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.

@LazyJayne, what other medications does he regularly take, as well as his arthritis diagnosis, what other conditions has he been diagnosed with?

Call the surgery for an in person consultation, they are available but might need to wait a few days as it's not an emergency. Say you need a medication review and would like to check there's not any different options for him. However I suspect it is the natural aging process, people tend to very rapidly loose mobility at that age, and perhaps your df has already expressed his wish to the dr not to have invasive tests

Can you afford to go private?
Like you, I have elderly family with various issues. The GP was continually rubbish! They just see age and write them off. I arranged a private assessment and subsequent treatment. It's expensive but I'm lucky enough to be able to afford it.
You can't stop the ageing process but you can still ensure quality of life.

Ring GP and ask for referral for frailty assessment which includes a physio assessment. Face to face GP appointment won't make any difference, he needs gerontology specialists.
Painkillers are appropriate as pain restricts movement. Pain killers are not palliative medicine, although palliative medicine will involve analgesia.

Yabu.

NHS resources are stretched. What it would cost to do all the sorts of exploratory tests and physio etc you are demanding, is money taken from another area, for essentially very low likelihood of any value generated. At 90, it is near certain that aging is the primary cause of everything wrong, near certain that most treatments would have little effect and near certain that the risks & downsides of treatment would outweigh the limited, unlikely potential benefits.

There are disabled children with nowhere near enough access to physio. Do you really think resource should be directed to your 90 year old relative instead of children & young people with their lives ahead of them, for whom the treatment is much more likely to be successful and carry fewer risks?

This.

It is rubbish that the GP won't even consider seeing him F2F. How long has he been on the pregabalin ? How much paracetamol are they suggesting he takes ? What is the plan if that isn't effective, how long is he supposed to try the increase for until he contacts them again ?
It does sound as though he could do with an assessment by a physio and OT to see if there are any aids that would help with his mobility ? Not sure what the waiting time is like in your area for this though ?
The other worry if he isn't mobilising as he used to and is spending a lot of time sitting is the risk of developing pressure ulcers, does he have a pressure relieving cushion for his chair ? Could you ask the GP for a referral to the District nursing team to assess him for pressure relieving equipment, some teams can also assess for simple aids like frames, commodes, beds etc, say you are concerned that he could develop pressure damage due to his reduced mobility/frailty. I imagine the GP would be happy to refer him for that. It also means that you are known to the team, and they operate 24hrs a day and 7 days a week, so if he does deteriorate further you have someone to contact.

They can also check his obs and take bloods

This isn't how the NHS works. Yes, the chances of a fully reversible cause are slim. But there might well be interventions that could improve quality of life, if not quantity.

There are disabled children with nowhere near enough access to physio. Do you really think resource should be directed to your 90 year old relative instead of children & young people with their lives ahead of them, for whom the treatment is much more likely to be successful and carry fewer risks?

It shouldn’t be either or. Yes a 90 year old is absolutely entitled to appropriate care and treatment, not least because it saves money in the slightly longer term. Mobility reduces so many other risks. Do you have any idea how much pressure damage costs each year? About £3.8 million per day. Maintaining movement reduces those costs enormously. It is unreasonable that older people should be dismissed as unworthy of an improved quality of life. Physiotherapy and proper gerontology input can bring better outcomes, increase independence, reduce symptoms, reduce hospital admissions and far more.

Get a frailty referral.

Contrary to what pp have said, studies have shown that even people in their nineties can grow muscle tissue. Some of the decreasing mobility in people decades younger than this is due to lack of use, not some inevitable part of 'the ageing process".

But it is awful, in your father's case, that his arthritis is not being properly looked at and his pain attended to; old dogs get better care for arthritis from their vets than this. I do hope you can get someone to help your father.

@AloysiusBear

There are disabled children with nowhere near enough access to physio. Do you really think resource should be directed to your 90 year old relative instead of children & young people with their lives ahead of them, for whom the treatment is much more likely to be successful and carry fewer risks?

Bloody hell, so if you are elderly and heaven forbid need some quality of life, sod it, tough luck as the nhs is stretched and younger people need it. What an attitude to have! It shouldn't be either or, everyone is entitled to treatment and care, and if you are elderly you shluldn't be written off.

He needs to be referred to community physio and OT.

Make a formal compliant and insist on a face to face appointment. Unfortunately it's the only way to get anywhere these days.

Hmmm. Well, I'm no geriatrician, but I have three bits of experience to toss into this thread.

1. In June my knee grew so painful I couldn't walk. I ended up seeing a physio (privately). This month, suddenly I developed a frozen shoulder (which turns out to be more agonisingly painful than frozen btw). It wasn't till I went back to the same physio that she remarked that there could be underlying inflammation that would suddenly cause me to have two such affected joints in a single year and I should get tests for things like diabetes, arthritis, lupus. The NHS didn't tell me this. I am 56, btw.
2. My father, aged 88, suddenly started acting very very odd last Christmas with what the ambulance medics declared was a massive heart attack, the ECG readings they'd seen in years. At the end of it , though, he has no permanent damage to his heart and no risk factors for a heart attack (low blood pressure, excellent cholesterol readings, no family history). But he did have an undiagnosed urinary tract infection that may have triggered the heart attack. Once that was treated, he caught covid in hospital. At the end of it all, though, he recovered and is now bouncing around full of far too many beans for my liking: yet if that UTI had been caught earlier, 6 full months' deep trouble and bed-blocking in hospital (nasty term!) could have been prevented.
3. Aloysius, I have a severely disabled child, and also as a result have a lot of friends with disabled children, and I would never accept that there should be some trade-off here between treating my child, my father, and any other sick person! We may not be able to pay for everyone's nose job, but basic medical care we should pay for.
4. TL;DR -- if your dad has no previous history of arthritis or the like, go back to the doctor, say it's all too sudden, ask for them to check for underlying conditions.

P.S. on point 1, I'm now awaiting the results of the tests so can't tell you whether it was worth MY going back to GPs!
😀

My DS's father-in-law went suddenly from full mobility to hardly being able to walk. His GP had the same attitude as the one the OP has described and nothing was done. After a private consultation identified some issues (not sure what) and he's improved amazingly and is back to mowing the lawn etc and enjoying life as before.
We shouldn't have to use private medical care to get proper investigations and treatment but austerity and under-staffing plus Covid has really damaged the NHS.

Home Exercises to keep his muscles in as good of shape as possible. An assessment of mobility aids for his situation. These are things that might help and keep him independent and healthy.

surgery at his age has been shown to cause cognitive decline and hasten death. I wouldn’t push for any kind of invasive intervention.

i would just book him for some
other reason as soon as something crops up and tell them he has gotten older so his appt may take a bit longer than previously since everything with him is slowing down a bit. Then attend with him and bring up the mobility as part of the discussion.

YADNBU

If your DF has arthritis he needs to be on the right medications for this. If he doesn't have arthritis then the cause of his pain needs to be investigated and treated.

On a separate note he should request a care assessment from his local council to assess whether he should be provided with adaptations to his home. Depending on his finances he may have to pay for the adaptations. Part of the care assessment may enable him to access better care for his health needs.

Of course!
She was one of the richest women in the World 🌎.
No waits for Her Maj.

She was riding her pony at 90!
That’s amazing.

@LazyJayne
I’m sorry your Dad is in pain.
My lovely FIL was in his nineties - I’d have loved for him to have still been here.
He was so mentally sharp, just physically frail come the end.