Illness and Age
Here is something to look forward to. If you live long enough, and many people now do, there is a whole cocktail of complaints, conditions and illnesses which can blight your life.
Aside from dementia, there is an extensive range of nasty ailments common to many older people. Genes play a large part in whether you are going to get all or any of these but so does lifestyle, exercise, age and just bad luck. Aside from our familiar big killers – Stroke, Heart Disease, Respiratory illnesses and high blood pressure – there are a plethora of nasties. This is a far from exhaustive list but it contains many 'niggling' conditions which can be a considerable problem or even fatal for older people.
COMMON, BUT SERIOUS, CONDITIONS
Deafness – not funny, whatever the popular view, but very serious. Deafness affects many older people and increases problems with social isolation, mental health and general well-being. If you’re having hearing problems, you can be on your own in a room full of people. If you have dementia, deafness will only make it worse. Ask the GP for a hearing assessment. Many older people are eligible for free hearing aids from the NHS or through charities such as Action for Deafness, although you can pay £1,000 for the latest in-ear devices. But, whichever type you have, you need to wear them!
Arthritis – a widely-suffered degenerative condition which can be very debilitating and may require replacement surgery. Often, doctors are reluctant to send old or frail people for surgery, because of the obvious risks. But immobility is also a major problem of age, with serious consequences for those unfortunate enough to be immobile. It obviously increases social isolation but it also creates problems accessing services and social and family opportunities. Every effort needs to be made to help older people keep mobile, walking, if possible, but at the very least, standing. If someone is just able to stand without being ‘hoisted’, they will be able to continue with a relatively independent life. Once someone is ‘wheelchair bound’, everything becomes more difficult and expensive. Wheelchair-friendly taxis can cost double! And nobody likes being hoisted.
Type 2 Diabetes – this is very common for older people and becoming more common. Linked to health and weight gain, diabetes has serious implications for stroke and life expectancy. Potential sufferers are often identified through a growing tendency to be thirsty or to want to go to the lavatory. This can be confirmed – or not – with a routine blood test. Few such sufferers are actually required to inject insulin but they need to keep a close eye on their sugar levels and diet
Incontinence – this is extremely common in older people but is still something we don't talk about, highly embarrassing and debilitating. With the correct pads and special pants, however, many sufferers can carry on with normal lives. These are costly, however. It is well worth contacting the GP to see if your local incontinence nurses can provide pads free of charge. These are often better than is available in the high street and the incontinence service will come to collect used ones.
Depression – on some measures, older people are the second largest group affected by suicide, next only to teenagers as the demographic most likely to take their own lives. Ill health, social isolation, poverty, abuse, neglect all play their part. Old people are for life, not just for Christmas. Many older people are routinely prescribed antidepressants.
UTI – Urinary Tract Infections – for most people, these are a minor inconvenience, treated with a quick course of antibiotics. For older people, a UTI can be fatal. UTIs can also have extremely alarming and unpleasant consequences for the sufferer and those around them. People die of untreated UTIs each year or where the wrong antibiotics were prescribed.
UTIs can be hard to avoid, particularly if someone is incontinent, but there is usually no reason at all why an older person should suffer repeated infections – whatever the care staff tell you. If they are going from one infection to another, then there could be a problem with the hygiene regime. Aside from causing extreme discomfort, UTIs in older people can cause the appearance of dementia, including crazy behaviour, hallucinations – the full works. Think George III. If treated in a timely manner with the correct antibiotics, this can be completely counteracted. If not, it can be a very quick way to die.
Cancer – if nothing else gets you and you live long enough, the chances are that cancer will. Many older men have prostate problems and need surgery. Breast cancer claims many victims among older women. But older people can suffer from all sorts of cancers from non-Hodgkinson’s Lymphoma to bowel cancer to lung cancer and mesothelioma. Many oncologists do not recommend palliative chemotherapy for frail older people – in cases where the cancer is terminal and the chemotherapy is only offered to extend life by as little as a few months. The cure can be almost worse than the illness, undermining their ability to enjoy their last months. Chemotherapy, even in mild doses, is a powerful treatment and frail individuals may be knocked sideways. It is not unknown for older patients to die from the treatment or to have their health wrecked and their life consequentially shortened. Unless there is a chance of a cure, many doctors caution avoidance for older patients
Dehydration – this is a very serious problem for older people. Many people do not drink much when they are older and it can cause a UTI which, as described above, can have very serious consequences. Dehydration can have a very adverse effect on the kidneys and other organs too. If someone has gone beyond a certain point, they may need intravenous fluids to re-hydrate them. It can almost seem as though they have returned miraculously from the point of death. But, sometimes, miracles don't happen
Impaired kidney function – many older people live with kidney failure, which is measured on a scale of one to four, and they can live with it for many years. It is essential, obviously, to ensure that such people are kept well hydrated. A sign that the condition is turning fatal can be a change in personality – or weakness and non-responsiveness. They may seem barely able to answer or even to lift their hand. It can be possible to bring someone back from that point, with urgent hospital treatment, but it can be another quick way to die.
Older people may struggle to get doctor’s appointments, because you have to hit the phones at 8am to get one or because they are unwilling to ‘waste’ the doctor’s time. And they may well need support getting an appointment at a time when they will be able to get there - ie not too early or during rush hour or school pick-up time when the roads are full of traffic.
If you are really concerned, do not be afraid to call the doctor out. House calls may not be as common as they used to be. But they do still exist, for people who cannot get out. Do not be put off by overbearing receptionists. And avoid diagnosing the problem over the telephone. This is no substitute for a proper consultation and examination. Do not allow yourself to be used as a proxy doctor and do not give opinions, unless you are a doctor.
If your relative is not responding, is having difficulty breathing or is completely different from usual, call an ambulance. It could be their heart or lungs. Or it could be an out of control UTI, kidney failure or dehydration. They could be dying.
Making an appointment is just part of the battle. Getting there, being heard and understanding what is being said is another. Just having another person there can help, particularly if there is a lot of information to take in and if the doctor or medical professional speaks quietly or in a difficult or unusual accent. It is nothing to do with prejudice, but everything to do with what someone – possibly with poor hearing – is able to understand. And, sadly, many medical professionals do not pay much heed to older patients' views but will suddenly sit up if a younger relative is present.
When one older lady went to see her Oncologist, she couldn't understand his accent and didn’t register anything beyond the cancer diagnosis. She was amazed and distressed later when her niece explained the cancer was terminal
Going to see a mental health consultant, an older couple both appeared to have dementia, because they couldn’t understand a word he said, partly because of their deafness and partly because of his heavy foreign accent. It was frustrating and embarrassing for everyone. If their daughter had not been there, they might both have left the room with a dementia diagnosis.
An older man sat waiting for ages in a hospital for an appointment. He had been forgotten, until his daughter appeared - at which point staff began talking to her. She referred them to her father - who ran his own company, despite being 75.
Many older people need help with transport but hospital transport services are pretty dreadful and, if there is any chance a member of the family could go with them, for support but also for a lift, it would be advisable.
I once saw an older couple in the A&E department of our local hospital. It was nearly 5pm, they had come for an appointment at 9am and were still waiting for the hospital transport to take them home. They had been too nervous to go to the café to get a cup of tea, because they were worried about missing their lift. They had not had anything to eat or drink since breakfast. Sadly, this is not unusual and people using hospital transport will almost always have lengthy waits.
How old did you say you were madam? Some doctors will not recommend surgery for older people
Keeping mobile is essential to an independent life -even if it only means being able to stand
Urine infections are deadly for older people and can assume the appearance of dementia