A Hard Truth to Swallow

Ruth Kelton Apr 25, 2008

Illustration by Jennifer Lew

Things weren’t going quite right. I noticed I was tired enough to put off going on errands that demanded a long walk. And I was weaker than I had ever been. My balance was a bit — no, a lot — off, and I was dizzy from time to time. At 75, I dismissed all this as “just getting old,” although I did complain mildly to my phalanx of doctors about general fatigue. I griped to my primary care doctor about the armload of prescription medications I was taking. Her response was, “Well, you have a lot of things wrong with you!” And she was right. I live with a medical textbook’s worth of pathologies, including severe vision impairment, atrial fibrillation (heart disease) and kidney issues.

I spent time hopping from specialist to specialist. My cardiologist sent me for a batch of ugly tests — all of which I passed. My kidney doctor frowned and told me, “You are going to have to go on dialysis.” This was serious stuff, involving running my blood through a cleaning machine three times a week. I bit the bullet and got set to have a permanent hole poked in my arm.

Then one day last August I fell in the middle of a New York street and broke my nose.

I was taken by kindly passersby to a nearby hospital, where the young intern minding me looked grave and said, “You’re taking a dose of a couple of blood pressure meds that could make an elephant stagger!”

I was taken off those meds immediately, and — surprise! — within weeks I had lost the dizzy spells and kicked the fatigue, and, wonder of all wonders, my kidney function zoomed up 15 percent.

So what had happened to cause a medically hip, smart-alecky geezer like me, and a whole brigade of hotshot doctors, to miss the onset of medical overdose? And how can we, the old and our support groups of family and friends, avoid such risks?

I did some heavy research and talked to some experts in general and geriatric medicine; however, no one would talk to me on record. (I should not have been surprised that I had almost no luck getting doctors to talk to me about medical error for publication.) As it turns out, my story was not uncommon among the elderly, and is as applicable to younger people with aging relatives.

Here’s the very short list of medical-care problems faced by older adults and some suggested solutions:

1. Communication Breakdown: When my friends, family and doctors asked how I was, I answered, “Fine,” even though I knew very well that I was not fine. Also, although I informed my doctors about all the meds I took, most of them did not attempt to compare notes.

The Answer: Get real. Tell your docs how you really feel. Be specific. Doctors aren’t psychic. Push them to talk to one another, to share notes and files. Have a family member help talk to them if needed.

2. Ageism: Discrimination based on age flourishes in the United States. The old are frequently discounted as impaired, unintelligent, low-status and powerless, and their assessment of their own problems is often disregarded.

The Answer: Ageism, like any other prejudice, is hard to combat. Do not accept second-class treatment. And call in your calvary of family and friends who can rally to help make sure you are treated fairly. Advocacy groups such as Joint Public Affairs Committee (JPAC) for Older Adults (212- 273-5262, can help with advice and information. Remember many seniors are not familiar with the computer, email and Internet and often need help navigating through the technological world.

3. Medical Indifference: Studies show, and some doctors will even admit, that there is a tendency on the part of the U.S. medical community to tune out older patients, potentially endangering their health.

The Answer: If you think your doctor is not paying attention, try telling her so in a non-combative way. Invite a relative or friend to go with you to your medical caregiver to discuss the problem. If these measures do not help, it is time to change doctors. And if you are seriously harmed by medical negligence, it is time to seek legal aid. JPAC or other senior advocacy groups can help.

4. Too many Doctors, Too many Meds: Patients who take a lot of prescription drugs, and have an army of doctors prescribing them, run an increased risk of missing or doubling their dosage accidentally, or simply being prescribed drugs that conflict or, as mine did, over-medicate them. In addition, older patients frequently develop heightened sensitivity to some of their prescription drugs.

The Answer: First, be aware yourself and make sure your support group knows what you are taking and how you feel physically and mentally. Be alert for unexplained or sudden changes in energy levels and mood and make sure all of your physicians exchange information about your condition. Finally, if you have trouble remembering to take your pills, try making a personal calendar of “pills to take when” and check each dose off every day as you take it. Try the brown bag approach for your doctors: put all of your bottles of medication in a brown bag and take them with you to the doctor every time you go. Insist that the doctor see exactly what you take.

5. The Joys of Aging: A battery of studies have shown that “normal” aging can cause lessening of physical and mental abilities.

The Answer: Engage in physical activity and continue to challenge your mind. Take a class, join an exercise group, tutor a child, learn a language, volunteer for political, social activist or charitable groups of all ages. Recent studies have shown that seniors who volunteer for at least two causes or activities live longer than those who merely sit at home.

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