Intervention or interference? Making the best decisions

I suppose because my mother lives on the advanced-care floor of the nursing home I probably hear more than my fair share of debates regarding when and how medical specialists should be called in. In fact, I have also been engaged personally in these discussions when my mother has contracted various illnesses. After all, she’s had everything from pneumonia and bladder infections to dental care and ongoing bleeding skin sores that no one seems to understand.

But that’s the way of the eldercare world. It’s our job as family caregivers to help determine the best course of action to protect our loved ones without causing them any additional personal drama or trauma. In other words, we need to be prepared to consider and reflect on which medical interventions are critical and which are optional, and then to decide when intervening simply won’t make a difference this time.

What is “a line of need”?

What I’ve learned is that we need to examine, and then define, “a line of need.” That means consulting with medical specialists and a good geriatrician and figuring out what to worry about and what to act upon given the condition, age and circumstances of my mother.

For example, I have an excellent dentist who examines my mother’s mouth on a semi-regular basis. He also reviews and counsels on treatments based on the report of the dental hygienist who twice annually cleans my mother’s remaining teeth and aligns her partials. The most recent hygienist report noted that my mother has two new early-stage cavities. His advice? That I should consider the implications of moving my 95-year-old mother to a dental clinic, stating simply that, “I need to keep close watch and take action only if they get worse.” The outcome? I decided that not dealing with the two cavities outweighs the trauma of moving my mother to a nearby hospital dental clinic. At this stage, treatment may not make a significant positive difference.

A parallel example is that in discussions with my mother’s geriatric team, we concluded that travelling to periodic exams really wasn’t worth the time, energy, discomfort and personal upheaval she would experience. Given her current state of mind and physical health, we could most likely achieve suitable results with phone conversations. This eliminates the need to introduce her into what could otherwise end up being a stressful situation.

Thinking back just a handful of months to when my mother was battling what turned out to be a bout of pneumonia, I remember the nursing home physician asking if I wanted to have her hospitalized. We discussed the options and implications and determined that given her age and the risks involved, we were better off leaving her at the nursing home, tracking her situation very closely and ensuring the right medications were used. Again, we elected to avoid disruption and keep her safe and comfortable, always mindful that there was an option to move her to hospital if the situation rapidly deteriorated.

My mother had a hard go of it, but ultimately staying in the nursing home—the place she trusts most and finds some comfort in—was the best option for dealing with her pneumonia.

Watchful waiting may be best

The challenge for all of us who care for aging parents and loved ones is to keep on top of their ever-evolving medical conditions. If we can do that then we can follow-up and ask the right questions, regardless of the issue the physician may be assessing.

In addition, we can then make a much better judgment call about the kind of specialists who might be needed—and for what reasons—and to consult them in a timely way.

A really good family physician will bring more knowledge and experience to the issue than we might think; he or she can make professional assessments and order many tests that can be done in the home.

What’s really necessary?

What medical action or intervention an aging parent or other loved ones might need, versus what “it might be nice to have,” is a very serious consideration. What should drive each and every one of us is the recognition that our primary objective at all times must be the best care, the most comfort and the optimum safety of the people we are looking after. What we think might be good for them may not be; it may only be wishful thinking on our part or a desperate need to feel we are actually “doing something.”

When decision-making is key, it may be wise to take a firm step back, pause and examine the situation with a dispassionate lens. We need to get sage advice and then move forward with the confidence that we’re making the best possible decision for everyone involved.

Never lose sight, however, that the first “everyone” should be your parent or loved one. Their real quality of life will often override what may be your wish for quantity of life.

Six questions to ask about specialists

1. Why do we need a specialist?
2. What will that specialist be able to tell us that we don’t already know?
3. Is that specialist knowledgeable about conditions of the elderly?
4. Is that specialist sensitive to the needs of the elderly?
5. What will be done with the specialist’s report? Who will act on it and how?
6. What arrangements have to be made regarding a visit to or from a specialist?