Doctor given up on elderly father

[LazyJayne]

My father is in his 90s and was until recently very mobile.

Over the past few months, his mobility has deteriorated rapidly. He suffers from stiffness and pain in his hips and legs, which we think is due to his arthritis.

He now requires a wheelchair and can no longer stand up unaided. He can take a few steps with a stick.

On the one hand, obviously decreasing mobility is part of the ageing process. On the other hand, until six months ago he was walking upright unaided without issue and walking briskly up and down the stairs as exercise.

When this was mentioned to his doctor (over the phone as we can't get an in-person appointment for the life of us), the doctor's response was to take more painkillers.

What we really want to know is whether the pain and mobility issues he is facing are inevitable and degenerative or whether there is something else going on that can be treated.

His doctor are not interested in exploring this, and is refusing to see him in person. We think they have written him off due to his age, and are now thinking along the lines of palliative care (more painkillers).

AIBU to feel this way? Are the painkillers a reasonable treatment plan and something we should accept, or should we be pushing for an in-person appointment/examination/x-ray (or something else?)?

When we have asked for one an in-person appointment previously (several times), the doctor and receptionist say we'll just get the same advice as we are being given over the phone.

I'm sorry op. I've recently been through this with my parents.

Ultimately between the GP and other medical professionals involved with him the consensus was simply that this is the natural ageing process, and we had to accept that. Medical intervention has meant that people are living past the point that their body is able to naturally sustain them, and although modern medicine can keep them alive longer it's inevitable that they will deteriorate as they age.

It was awful to watch my parents losing their mobility and their faculties, but in the end it's the natural order of things in your 90s, and medicine can only do so much.

What do you want them to do? If it is his arthritis at your father's age they likely won't operate. Does he need mobility aids in the home? You can buy these or call social services and ask for an OT to visit. Is he in pain? Pain relief is absolutely the right course of action

I'm not being facetious as it is horrible watching a loved one deteriorate but be careful what outcome you're seeking before you push for it

But in reality, what can the doctor do? They can't reverse the ageing process...

What does your DF want?

But how do they know it's the ageing process? How do they know that they can't improve things if they won't actually see him? Is it just pain that is slowing him down, it could be heart or lung related also. But without seeing him how do they know. Can he afford a private consultation? Is there a geriatric clinic in the local hospital. I'm in Ireland so different system, but my mam and granny were under geriatricians in hospitals and were seen once a year.

How does your df feel about life? I work in care and I'd say the way people feel, the enjoyment they get from day to day is feeling loved, needed and engaged. It keeps people healthy and happier far more than their physical abilities might be missed by them.

Unfortunately bodies fo wear out, but if you arrive at 100 with a fully functioning everything you'd be very very unusual. Life must also be enjoyed, not endured.

The doctor can check the underlying process and give a treatment!

it could be rheumatoid pain, arthritis etc. and there are drugs he could take to slow down the process or take at least some of the pain away.

it’s clear they have written him off but you don’t have to!

my dad has lots of issues and unfortunately we had to take him private. He could have died 7 years ago if left to the gp!

He is stable now with his medications, mobile bit has to stop after a few steps, goes to the shop and back, staff like that, no aids. Once the issues were assessed he only needs a check once every 6 months, sometime they adjust the drugs. Sometimes he has refused going as he didn’t feel any worse and we took him after a year.

good luck to you and your dad. I’m sure if you ask him he’d like to live longer and you to try for him. He is mentally well, and not in terrible pain, like my dad, so he can have a reasonable good quality of life.

I would definitely be asking for a OT visit. My mum has poor mobility but it declined gradually and even during covid had no problems getting to see her GP. Hee last two years were in a home and the gp would also see her at the home. I once took her myself for an appointment. A relative who is a gp overseas is still seeing their elderly patients sometimes at home or in their office.
Don't see why your df should be written off just because of mobility issues. Does he have any other medical conditions and is his mind still sharp. My dm may have had mobility issues but was as sharp as a tack and took no shot from anyone including doctors.
I would maybe see someone private if you can.
I remember years ago reading about an elderly woman who had been basically written off by her doctors. She was seen by a geriatric doctor who afterwards had her back to living a much better life. Which I had kept the article.

When we have asked for one an in-person appointment previously (several times), the doctor and receptionist say we'll just get the same advice as we are being given over the phone.

Then you reply " Then we still need that F2 F appointment, so a doctor can assess the right dose of pain relief"

Speak to Dad's MP and ask him to help arrange a simple medical check up.

