Elderly MIL - refuses to see GP

[RosesAndHellebores]

Any advice welcome please.

MIL is 87 and has always been resistant to any form of medical consultation. I think she thinks it's a sign of weakness. I cannot remember her ever visiting the Dr and FIL died aged 79, many years ago, very suddenly (he dropped dead and it was his heart). He had had a couple of funny turns, one involving A&E where he was advised to go to the Dr due to very high BP. He died two or three years later and he and MIL refused to make a GP appointment on the basis that if the Dr felt he should be seen, he'd be contacted. Sorry, the foregoing para sets the scene.

Anyway MIL, now 87, twitches and is less steady. When walking she swings her left arm uncontrollably and unintentionally. About 12 years ago she had to have her wrist pinned under GA (she bore the pain at home for three days, before going to A&E). Weeks after that she lost her sense of taste and smell and puts it down to the GA.

Her sight is not good. She uses a magnifying glass as well as her glasses. This has been going on for years but evidently her optician has advised her repeatedly that her cataracts are not bad enough to be referred. I understand she has recently been referred but doesn't know what the wait is.

She eats well but is thin and I understand from DH she has problems with her bowels (possibly can't always control them). We took her on holiday in the summer and she would disappear to the lavatory for 30 minutes - SIL and I were on loo watch. SIL was shocked (lives abroad and hadn't seen her for five years). MIL promised she would go to the Dr but has not. She now allows herself one cup of coffee a week due to its impact.

DH visits monthly and for the last 18 months or so a "carer" goes in once a day to make sure she has a cooked lunch. Often a different carer and often they don't have English as a first language. She is 240 miles away and her dd's live abroad. There is only DH really.

I am just back from visiting and think she has deteriorated mentally and physically. DH's view is that she has capacity and he cannot force her to go to the Dr.

Does anyone have any ideas please? I don't think it's dementia related. She's sharp albeit she has always been quaint.

She will never ever leave the family home of her free will. It's the house that time forgot but clean and comfortable.

In my view, if she got some medical attention it could help her greatly.

Could you contact her GP's surgery outlining your concerns and asking if they could invite her in for a 'routine MOT'? Whilst I generally agree with your DH, it sounds from your latest visit that her capacity may be reducing.

@Mackeroo I don't think that would help. She has told me for decades that she's had the 60, 70, 80, invitation for a check-up but it isn't necessary to see a Dr unless you are ill.

It doesn’t sound like she would take any advice they gave her even if she did see a GP . I don’t think there is much you can do OP unless you can get her to move closer to you / her son or you move your family to her location .

Sounds like parkinsons

Your DH is right. It sounds like she has capacity.

This means she can make her own decisions about her health, even if these are harmful to her.

This can be very stressful for family watching, but it is her right to choose.

What usually happens is that she will become ill/have a fall and then medical services are inevitable.

@Floralnomad we tried to persuade her to move closer to us when FIL died, or at least into a flat, but she would have none of it. Us moving closer to her isn't an option. DH and I are both still working and DH's role is not transferable from London.

All power to your DMil; to get to 87 without serious illness and no medical intervention is pretty decent.
Does she have Attendance Allowance? Could she use that to pay for someone to come into the house and read to her? And then could that person do additional tasks that the daily carers aren’t? I guess build layers of care. The medical interventions probably will only happen when she is poorly.

First thing I thought. Just lost a parent and have dealt with it for years in our household. Not sure how you can force her to deal with it without maybe getting social services involved.

Is she happy? because thats the main thing. You can’t force her to see a GP. She’s ageing fairly well IMO. What may well happen is that she will have a fall, end up in hospital and support needed will be identified at that point. Maybe talk to her about having a call pendant just in case she does fall.

If she has capacity, then good for her. To be honest, she's right that there is no need to go to the GP unless really ill.
This is her choice - if things go pear-shaped then she may have a rethink but, until then, I think you can only admire her independence.

Thank you for all your suggestions and advice. Parkinsons has crossed my mind too, except there's no shuffling.

Someone going in to read to her is a good idea. It's difficult to tell if she's happy. She's a strange contradiction of having a cheerful disposition and yet the glass is always half full. She has no friends but never has - pre covid she went to luncheon club, book club, theatre group, etc., things that were very structured. In all her years she has never been for coffee or lunch or invited anyone to her home.

She's 87. She sounds like my Mum who at 87 wasn't taking a single medication. There are always downsides to every medical intervention, especially at this age.

I think let go of the idea that she should live in a particular way or that your dh should interfere with her life. I've no doubt that there will be a medical crisis at some point and she may have to go to hospital, and she may die, but thats because we all have to die of something and it's part of her values to be independent and unmedicated.

You're absolutely within your rights to speak up when she says 'you only visit a doctor when you're ill' and say that you disagree. Of course you are allowed to say you're worried about her. But it isn't your responsibility to fix this. Imo tbh there's nothing to fix.

