Studies: Some Nursing Home Elderly Get Futile Care

It's a smart nurse who listens to the aides.

Having worked in the acute care setting, home care, and hospice I would say that pain control in the elderly is no where near optimal. Too many elderly both in their private homes and in LTC and assisted living facilities are living with daily pain that seriously impacts their quality of life. Some of these people are not able to adequately communicate their levels of discomfort. Many, however, are simply poorly managed by their medical team. I find this fact horrifying, sad, and all too common.
Surprisingly, I find that many of the persons actually providing the care to elderly residents of LTC have little knowledge about the health issues most prevalent in the geriatric population. Looking at this "futile care" from that perspective then makes a bit more sense...they really DON'T know what kinds of things to look for, what signs and symptoms to anticipate, what strategies might improve quality of life or health outcomes. Don't get me wrong...there are lots of excellent geriatric health professionals out there...there just needs to be many, many more. And the education needs to get all the way to the person wiping poop off of wrinkled butts.
In terms of advanced directives and health planning for the elderly...most of these families simply need a rational, compassionate, well informed health professional who will provide honest information for them. We (as a medical community) need to stop fearing death and focus more on quality of life and the wishes of the person. Our traditional medical system remains very much in the business of advocating for "one more" pill, or procedure, or treatment; even when the bulk of the data suggests that such options will be unlikely to increase the life span and may well actually decrease the overall quality of life in some fashion. The "risk vs benefit" value of some of these options is not even discussed in some cases with the family or patient! Take for instance, the 80 something person who is diagnosed with a cancer of some sort...and the MD recommends a course of chemo and radiation even though they are well aware that the success rate may be below 50% for an increased life span. Some docs will not even discuss, honestly, with the patient and family the negative effect the treatments will have on the quality of life that patient will experience. The SE of the chemo, the hours spent in chemo, in radiation, in appointments, the multiple blood draws...etc, etc, etc. Given the ACTUAL options, a reasonable percentage of those elderly may opt to enjoy their lives and forego the treatment. It is fine if people want to go out with guns blazing...however, there are many people who are really at peace with their lives, with their mortality, and with the concept of death. Perhaps the mistake that some families make is in assuming that if their elderly loved one is resident in a LTC that they are receiving good oversight of their medical care and needs. The families often do not realize that THEY must be the ones to advocate for timely, appropriate medical care. Take for example a case I dealt with just yesterday...the bedside aids had reported to their superiors last week that an elderly dementia patient had a foul smelling vaginal discharge, the superiors did NOTHING with that info, they didn't even bother to advise the family. When they told me, I assessed it, notified the family and the doctor, and got an RX for the most likely cause of the discharge. No reason the demented woman must suffer through a vaginal infection simply because she cannot complain of the itch or discomfort. In this case there was no professional advocating for this patient although the family sort of expected there was.