I worked in elderly care for many years, and found that when a decline started, it was often fairly rapid especially in someone in their 90s.

However being in pain isn't acceptable, and you need to badger them about that.

you could

• do what @2bazookas says (and ask for a medication review at the same time). His health has clearly changed significantly over the past 6 months.
• ask for a referral to a frailty hub or geriatrician (there will be some such service round him)
• say he is afraid of falling and ask for a referral to the falls team/OT

Of course none of this should be necessary - the surgery should be doing it themselves. If you don't get a proper response next time you could put in a formal complaint - not negative feedback, a formal complaint - to the GP practice + your local ICS (google it) + NHS England.

Pre covid he would have been seen in person so yanbu. Is he stooped? Have you thought about parkinsons.

If your dad has any money would he see a private gp for about £80 for a face to face? My mum is minted but quite happy to wait two years to see the neurologist about suspected parkinsons.

It's not goingbto change her outcome but she is also delaying her choice to downsize if she has parkinsons. So private and proper face to face would give answers even if it changes nothing

Also, look into polymyalgia rheumatica - just in case that fits the symptoms. The GP should definitely see him to at least assess what's going on

Look at the Queen seemed really well a few months ago then boom couldn’t really walk and died I think that he’s in his nineties and this is to be expected

The doctor can check the underlying process and give a treatment!

This, totally! Or at least prescribe appropriate pain relief and can refer him on for physio/OT etc if appropriate.

Don't let them fob you off. When my (very active) DM fell in her 80s and broke her hip, they sent her home after her op with one leg two inches shorter than the other. The consultant told her that "it wouldn't matter" but of course it did, and they only said it because they assumed she sat in a chair all day rather than being out walking, going to all sorts of activities and meetings, and doing all her own shopping and housework. She still manages things but it is much harder going.

The GP could at least give him an appt to check him over. It’s a disgrace they won’t even assess him. I would be very upset and very angry at that and would have to take it further.

I'd book an appointment with a physiotherapist to review his mobility issues . I can see a DR feeling his options are limited but it could be something a Physio could assess

What do you mean by "painkillers", OP? Do you mean a non-steroidal anti-inflammatory (e.g. naproxen), paracetamol, codeine...?

What kind of arthritis does he have? Is he already on any medication for this? Has he had any investigations?

ahhh bollocks to that GP, that's disgraceful practise if they've not even seen him in person. Have they not even considered asking a physio and OT to assess him? Of course he is heading towards the end of his life and it may well be that it's not reversible but having worked in palliative care as a therapist I got more than a few people back walking again that had ended up in bed after "advice" from their doctors. It's very much what does your Dad want? Is he wanting to do more? Sometimes even just regaining a bit of movement and strength to allow someone to stand or change their position in the chair or bed can help with their pain and stiffness. It is much easier for carers too. You could also ask the surgery if they have access to a community matron, specialist nurse or whoever else is there to support older, frail people in the community. This attitude of writing off older adults was really common in the first part of my career but then there were moves to avoid restricting services on basis of age alone ......but perhaps the lack of resources & deterioration in NHS care is impacting on what the GP is willing to push for.

“How do they know it’s the ageing process “
AT NINETY??

That’s ridiculous.
All things senesce - Trees, rocks, plants…
All things get old and die

Ninety while being fit?
Anyone in that position should Count themselves lucky!
90 is old.

The suggestions about physio, OT etc support are all good but you could spend a lot of time and energy (not to mention cash) chasing up a number of options like that without any guarantee that they're addressing the core problem. So in your position I would pay for a single private consultation with a geriatrician. I suspect they would be best placed to assess and advise on the best way forward. This may not be as expensive as you fear - my best guess based on my own experience is that it would be well under £200. If treatment is needed then provided that treatment is available on the NHS, it can be done on the NHS.

Failing that I'd be asking for a referral to the palliative care team, if there is one. Again in my experience they are much more clued up than the GPs about the range of interventions available.

It seems cruel but there probably isn't a lot they can do if his overall health is failing.

My Neighbour is in his 90's he goes to hospital every week in an ambulance and they send him home once they check him over in a&e.

It's stressful but I don't think there is anything they can do.

You've got to think of quality of life. Does your df want an operation, would he cope with it? What if the last months of his life are spent trying to recover, and stuck in hospital?.
Sorry to be blunt, it hurts when you love someone. X

He’s 90 OP.

And often when elderly people go downhill, it’s fast.

What do you actually want them to do?

I'm sure the queen in spite of being in her nineties and frail was able to get an in-person appointment with her GP.