Recently a patient brought home to me how inadequate the help I can provide my elderly patients as a GP can be. Among more than 50 phone calls I fielded one day as one of the GPs dealing with urgent requests, there were two from a patient in her 80s who is the main carer for her husband who has dementia. She also has health issues and he is unaware of the problems they face. The receptionist learned far more about the difficulties they were having from the woman’s phone calls to the surgery and from observing them in the waiting room, than I did from my snatched telephone conversations and the scrawled note left for me. I found out later that the only way she could get to the surgery to bring the sample I requested was by locking her husband in the car outside. I knew that things were difficult, but this was a new low.
Over the last year I have been increasingly involved in the care of a man who is in his 80s and moved into my practice area to be nearer to his family. He enjoys telling me about his past when he gets the opportunity and I recall how his eyes sparkled as he told me that adopting his daughter was the best decision he and his late wife ever made. He knows his dementia is worsening and was the one who recognised the initial symptoms, well before these signs were noticed by others around him. He looks crestfallen as he recounts to me how he sees the frustration and sorrow in his daughter’s eyes when he asks the same question another time. He is annoyed by his failing health and memory and feels he is a burden to those around him. At times he is too proud to ask for help.
The population is ageing, with the number of older people with care needs likely to increase by more than 60% in the next 20 years. One in three over 65s will die with dementia, and it is the leading cause of death of women in the UK, yet dementia research is poorly funded, with combined charity and government research significantly lower than cancer research. Every day as a GP I see patients in difficult situations, where an elderly person is struggling to care for themselves and their spouse, with implications to the health of both. I see families trying to maintain their jobs and daily activities, while providing increasing support for their elderly relatives. At the end of a long day yesterday a son called me in distress; his mother was already an inpatient and he was left to look after his father, but felt getting involved in intimate personal care was a step too far.
As a GP I am the person that people often turn to, but at times I feel I have little power to make positive changes for these patients. I can only provide brief intervention, refer and signpost to over-stretched services – this is not the level of care and support that they need. Those that come to me are often at crisis point, having struggled without any input from outside services until they cannot continue any longer. There are undoubtedly those that I’m not aware of perhaps until an emergency admission or mishap alerts me. These patients may come into contact with many services; as health professionals we often see an aspect of their lives, dealing with high blood pressure, an arthritic knee or continence issues, but do not realise the enormity of the situation or assess it properly.
Older people’s mental health services and social care are limited. Yes, I can refer, but these services are overloaded and don’t provide much help. We need more resources, more time, more services, more people available to provide assessment, listen and support. We need to start focusing on ageing and older people and encouraging planning for the future, or this situation will only get worse.
*Some details have been changed to preserve patient anonymity
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