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.

Op, this is crazy. Yes, he's 90 but that doesn't mean that none of his issues are treatable. If he has a bacterial infection would they withhold antibiotics because he's in his 90s? Would they refuse to examine him to determine what kind of infection he has?

Maybe there's nothing that can be done but of course he should be seen to see if there is. You can't just assume it's age related. I'd go back to the gp's clinic and keep pushing. If you can't get an appointment then try a n e.

Is he otherwise ok?
Any other changes at all?

Handhold OP, it’s very sad seeing someone you love so much age and lose mobility, yes he’s in his 90’s but he’s still your dad, I completely understand you want to do your best by him.

It sounds like she wants them to treat him as a human being and explore a few options, age is not on his side but what if there are better arthritis drugs or physio that will help him maintain a better quality of life, if he stays mobile his overall well-being will stay better, it seems unfair that he gets to this age and doesn't deserve the benefit of a once over and a look at his case, they are signing off on an inevitable fast decline if they don't do anything and he's left immobile and in pain, it might not be inevitable, surely it's reasonable to ask for a consultation to ascertain if there are some treatments to make him comfortable and improve his life quality however long it may be

Thanks for the advice all. I’ll look into some of the options for assessment (geriatric care, physio) later. To answer a few questions:

• He wants to be able to get out and about and to be as independent as possible.

• The painkillers he takes are pregobalin and paracetamol. The doctor has advised him to take more paracetamol.

• We don’t want the doctor to ‘stop the aging process’, we just want a proper assessment so we can be sure anything underlying is being properly treated and we feel brushed off.

He should at least be seen by the GP. He could just ring up and ask for a face to face appointment and when the receptionist asks why, just say you will talk to the GP but you need to see someone face to face.

Has he been diagnosis with arthritis? If so does the Dr see this as an progression of ongoing condition?

He deserves an assessment regardless of his age.

It could be an infection or anything.

I know what you mean. Determining whether or not it is just old age and to be expected, or something going on that is possibly being overlooked due to his age is very difficult.

Has your DF ever had any mobility issues when he was younger?

My DF for as long as I remember has always been quite unsteady on his feet, clumsy, with lethargic movements and I often wondered if there might be something that was never picked up. He never acted on it. My son has dyspraxia and is similar at only 10 so I often wonder... DF is now 85 and even with taking age into consideration, since 5-6 years ago, he can barely move with bad stiffness, although he has no pain so isn't arthritis. Struggles to stand up from sitting down, has zero balance, and really struggle with all his movements, not just walking (picking up things). His gp just says 'old age' all the time, which it may well be, however I know people in their 90s less stiff and lethargic than he is, and has been for the last 5 years.

If your DF has had history of any mobility issues then insist his gp is reminded of this. As others have said, it might just be his age, however it also shouldn't be just written off as old age either without any investigation. I'd expect them to run a few tests and rule anything out, and THEN determine it as old age. If your DF is in pain, then you definitely need to get this sorted first and foremost.

Good luck, hope you get somewhere with the gp.

Whatever it is, its unlikely that he’d be a good candidate for surgery or other gruelling treatment at his age.
However, he could have a condition where his quality of life could be improved with medication or physio or aids.

Can you afford a private Gp appointment? That would be the least stressful option. If not, then you need to advocate with his Gp practice on his behalf. If you can make it less hassle for the Gp to just see him face to face than it would be to continue to fob him off then....

Tell the GP that you understand that some impacts of age are inevitable, point out you don’t expect a magic wand nor gruelling treatment. But that you’re worried that he could end up with a few years of increasing pain left rather than a few years of relatively good quality life.

If no dice, then get a sibling (or partner or spouse) to call the Gp, they can imply they don’t think you’ve or your DF have got the story right: “surely it’s not the case that they’re dismissing medical need because of age”? Is there a pre-existing diagnosed condition that you don’t know about?

Honestly, the squeaky wheel gets the oil.

Ask for physiotherapist and occupational therapist assessment

I'm a GP. I'd see your dad F2F. It might be that it's all the inevitable consequences of ageing - and sometimes we have to have robust conversations with relatives who don't understand that - but I agree that can't be judged on the phone. could you move surgery?

Of course he should be seen by the doctor. I’d insist on it,

So you advice is to make a formal complaint against a doctor because someone in their nineties is not as nimble as they were.

