Sliding in, struggling out

If you think of all the things there are in life that are easier to get into than out of – debt, addiction, depression, swimming pools – I think, the one that preoccupies me most, relates to the movement of older people into hospital.

I hope it doesn’t sound like I am repeating myself, (I am sure I am) – yet, we make it so very easy to get into hospital. That isn’t really a bad thing in many respects, for example, if I keel-over this morning with a cardiac arrest, I will be delighted, in retrospect, if I have a retrospect, that the ambulance was at my side within eight minutes defibrillators at the ready, hastening me into hospital, or if, I need my arthritic hip replaced, I will not have to wait too long and have to jump through too many hoops before I can have a replacement.

Yet, for those people who don’t necessarily benefit from hospital admission, for whom, the technological wonders of resuscitation and arthroplasty are not ready options, hospitalisation can be the wrong thing.

An old man, maybe 88 years old, who has been living in the same house for 65 years, the past five alone, since his wife died. (Shall I give them names? OK – Ernest and Ethel…) His nutrition isn’t great, his hygiene perhaps lacking, he navigates the place fumbling with furniture and usually sleeping in his armchair, he might even have problems with his continence, yet, he is getting-by; his world, diminished since Ethel’s death has shrunk to the extent that he is left with memories of his past and moments of pride in his surroundings.

All it will take might be a fall, a slip or a, clichéd trip and he is on the floor, struggling to get up.

The rest is history… Perhaps there is a phone within reach or a remote assistance buzzer or his neighbour might wonder why the curtains aren’t open at 10am.

Before Ernest knows it, he is in hospital, with strangers fluttering around him, recording his blood pressure, his oxygen levels and pulse.

And, there you go – Ernest is in bed, with hospital pyjamas, he now has raised blood pressure, he might have acquired diabetes and is likely to be in receipt of a urine infection; his initial disorientated awareness is translated into confusion, which becomes delirium and later mistranslated as dementia, as he moves from bed to bed to ward to ward to ward.

When Ernest doesn’t want to get into bed that night, anxious about the air-filled mattress and the flashing pressure alarm, preferring to remain in his chair, and even gets a little upset, his behaviour is labeled as ‘challenging’ and if he is not careful, his dementia becomes severe…

And how do we get him home, back to his house, his familiar surroundings? How do we repatriate him when we learn that his local council is different to that of the hospital or his GP in another town, or his lack of next of kin renders other options more difficult to explore; How can we let an old man get home when he can’t climb the stairs, and there is too little space for a bed in the living room – what can we do? What do we do when Ernest becomes fed-up and stops engaging with the nurses, the doctors and therapists, when Ernest starts to lose weight?

We look to medicine, whether nutritional supplements or antidepressants or physiotherapy, stand-aids and home-care, hygienic wipes to minimize any chance of his developing MRSA and a strict lights-out policy, unless the man in the opposite bed is unwell or can’t sleep.

And, none of this was necessarily avoidable; it is just what happens, it is the system, top-heavy and teetering at times;

An old man living alone, is that the problem? Is the problem that it is a problem? Models of care and treatment that have not adapted to the 21^st century certainly contribute. We seem a little trapped inside what was perhaps too easy to get into than get out.

Let’s think of solutions.