I have learned more about the issues facing our seniors dealing with the current healthcare system through my father than through any rhetorical editorial about aging parents. I should thank him, but since he did not volunteer to tudor me nor consciously provided data about himself, it would be inappropriate. i have witnessed neither alzheimer’s nor parkinson’s, neither broken hip nor broken anything, neither cancer nor severe arthritus. Although he had heart bypass surgery at the age of 81, this was supposedly to prevent a heart attack given he had never had one. I have witnessed chronic, non-acute conditions that plague him–spattered falls, non-acute pneumonia, eye infection, carpal tunnel, and other incidental events. He barely can use a walker now…but no one has prescribed either cane, walker, or wheel chair. The total package adds up to one unhappy, frightened aging adult whose days are very long, ever confining and less active, without anything but worse days ahead.

My Dad’s primary care physician, who is most familiar with my parents over many years, has nothing new to offer; Their cardiologist has tacetly given up on improving or optimizing the outcome of the bypass surgery he had recommended. He is arrogant, condescending, and distracted during the less-than-seven minutes he spends with my father. (I wish I had something nice to say…) During our last phone call he had said to call him if it looks like he is having a heart attack.

Most frustrating, a local geriatrician saw my parents, including each have 2-hours with a nurse specialist, and was so ineffective in his ability to relate to them, that they went back to their internist. Bedside manner is not to be minimized. When all else fails, such as patient’s sense of their own capacity, how their doctor makes them feel about themselves becomes their litmus test. In this case, it was a critical error on the part of the doctor.

The on-going frustration of chronic conditions can often be mitigated (if not cured) by conscious, often low-tech management. However, the healthcare system does neither encourage nor offer this kind of support. The system only responds to acute and episodic events for the elderly, not chronic, on-going often debilitating conditions.

As an adult child, I can watch and have little impact. Many times as I have done research and passed on suggestions offered by hospice and long-term care nurses whose experience has taught them effective management of pain and discomfort, incontinence, anxiety. However, without the stamped-approval of a physician, I am met polite resistance. In fact, I am basically ignored. This is the way of an aging generation for whom the physician is still the last, often only, word.

With the internet providing a plethora of resources for the elderly, it would seem that relief would be available. However, access comes second hand. My Dad is on email, but his hand shakes too much to deal with a mouse. The screen is 17″, but his eye-sight and ability to focus from 12-18 inches is limited. Thus, the information has to come from me..which puts me, again, in a one-step-away-from-relevant position.

The primary care physician who can only see treatable conditions as being his focus, could refer an elderly person for whom aging is not a disease, to the clinician trained to work with this age group. Aging is not a disease and therefore is not served by the current disease-focussed system. Each stage of life is a collection of chronic symptoms many of which are understood and accepted. However, aging is no different. It has its own symptoms, can be managed if understood, and are easier to deal with if accepted as normal for the individual who has them.

If a pediatrician works with kids and passes them on when they are older, why is it that a primary care internist that works with “adults” does not pass on their patients when the next life cycle begins? if they did, we would all do this better…

What is your local practice regarding geritricians..do you have any in your area and how are their referred?