For an elderly person, finding the right medical care can be a challenge, not because good doctors aren’t available, but because too few doctors really understand the unique needs of their aging parents. That was our chief take-away as we read this recent article from Forbes in which contributing writer Carolyn Rosenblatt has a warning for adult children of aging parents. The message is simple: unless you pay careful attention to the care your loved one is receiving, their health could be at serious risk.

Let’s take a look as Rosenblatt outlines the problem and offers some solutions. She also has a recommendation we strongly endorse: she advises senior patients to seek out the services of a board-certified geriatrician. We’ll have more to say about that a bit farther along.

Specialists Often Over-Prescribe, Putting Patients at Risk

“If there is an aging loved one in your life, chances are they’ve got some chronic medical conditions,” Rosenblatt begins. “Heart disease, high blood pressure, respiratory disease, and other common issues bring them to the doctor. And the primary care doctor makes referrals to specialists.” So far, so good, right?

But as she explains, that’s often where problems arise. “Each specialist focuses on their area of expertise and prescribes medications to treat what they see: keep it from getting worse or prevent crises caused by the condition. Before long, your aging parent is taking a dozen or more pills a day, sometimes three or four times a day.”  Unless someone is paying attention, this kind of over-prescribing can go on for months, even years.

Shoeboxes Filled with Prescriptions

“Is this a problem? Definitely yes,” writes Rosenblatt, who is a retired public health nurse and a contributor to a mediation website called AgingParents.com. “I distinctly recall visiting my many elderly clients at home and checking to see what they were taking. I sometimes found shoeboxes full of medication bottles, some the very same one prescribed by two different physicians. The client was taking twice the recommended amount of it and did not realize it.”

The problem comes when these prescriptions combine in hazardous ways. “I found some that caused side effects so serious that they interfered with the person’s daily life,” Rosenblatt writes. “I found some that were no longer necessary but the pharmacy kept renewing the drug and the elder kept taking it. It was scary. I wondered how many other aging folks were doing the same. They trusted their multiple doctors and did as they were told, but no one was paying attention to the big picture of their health.”

Medical Science Actually Makes the Problems Worse

One would think that advances in medical science would make this kind of dangerous polypharmacy – the taking of multiple drugs at once – a relic of the past. However, Rosenblatt observes, the opposite appears to be true. “More drugs are on the market,” she writes. “More are prescribed by highly knowledgeable specialists. But the specialists are not talking to one another. Few specialists look at the aging person’s overall health conditions in combination and most importantly, no one is considering the elder’s quality of life.”

Her point is that it often takes the intervention of a concerned family member to sit with a loved one’s primary care doctor and force them to examine the array of medicines a patient is taking. Since many seniors won’t challenge their physicians directly, a son or daughter needs to step in.

Geriatricians Provide Wholistic Elder Care

As Rosenblatt observes, the right solution is out there. “The exception to this trend is the aging adult specialist we call a geriatrician,” she says, “an MD who specializes in looking at the aging patient from a wholistic perspective. Unfortunately, they are rather rare in medicine.”

This scarcity seems odd in light of the aging population, but sadly the reason comes down to economics. “The number being trained in this specialty area in medical schools is declining at the exact same time the need in our aging population is increasing,” says the article. “It’s about how much physicians get paid by Medicare. You can imagine why a new MD will choose a higher paying specialty than geriatric medicine, relatively lower paid than numerous other specialty areas of the profession.” It’s a sorry state of affairs but sadly true.

Family Members Need to Make Tough Decisions

“For those of us with aging parents or other loved ones, there are some important things to consider,” Rosenblatt writes. “One is the issue of how long you want an aging parent with something very difficult, such as advanced dementia, to live with becoming less and less able to function.”  In other words, do you allow doctors to keep prescribing drugs for heart disease, asthma, high blood pressure, and so on, or do you focus on quality of life remaining – as Rosenblatt puts it, keeping the elder comfortable and in a dignified state?

“This may sound radical to some,” she acknowledges, “but there is no mandate to live as long as possible with poor quality of life, inability to communicate, and inability to perform any daily function independently.” Often, these questions are addressed during the estate planning process when we fill out our Advanced Healthcare Directive.

“Some people want everything done, regardless of the benefit, as long as they’re still breathing,” Rosenblatt writes. “But for most, the idea of aggressive medical interventions when we’re on our way out of life does not make sense. Multiple medications for someone who can no longer enjoy life at all due to disease is indeed being kept going by ‘artificial means.’”

As she makes clear, this doesn’t mean subjecting your loved one to undue physical pain. “Treating pain is quite different from trying to change the course of where nature is leading us,” she stresses. However, “we need to stop pretending that there is no end to the physical life cycle.”

Dementia Demands Special Consideration

Rosenblatt asks the ultimate tough question. “If you have an aging parent with multiple chronic conditions, especially advanced dementia, ask yourself how long you want to watch that loved one’s quality of life disappear. When the person can’t speak, can’t recognize anyone and can’t even feed himself or walk, what quality does that person have, if any?”

This is where families have to decide about all those medications. “Imagine that you are a decision-maker on an aging parent’s healthcare directive,” Rosenblatt says. “When you, in cooperation with at least one caring physician, decide to withdraw all those medications except pain and comfort meds, and allow nature to take its course, you are acting in the best interests of your loved one. This does assume that they, like most, don’t want to be forced to stay alive by artificial means.”

Three Suggestions for Better Elder Care

The Forbes article ends with three solid recommendations for adult children to follow. We’ve quoted these verbatim:

• Visit and make a list of everything your aging parent is taking every day. That includes physician-prescribed things from the pharmacy as well as over the counter remedies.
• With appropriate permission (Healthcare Directive or “HIPAA Release”), make an appointment with a reliable and accessible MD or nurse practitioner to review the medication list to determine the necessity of every single thing on it. Ask about the appropriateness of continuing all meds that might be just futile or no longer needed.
• Advocate for your aging parent. Quality of life is a very important consideration which seems to be missed by many medication-prescribing specialists. They are focused on their own “turf” rather than how it is for the patient to keep living with so many progressive diseases that only get worse. This is most significant for any elder with advanced dementia. Never be afraid to question a doctor or a prescription. You may be the only one who does.

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PHOTO CREDIT: www.bbc.com

(originally reported at www.forbes.com)