Responses have been really helpful. Not least because the SILs (her dd's) frequently ask what DH is doing about getting her to see a Dr and how important it is. They lay on the guilt, presumably because it absolves them from their own responsibility and absence. PP's responses have helped me rationalise that.

It will be sad if she has a fall and suddenly deteriorates.

Much of the problem relates to her bowels and I hadn't thought of co stipation as the symptoms are the reverse. I do wish she would see a Dr for that as relatively simple measures could make her so much more comfortable I suspect. Much harder being a DIL than a DD over this.

@RosesAndHellebores I feel your pain! One of my parents is clearly unwell, uncomfortable and restricted but utterly refuses to seek any medical help due to a staunch pride in never going to the doctors.

I deal with it by just not engaging - it's really hard but I can't listen to anymore talk of the impact if they won't at least try and find a solution or some respite. I have had to really distance myself and it makes me sad. I do need to recognise they have agency over their own life and choices though.

I don't envy you.

@RosesAndHellebores Sounds a bit like my FiL at 93 who was very resistant to help or outside involvement but had reached the age where somethings simply don't work as well. Then he had a kidney infection for which the symptoms were not physically obvious - it presented as a sudden onset dementia (which disappeared once the infection was treated). That did trigger a hospital stay where he had to accept some outside help. Weight loss and bowel changes is a worry but as you say - you cannot force a competent person to see a doctor.

For both him and DM we found much better continuity of care by hiring local independent carers rather than going through agencies. Visits were longer with the same person each day, plus the same couple of backup carers for holidays and emergencies (they formed an informal local group). Most areas have fully insured independent carers who work this way because they don't like the lottery of agency work and short visits.
We also found after a while that suggestions from the visiting carer were better received by FiL than suggestions from us. It was the regular carer who coaxed him to more medical visits!

Regarding the cataracts - at 87 and not much social contact this will really affect her quality of life. Would she let you pay to go private and just get them done? A reader is a good idea in the meantime.

Does she use an ipad or computer to take video calls or similar?

As for the absent SiLs - unless they plan to help in some constructive way they are simply noise. There is only so much you can do from a distance - as they should well know.

When she has her cataracts done, she will need help even if it is just going to and from the hospital. Maybe one of her daughters could stay with her for a while and help with the drops.

Thanks @C8H10N4O2. I'll ask DH to investigate independent carers although with MIL that sort of continuity may be a detriment as she has no filter and has fallen out with many people over the years.

Regarding the cataracts, she would vehemently oppose them being done privately. She believes that any care that's paid for is unnecessary care. If she knew DH pays for the carers there would be ructions.

I'm not persuaded she has told the truth about the optician advising her cataracts weren't ripe enough for referral until now. Her vision has been compromised for at least 18 months with her needing a magnifying glass to read, etc. I don't remember my mother or step reaching anything like that before theirs were done on the NHS.

She won't use an ipad or even a mobile phone. In the early 00's we tried to persuade her and FIL to go to silver surfer classes but they dug in their heels. When FIL died in 2007 we bought her a laptop and booked the classes but she refused to engage.

@Freddiefan that's a great idea, except they live in the Antipodes. DH will be looking after her when the cataracts are done.

@RosesAndHellebores I suspect my Yorkshire born FiL may have had some views in common with your MiL. He was never the easiest but whilst MiL was alive there was some common sense being applied and she did get them both online with my help (a lifeline for us with the widowed FiL who was mostly deaf). But you can't force these things.

We were concerned that the carers would not put up with him at more difficult times but the point they made to us is that few of their clients are pleased to see them initially - its difficult to come to terms with needing care. They also dealt with clients who could be really challenging due to dementia (especially frontal lobe type). It was obvious really - I just hadn't thought of it that way. They did form a good professional relationship with him and that definitely helped the family.

For both FiL and DM we found local carers by asking around contacts locally - most families experience care sooner or later and we found recommendations via individuals and from volunteers at day centres/clubs for the elderly. Independent carers do advertise but we were able to find people through the word of mouth route.

Re cataracts - if the optician is reputable I'm sure you are correct. Elders in the family certainly had compromised vision by the time of surgery but their opticians referred them to the list long before that stage. From memory it was picked up at the routine eye check, triggered a return visit to confirm progress about three months later then straight on the list. Is she possibly fearful of doctors/medical procedures?

I don't know if fearful is the right word but definitely doesn't believe in clinical assistance which she views as a form of weakness or failure. There have been endless comments over the years about, for example, ds's asthma not coming from her side of the family, her disapproval that our dc were grommetted privately because if they were necessary, the NHS would have done it, me failing to perform when I suffered a series of late miscarriages and her disapproval that dd was to be born by caesarean because she was breech - and big!

She has never been easy and has rather a school mistressy approach to the imposition of her views. She has pissed off countless builders and gardeners over the years who frankly chose not to deal with her. Hence my concern over sourcing independent carers. But that's DH's gig not mine.