WINTER IN THE AGING SOUL
by Cindy Hasz
American Reporter Correspondent
San Diego, Calif.
SAN DIEGO -- According to research published recently in the Journa= l of American Medical Association, not only do physicians underprescribe fo= r pain, 50 percent of nurses under-administer the pain medication does get = ordered.
This aversion to treating physical pain carries over in spades wher= e the treatment of emotional pain is concerned.
Many doctors have a hard time realizing just how painful it is to b= e anxious and depressed. Guess they've never been 80 and severly infirm, hu= miliatingly dependent on near strangers for even the most basic and private= personal needs, absent caring family and with only death to look forward t= o.
One such physician I work with was asked for something to he= lp a patient who was so anxious and depressed she pulled huge clumps of hai= r out of her head and picked at her skin until it bled. She didn't want to = prescribe what I'd suggested (a small dose of one of the best anti-anxiety = medications) saying she didn't want to oversedate her and instead prescribe= d Buspar, an antidepressant that helps specifically with anxiety.
That might've been a good choice -- but the problem was, she only = gave us six. Talk about spitting in wind. This particular medication is not= given on an as needed basis (prn) but routinely in order to build up a the= raputic blood level. Six was next to useless.
When I called her again, she was out of town and the on-call doctor= returned the call. He ordered not only the anti-anxiety drug Ativan on a p= rn basis (to avoid over-sedation) but a routine medication to address the s= elf-mutilating behaviors.
He made a decisive move to help a woman who was literally tearing = herself apart. The primary physician may not enthusiastic about this when s= he returns but it's hard to argue with success: Our patient is no longer su= ffering. She is much calmer now and not so miserable in her own skin. = Of course, I don't want to see anyone over-sedated, especially if only = to make life easier on the caregivers. Such a thing is abhorrent and rightl= y called patient abuse. Stringent state and federal regulations of all psyc= hoactive drugs are aimed at prevented misuse in this way.
But refusing to acknowledge and treat the depressive ravages of th= e multiple losses typically faced by the elderly is no answer either. = There's a good argument to be made that turning a deaf ear and blind eye = to a patient's mental distress is equally as harmful and unethical as over-= sedation.
Depression is the No. 1 undertreated illness in the geriatric popu= lation. Unlike the profile of diseases that go along with aging, it does no= t show up on lab tests, or EKGs. It is silent and invisible except for its = effects.
If in doubt, go to you nearest nursing home or assisted-living faci= lity and look around.
People slumped in wheel chairs, seeking the solace of sleep, line = the halls in even the best homes. Pale and withered men and women trying ve= ry hard to be brave walk around gingerly, afraid of falling. Many more give= up walking about the same time they give up caring. Some bear their inner = storms in silence while some cry and some literally scream for help.
Those are the ones the staff learns to tune out.
What's not to be depressed about? It is grueling business this gett= ing old, and arthritis, congestive heart failure, diabetes, chronic obstruc= tive pulmonary disease, kidney failure and pressure sores from bad circulat= ion are not even the worst of it.
The unrelenting deterioration of the physical body is insult enoug= h to make anyone despondent but the real traumas are those inflicted on the= spirit by bruising emotional losses peculiar to old age: loss of spouse, f= amily members, friends, home, independence and self-esteem.
The cumulative stress of a lifetime compounded by the rapid devasta= tions of old age can crystalize into acute emotional distress. Because of d= ecreased levels of serotonin and other neurotransmittors vital to mental an= d emotional balance, the burdens of life formerly borne with resilience and= resolve can in the twilight years become completely overwhelming.
If our culture is notoriously stoic when it comes to physical pain= it is positively sclerotic when dealing with emotional pain.
Improved quality of life can be achieved for the elderly through a= judicious, compassionate use of medications. When we have the means to eas= e their suffering, even just a little, it is more than a crime to refuse to= do so.
Cindy Hasz is a nurse and freelance writer in San Diego. She can be reac= hed at email@example.com