of as well . Even if for some selfish reason (beyond my comprehension), there are those who are unable to empathise with today’s elderly, surely the thought that eventually, old age will creep up on them too, should stop them in their tracks?

I will end this column by quoting a doctor who wrote a comment under the post I shared, and who summed up the situation much better than I ever could:

“Malta’s most pressing health sector concern for the years to come will be elderly care. The challenges in this sector are multiple and in reality there is no quick or easy fix.…but the sooner we start preparing for this oncoming tsunami, the better for everyone – patients, their loved ones and the service providers themselves.
Providing care to the most vulnerable is not merely a job and can only be performed well if done by motivated people and with an aim which goes beyond a pay cheque – not many are willing to take on such a mammoth task and I therefore genuinely hope that administrations stop focusing solely on numbers when it comes to human resources….It is much more complex than simply stating that ‘x’ number of nurses/carers are needed to cater for ‘y’ number of elderly. Motivation, in its various forms, is key.
We are what we are thanks to the generations we are caring for today – they deserve nothing short of the best.”

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