Our Ageing Population

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Last Thursday evening I watched episode 2 of BBC2’s Protecting Our Parents programme, and as the elderly and their mental health is something that I am passionate about, I thought that I would share an outline of the programme’s content.  Although I had caught the first episode the previous week, I found the last instalment particularly poignant, as it was exclusively focused on a married couple, Kathleen, aged 80, and her husband, Leonard.  Kathleen and Leonard were both clearly very much in love, and it was perhaps this observation in general, that made their story quite heart-breaking to watch.  The couple had been married for 60 years, and Leonard still recalled, with obvious fondness, Kathleen’s beautiful hair when she was younger.

Kathleen was recovering from a kidney infection in hospital, and desperately wanted to go home.  Her husband, Leonard, was missing her terribly, and she, in turn, I think was missing him.  The problem with Kathleen’s return however, was her constant habit of calling ambulances.  To date, it had cost the health authority £57,000!  Kathleen’s general reason for phoning was because she needed assistance with being moved in bed; Kathleen was uncomfortable, and it was still to be some time before her home-carers were due.  The reason for phoning was for anything, except for a real emergency!

Before Kathleen could go home therefore, the social workers needed to make arrangements that would alleviate the risk of her constant phoning of 999.  The hospital was keen for Kathleen to go, as her bed was costing them £310 per day, and was moreover required for someone who was more in need than Kathleen.  To help determine Kathleen’s mental capacity, a Consultant Psychiatrist questioned Kathleen about the reasons behind her ambulance calling, but she clearly denied all knowledge of ever making the calls.  The psychiatrist carried out a mini-mental state examination, first asking Kathleen to repeat and remember three objects – a lemon, a key and a flag.  Kathleen was then asked to say the days of the week backwards, which she managed to do, but was then asked to recall the three objects.  She failed this last task.  The psychiatrist concluded that Kathleen had genuine memory impairment, and therefore lacked full capacity.

It was interesting to note that the social workers did not agree with the psychiatrist’s conclusion.  Kathleen seemed fully lucid when they spoke to her about the ambulance calls, and she seemed to comprehend why they were wrong.  The social workers decisively concluded that Kathleen fully understood about the emergency calls.  In order to minimise the risk of reoccurrence, the social workers decided to arrange two extra care visits, per day, to Kathleen and Leonard’s home.

On the day that Kathleen was due to be discharged from hospital, it was found that Leonard had disappeared.  Eventually it was discovered that he was also at the hospital, suffering from a twisted bowel.  Kathleen’s return for that day was therefore in jeopardy; particularly on account of her being alone and isolated once she had returned home; and therefore perhaps, as a consequence, she may have been more tempted to call the ambulance again.  However, the discharge went ahead, with two carers attending to meet her at home.  The bed in the hospital was just costing too much, and evidently was more costly than the expense of two home-carers.

In the morning, Leonard arrived home with plenty of painkillers.  Kathleen and him-self were so happy to be reunited.  Their affection was candid and touching, and had the effect of making the observer feel so warm and empathetic inside.  Kathleen talked about never wanting to give up her home, and moreover never wanting to go into a care home.  Leonard commented that he would like to die first, as he could never cope with being on his own and was not emotionally strong enough to cope without his wife. 

A month later, it was revealed that the emergency services had been called forty more times!  Kathleen was demanding 24 hour care in her home; not in a care home.  The social workers visited her to discuss these issues, and said that she could have home care if she was willing to pay for it.  Kathleen instantly rejected this, as she felt that her-self and Leonard had paid enough in taxes and national insurance contributions throughout the years.  The social workers’ response was to offer Kathleen, and Leonard, a nursing home; the social workers desperately wanted to keep them together, which was only morally right.  Kathleen was adamant though, that a care home was not going to happen; she was intent on staying in her home.

Kathleen was upset, and so her GP came to pay her a home visit.  He brought along a different psychiatrist whom Kathleen had met before.  The GP was worried about Kathleen’s incontinence and pressure sores, and how having occasional care visits was not really addressing these issues.  The psychiatrist performed a different type of mini-mental state examination, and Kathleen did not respond very well as she was clearly emotionally upset.  Kathleen told the psychiatrist that she felt a nuisance.

On leaving the house, the psychiatrist told the GP that Kathleen’s mental capacity was definitely questionable.  A ‘best interest’ decision was mentioned for the first time. 

We later learned that Kathleen went back to the hospital, having contracted pneumonia.  Leonard, in his isolation, telephoned the ambulance and told them that he could not stand being on his own.  Leonard later had a fall and was admitted to hospital himself. 

Six months later, it was definitely decided that Kathleen no longer had mental capacity.  Kathleen and her husband had very different care needs, and it was hard to practically unite the care plan and the couple as one.  In response, a multi-disciplinary team meeting was held, with Leonard in attendance, on behalf of him-self and Kathleen.  Everything was carefully explained to him, and he had several opportunities to put across his views.  Leonard was happy to go along with the nursing home plan, because him-self and Kathleen would remain together, and she would also be able to receive the 24 hour care that she so desperately needs.  Leonard knowingly predicted however, that Kathleen would not comply with this option, and of course, knowing his wife for sixty years, he was absolutely right.

Total overnight care was another option that had been previously mentioned; perhaps more as a compromise in meeting Kathleen half-way.  At the end of the programme therefore, we learned that Kathleen had gone home with Leonard.  Kathleen was now receiving eleven visits each day, and this presumably, included overnight care.  In the short time since Kathleen had been home, the ambulance had been called thirty-eight times, and there had been visits to Accident and Emergency on several occasions.

It seems that it is only a matter of time before Kathleen will be forced to go into a care home, albeit with her husband.  The ambulance and care-worker costs combined must be far more than the expenses that are charged in a care home; and to add weight to the argument, desperately ill people, who need the emergency services, are potentially having their lives put at risk. 

In an ever increasing ageing population, it seems that stories like Kathleen and Leonard’s will sadly become more common.  It must be so hard to accept some of the changes that accompany the ageing process; especially when you have shared your life and home with a partner for over 60 years.  It is up to us as nurses therefore, to offer the elderly compassion, care and understanding.  We must try to make what is potentially a difficult journey, just a little bit easier, with some heart-felt kindly words and a good measure of empathy.   

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For more information, please visit:

The Open University

OU on the BBC, Protecting Our Parents

http://www.open.edu/openlearn/whats-on/tv/ou-on-the-bbc-protecting-our-parents

 

BBC Two

Protecting Our Parents

http://www.bbc.co.uk/programmes/b041mq9q

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