Old people

In the state system in South Africa, we didnt see old people. Not REALLY old people. The combination of HIV/AIDS, poorly controlled diabetes and hypertension and trauma meant that sadly, if you made it to 75, you were lucky.

In Ireland, we have the flip side of the coin.(I am sure this is true of most '1st world countries'). People get Old here. Really old! I did 6 months of medicine last year, and it was a massive crash course in geriatrics. I had no idea of the intracacies of taking a history from an aged person, or which are the right questions to ask, or how to ask them, or what differential diagnoses you need to consider. It was a steep learning curve, but I got there in the end, and now feel pretty confident with the oldies.

I have mixed feelings about the aged population: they can be VERY difficult to deal with, and sometimes their families are even worse. So here are a couple of thoughts about old people...

1)Their bowel movements are REALLY important to them. I once (accidentally!!) made an old lady cry when I told her I needed to put on a backslab for her elbow fracture: she wasnt upset by the fracture or the backslab, but the fact that she needed to have a bowel motion at 8 am every day, and wouldnt be able to successfully do so with backslab in situ.

2)Their families can be their best allies... or their worst enemies. People who care for the aged fall into two categories: excellent or appalling. The former are supportive, visit their old person regularly, dont mind helping change dressings or adult nappies, provide practical help with food and walking aids etc, and are generally well informed about the medical conditions, medications and are willing to practical and realistic when the time comes to make big decisions, eg resus decisions.

The latter are the opposite: they are overly 'possesive' of their old person, but without any thought to how to really help: I have seen old men who live with their daughters coming in with weeks worth of dirt caked in their fingernails, dirty greasy hair, and toenails creeping under the bottom of their toes- could you not run your dad a bath? could you not help him clip his toenails? With his arthritic back and hips he probably cant manage to do these things on his own anymore.
When you suggest to this type of person that the old person needs to go home with a catheter/have dressings changed daily/have someone supervise medication, they will argue loudly with you and explain why they cant possibly do this, even though they are the 'carer' (and sometimes, getting the state 'carer's allowance!).

3) They are NOT stupid, but people treat them like they are. For the first time in my life, I encountered patients here who have never been told their diagnosis, even when its something like cancer!, because their family 'thought it best' not to tell them. What a load of hooey.

4) Loneliness is what kills most old people. (Apart from strokes and MI's obviously!). My heart breaks for these old ladies who have outlived their husbands by 30 years, or old chaps who live on their farm with their equally old brother, unable to farm anymore, but without anyone to sell or give the farm to. There is a big problem of alcohol abuse in the elderly here, but I understand it to an extent: They go off to the pub every day and have lunch there, both for the food and the company, and end up with a life long habit of 2 or 3 pints a day.

I'm not a big fan of oldies, and those who know me will know that I am not the most patient or people: but in dealing with the elderly I have learnt a bit of compassion, and also what it means to really be the patient's advocate: someone needs to stand up for them! Then again, maybe I'm just getting older myself, and a bit soft in the head:)