Helping 75yo father manage health care - from a distance?

For the last year my 75yo father has been getting one medical evaluation or procedure after another (including, last month, getting a pacemaker installed). There was no dramatic starting event for this - he just went to a nurse practitioner for a physical and she didn't like the sound of a (he says) longstanding irregular heart beat. With each new procedure, and the addition of each new medication (he is now on 8, having started the year on 2), his condition seems worse (at least to the untrained eye). Last Christmas, he was a guy with a longstanding weight issue, terrible eating habits, and a very sedentary life style, but generally functioning normally. A year later, he is someone who gets winded standing up from a chair. A procedure today showed no heart problem cause for this, so in addition to the two cardiologists he has been seeing, they now want him to go to a pulmonary specialist. He is in Philadelphia and seeing doctors at a good hospital, so I guess the standard of care is good, but I want to make sure we are not missing the big picture (and it seems like an awful lot of medicine...). Anyway, let me know if anyone has thoughts for anything I could do to make sure he is not just getting caught up in the health care system (not even sure what I mean by that....).

Thanks!

PS if anyone has found a way to get someone of this age to meaningfully improve their diet, would love to hear about that as well.

Why don't you go with him to his doctors' appointments and maybe even make a few second opinion appointments? Philly is a 70 minute drive, not exactly long distance"

lporter1025 said:

For the last year my 75yo father has been getting one medical evaluation or procedure after another (including, last month, getting a pacemaker installed). There was no dramatic starting event for this - he just went to a nurse practitioner for a physical and she didn't like the sound of a (he says) longstanding irregular heart beat. With each new procedure, and the addition of each new medication (he is now on 8, having started the year on 2), his condition seems worse (at least to the untrained eye). Last Christmas, he was a guy with a longstanding weight issue, terrible eating habits, and a very sedentary life style, but generally functioning normally. A year later, he is someone who gets winded standing up from a chair. A procedure today showed no heart problem cause for this, so in addition to the two cardiologists he has been seeing, they now want him to go to a pulmonary specialist. He is in Philadelphia and seeing doctors at a good hospital, so I guess the standard of care is good, but I want to make sure we are not missing the big picture (and it seems like an awful lot of medicine...). Anyway, let me know if anyone has thoughts for anything I could do to make sure he is not just getting caught up in the health care system (not even sure what I mean by that....).

Thanks!

PS if anyone has found a way to get someone of this age to meaningfully improve their diet, would love to hear about that as well.

There comes a time when there is no wiggle room. I am close to your father's age. I was hurt slightly doing a chore and when the squad came to help me and later at the ER my blood sugar level was through the stratosphere.

I was given a shot of insulin but the ER doctor wisely knew that keeping me over night would do no good.

The work to be done was mine and mine alone. I am a Diabetic 2 by the way and have taken Metformin for a few years

So that was it............no more sodas, juices, beloved sweets, no sugar in the coffee or tea and anywhere else for that matter.The Entemen's aisle at King's no longer knew me. Happy to report at last physical I was still somewhat over the recommended level but my doctor actually had a smile on his face for a change.

After a heart attack a few years ago, I was sent to a specialized cardiac rehab. Most of the participants showed improvement in the wind and stamina after only a few months. Perhaps a program with a physical therapist will help your dad's situation. It is the discipline and will to participate.............to be part of his life and not an easy chair participant that will see him through. There is no magic bullet.............just a will that will find a way

Good luck

Assuming your father has good cognitive functioning, he should be able to manage his own health care with a little support. One thing you can do is to speak with him regularly to see how he is doing. If he is sufficiently computer literate and has the right equipment, consider using something like Skype or Face Time so you observe how he looks as well as how he sounds. This could avoid the need for some of the questions you might otherwise ask that he could take the wrong way.

Get a listing of his medications including dosage, and time of day taken. Bring that listing to a pharmacist you trust and verify that there is nothing in in any of them, counter-acting drugs, known side effects, foods he should avoid while taking, etc. that could explain the decline you are seeing. Make sure that listing includes vitamins and supplements. Ask for any diet restriction recommendations: low fat, low sodium, diabetic diet, etc. You can't prevent your father from eating the wrong foods; but, you can make sure is aware of what he should be doing.

If you have a medical power of attorney for your father (a really good idea for all of us) you can go further. Get a listing of his doctors with their contact information. Call the appropriate doctor's office with any specific concerns. You may need to send each office a copy of the medical power of attorney before they will discuss his condition/treatment options, etc. with you. If your father is unwilling to provide the medical power of attorney, make sure that you are listed as an emergency contact for him at each doctor's office. This may help you get additional information but the medical power of attorney is better.

If he has an additional health insurance besides regular medicare, call or urge him to call the number on his insurance card to determine if the insurance coverage includes the services of a case manager who can help coordinate his various health needs. If it does, help him set up this service and make sure he knows how to use it and follows through.

If he has a primary care physician, that person should be coordinating your father's specialist visits and receiving reports from the various doctors he is seeing. This will help identify if he is getting the treatment he needs. If you are able to go with your father to any of his medical appointments, this is the one you need to go to so you can ask global questions regarding your father's overall health and the care he is receiving.

Please be careful in how you approach all of this. Us "older adults" have our pride and need for at least the appearance of our maintaining our independence and decision making ability. Let him know you are proposing all of this because you care and because all of us regardless of age or physical ability need a back-up plan when it comes to our medical care. While you are at it, make sure you have a similar back-up plan in place for yourself and let your father know you have done this too.

Have you considered overmedication? Common is the elderly.

Thank you so much for the responses - tremendously helpful.

try a gerontologist visit? They are good at working to avoid polypharmacy -- taking more than 4 drugs. nobody really studies how more than 1-2 drugs interact with each other. good luck!!

Added, ask the Bar Association in his county for referrals for Elder Law. If you can convince him to go with you, great.

Also, is he a war veteran?

MANY excellent pearls in this thread. Every response has good advice. Especially from Joan.

lporter1025 said:

Anyway, let me know if anyone has thoughts for anything I could do to make sure he is not just getting caught up in the health care system (not even sure what I mean by that....).

You may mean you want to ensure that the main beneficiary of the "care" is your father (rather than the providers). Note jerseyjack's query.

I can understand your concern. We need to take proper diet to maintain our health. I found many people going for élastique fitness for getting a toned, fat free and healthy body. A proper nutritious diet is also essential for a healthy body. We need to adopt good eating habits in our daily routine to stay fit. You can ask your father to take up a balanced and nutritious diet. This will also help to improve his health and fitness.

I don't think you stated your Dads living situation. If he's in any kind of a retirement community, there are likely resources there  (and if he's not, now is the time to make that move!)

When my parents initially moved to a retirement community in south NJ some 15 years ago, in their late 70's, both my Mom and I were highly skeptical.  She loved her house, her yard, etc.

Now looking back, it was the best thing they could have done. A community of folks, all more or less in the same stage of life, sharing challenges and joys. Many of resources seniors need right there, everything else close by.

if that's not the case, there are likely senior advocates he could turn to. I know it's not easy fir many, especially men, to admit they need help... that's where a social worker or religious leader can be most helpful.

All the best.