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Haslam D. Life is for living in old age. Practitioner Feb 2020;264(1834):31

Life is for living in old age

24 Feb 2020

AUTHORS

Sir David Haslam CBE FRCGP, Past President BMA, Past President RCGP

Article

Some patterns of behaviour are recognised by every GP. Take, for example, the inevitability that if you have tickets for an evening out and really do need to get off work on time or else risk a painful divorce, then your last patient in the evening surgery will turn out to be extraordinarily complicated and will need, and take, time.

There was one other pattern I also noted during those weekends when I used to do out-of-hours duties.

On a Sunday evening, just after six o’clock, there would be a caller demanding that ‘something must be done, now’ for their elderly parent.

Sadly 6 o’clock on a Sunday evening is the time when it is least possible to do anything for anyone – particularly if it involves social services.

The very elderly who live alone are a fascinating group of people. In general, they need to be very determined, and very single minded to be able to cope. 

It is this determination and single mindedness that is then, all too often, interpreted by relatives as bloody mindedness.

If they weren’t determined to cope, they wouldn’t. As in so many other aspects of life, our strengths are our weaknesses.

Inevitably, many of these extremely old people will hang on trying to cope at home for somewhat longer than is ideal. Ultimately, this leads to sudden crises of care for families, friends and carers. Yet I remain firmly convinced that the risks they take are risks well worth taking.

Life is for living, not for just existing. Spending one’s final years wrapped in risk-averse metaphorical cotton wool is no way to live.

When families put pressure on GPs to get a relative ‘put into a home,’ we can often see the logic of the request.

Yet we know that going into a home may take away the final vestiges of individuality from an old person who still loves their cat, their flat and their possessions – however chaotic and untidy their life may seem.

‘This is ridiculous,’ I well remember one woman saying to me. ‘Can’t you force her to go into a home? She just isn’t safe.’

While this daughter was right that her mother’s flat was a total mess and she was only just about hanging on to her dignity, my response was clear.

‘Not only can I not force her to go into a home against her will, I really don’t want to live in a society where I could,’ I retorted.

I could feel the daughter’s obvious irritation at my attitude, but I still believe this is the only course of action we can take.

I do understand the challenge from the relative’s point of view. After all, I’ve been there, done that, and experienced the anxiety and distress that old age can trigger in those who feel responsible for an old person’s welfare.

‘Something must be done!’ is so often a cry of despair. However, all too often the only response we can offer is sympathy, empathy, and an attempt to involve other team members who can support and maintain continued life at home.

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