Blimey. No wonder no one wants to be a GP any more.

So because he is old, it's ok for the GP to assume what he has is age related and not bother assessing it just in case it's not age related and is treatable? You are suggesting that when people are old, we don't need to bother looking after them properly, which is despicable

I think he needs a face to face and am surprised the GP won't see him.

It may be that aids and gadgets can help and I would expect some sort of home assessment would be beneficial - some areas have OT/physio/living well teams that can coordinate this.

However expectations need to be managed - there may be no benefit from investigations as they won't necessarily change the outcomes in terms of management. I don't think he's necessarily being written off due to his age but I do find some people have unrealistic expectations as to what can be done for the very elderly.

I would be planning right now for the forthcoming weeks and months over which he is likely to deteriorate.
Does he live alone? How will he manage to shop, cook, dress, wash, clean etc. Does he have a lifeline? How realistic is staying where he is?
A social services assessment is key, get him on their radar at least as things often fall into a crisis very quickly in these situations. One fall, one broken hip, all very predictable.
POA probably useful too.
Medically, he should have a GP f2f to be physically examined, and a set of basic bloods done at the very least.

My father had a double hip replacement when he was 88 & 89 yrs of age. The pain he had suffered reduced significantly. He had been admitted to hospital for a urine infection & the Hospital doctors took note of his extreme pain & immobility. His own GP had previously been uninterested.
He lived another 6 years & another fall subsequently ended his life 2 years ago. He was mentally fine. Everyone is different & should be given a chance of life. We only have one. At his age he had also paid NI & taxes from age 14 when he left school.
In 1944 he was critically injured in his tank after D Day & suffered pain & flashbacks for the rest of his days. I am pleased he was offered extra time rather than writing him off as ‘old’.

I've just had cortisone injections to reduce the pain in arthritic joints. It wasn't exactly a fun experience but it wasn't awful and I don't need painkillers at the moment. Maybe the doctor could arrange something like that.

My DM moved from a house with stairs to her council bungalow - her ability to climb steps and stairs just went.

what medication is he on? Could that affect him? How is his diet?

Once you lose strength in your leg muscles you lose independence - I would get a private physio to see if they can help. Otherwise it’s all day sitting about getting weaker and weaker.

I don't really have any advice other than to send you some support.

It doesn't matter how old they are - they are still important and i completely understand how horrible it is to keep having to fight for them.

You sound like you are a lovely daughter and he will know this. X

@Bramblejoos is right with this analysis "once you lose strength in your leg muscles you lose independence". An echo of something a home care provider manager said to me a couple of weeks ago - "you see it so often. Elderly client goes into hospital and they are in bed for a couple of weeks. Then when they get out they can't walk and it's all downhill."

Private physiotherapy asap at client's home if possible I would say and make Dad do his exercises that they prescribe. Very best of luck.

It is not right that he is not being seen and his health assessed properly. Why are they just assuming that it is arthritis that is his problem or only problem? Can you push for someone else in the surgery to see him, or move to another surgery if your DF agrees. If at all possible, get him seen privately if nothing on NHS works out. This is so worrying for everyone, that people are being wsritten off because of their age. What kind of society are we? Hope it all works out well for him OP.

Write to the Practice Manager, asking for an F2F? Once it is in writing you have a record of your requests.

Can you speak to your local version of Age Concern?

I had to ring them recently about getting 70s+ covid shots in a place that was suitable for disabled access. They were v helpful. Also the local library had a lot of information as they hosted age related events/talks etc.
Also Social Services. You should write and say that you can't get an appointment and you have concerns... it might be that he needs a home assessment. They will know what kinds of mobility aids he might be eligible for, or if there are any local groups that might help. (eg FIL just had a stair lift, which has made a huge difference. Bathroom remodel so he can now have sit down showers. )
( also who is registered as his next of kin at the GP, you might want to make sure someone goes with him to the appointment (to remember what was said and to ask questions)
What about the local health authority - their website should list what services they provide. They may have details of specialist physios. Even one appointment with a physio would provide some kind of mobility diagnosis and you would be better informed if you need to ask the GP for xray and scan referrals. Again if you submit a physio's referral to gp in writing they have to acknowledge it.
Best of luck to your dear Dad.

When I said home assessment.. I don't mean for going into a home, I mean to look at how his existing home could be modified to make him more comfortable and independent.