My 87 year old mother has never liked going to the doctor and would cancel her appts numerous times before finally going. Her doctor of more than 35 years joined a new practice and they now require blood work to continue to be seen and get prescription refills. She refuses to have blood work and does
not want to go to the doctor now, I assume out of fear that they may find something wrong. She is going to be out of high blood pressure med refills soon and I sense her plan is to just stop taking her pills which I know will lead to a health event of some kind. Are there any options for getting her care that would allow her to get her meds refilled? The suggestion of telling her you’re going somewhere else and showing up at the doctor will not work because I can guarantee she will NOT get out of the car. Any ideas are appreciated.
Or assure her, as can you, that nothing will be treated that she doesn't want treated.
Have you asked her why she doesn't want to go?
You can't argue using reason or logic with a phobia (if that's what it is but she would have had this prior to being 87) or, she more likely has the beginnings of dementia and the cognitive confusion and diminishing ability to use reason and logic is making her appear stubborn or phobic.
You can purchase a BP cuff to see if she'll even let you do it yourself at home just to see if she'd even comply with any other testing. Because if her doctor can certify her as "home bound" then Medicare may cover an in-home visit. What she probably really needs is a cognitive exam and test for a UTI.
https://www.medicare.gov/coverage/home-health-services
Does you mom have any other physical conditions that are of concern?
If not maybe have a conversation that goes like this....
Mom, I have a POLST (a form like a DNR but more detailed, can called by different names in some states) I need you to fill it out so that I know what you want me to do in case something happens. Since you won't go to the doctor I need to know what you want if I have to call the paramedics one day.
You can go through all the possibilities of what can happen if BP goes uncontrolled but at 87 I am sure that she figures none of that will matter. The thing to impress on her is IF she has a stroke and survives she will probably not recover fully.
Bottom line is...if your mom is cognizant she can make her own decisions and if this is the choice she wants to make then that is her decision.
Its a little costly but worth it in so many ways. Good luck.
Explain to her what will happen, if that is not possible try to understand what their wishes would be if they were on life support and wait it out.
Create a log of her blood pressure readings. Ideally, you should check her blood pressure at least 3 times during the day - first thing in the morning upon her waking up, sometime in the middle of the day, and before bedtime. Try to get a week's worth of readings before the doctor's appointment. If mom won't see the doctor in person, get those readings to the doctor before or at the tele-appointment. Buy an automatic blood pressure cuff. I am an RN and I have one that works on the wrist so that you don't need all the different sizes of BP cuffs.
If she still needs bloodwork, take her to a lab and ask them to use a butterfly set and mini-tubes. Some of my older patients tend to do better when I use a butterfly set-up and use a syringe instead of the vacutainers. (Feel free to print this out and take to the lab so they can read what I wrote.) The doctor can also prescribe numbing medication to put on her elbow creases and back of her hands 1 hour before she gets lab work drawn so she won't feel the pain,
Did you ask if this is her way of dying? Did you tell her you’re not ready but you understand? And if she wants to die, are her affairs in order? Does she understand the physical and possibly mental repercussions of a heart related health event? Or how long it could last? Or what care she might need and how to pay for it?
Have you asked yourself what kind of life you want to live at 87 or 90 years old? And at what point you’ve spent enough time on Disney Earth, ridden enough rides, seen enough sights, had enough highs that exhilarate, persevered enough storms; but you’re tired, it’s not much fun and you’re ready to go home?
A relationship of 35 years is not to be tossed aside lightly by either party. If I were you I'd call that doctor personally, explain the problem, and ask for help with it. Perhaps s/he can speak to your mother and get her agreement.
The elderly mother's insurance pays for her bloodwork and doctor's appointment. To be sure it's a rip off, but she's not actually paying for it.
Sometimes an elder has to be asked if they're willing to die of stubbornness. If the mother stops getting her blood pressure medication she'll have a stroke.
She had to be transported by ambulance to the doctor's office. He really didn't even examine her. The medical assistant took her blood pressure and he listened to her heart. Both could have been done at home by a visiting nurse. They're only insistent like this to run the bill up. No other reason.
Stop trying to humor your mother and work around the asinine stubbornness so many of our elderly population have.
Tell her exactly this:
Your doctor now insists on bloodwork getting done to keep your medications refilled. I do not run his office or the American medical industry so don't complain about it to me because there's nothing I can do about it. Here's what happens if you stop taking your blood pressure pills. You will have a stroke. If you don't die from it, you'll spend the rest of your natural life in a nursing home because you will need professional care that I cannot provide for you. Getting bloodwork done and seeing your doctor really doesn't seem all that bad now does it? You've lived a long life of 87 years. Do you really want to die of stubbornness? It's your choice if you want to.
I'm pretty sure if you tell your mother in exactly these terms she won't give you a hard time about going to see her doctor and getting a bloodtest. Good luck.
I do get it limits profits for the doctor. I have seen what my mother's doctor charges her insurance for a routine visit that consists of asking a few questions, and checking vitals.
Hugs for you!
Most of the Doctors around where we live have started requesting blood tests/prescription refills every 3 months. I truly think it's about greed. More visits = more money. It's very hard on the patients, esp people who take off work & lose money to see the Doctor, and the elderly who hate going. Even every 4 months would be easier for patients.
Might be time to change Doctors. We changed Doctors for a similar reason - difficulty getting to the Doctor, because we had to pay a private ambulance/stretcher each time.
Found one that would send out a Nurse Practitioner to the house for visits, and they were able to advise of a Lab that also made house calls. (Side Note: My Mom is bed-bound, paralyzed.) They're also less picky about the timing, for established patients the visits are as-needed, or every 4-6 months. Works well for her. In fact, I'd say it works perfect for her.
I had to do all of the research myself. The Area Agency on Aging didn't have any recommendations, her insurance was clueless. I just got on the Internet and started searching and calling.
I recommend the NextDoor website for asking others in your area for recommendations on practitioners that do home visits in the area.
At 87, prolonging life shouldn't be the goal. If she has a stroke because her BP is through the roof then explain to her that that is a real possibility. If that's a risk she's willing to take, then she should follow through, get herself a living will that clearly states she's DNR (do not resuscitate), she only wants palliative/comfort care, and to allow for natural death.
Obviously, you will not trick her into doing anything she doesn't want to do and so, at this point, I would focus on making sure her wishes for end of life are spelled out clearly. Enjoy whatever time you have left together.
"Not trying to force my mother to prolong her life for my benefit so please stop judging. If she wanted to die, I would certainly let her. But she has given me no indication that that is the case. My mother is part of a generation/mindset that felt doctors and hospitals only meant they would start digging around to find a reason to put you in a nursing home. Doesn’t want the bloodwork because she’s afraid of what it might show. Afraid she might have to go into the hospital. (Yes she knows not going to the doctor may cause this anyway) Put yourself in her shoes, show some compassion, and understand the fear of this aging population."
So, Phoebe, what is mom's reason for not going to the doctor? Have you asked her and gotten an answer?
Does your mom understand that she can say "no" to further investigations? My mom was shocked to learn that she could say "no" to a bone biopsy and spinal tap after a few abnormal cells were seen in a test!
Our parents grew up in a culture in which to say "no" to a physician was to be labelled difficult and tossed away, blacklisted as a patient.
We eventually got mom to see that it was no longer the case, but she did a lot of weeping before we got there.
If she has paperwork that states she doesn't want certain measures taken. Be sure you know where the copy is. And as hard as it is for you, you might have to let it happen. How high is her BP?
My husband had a low BP incident the other day. I called 911 and the medics wanted him to go to the hospital in an ambulance and be checked out. He wouldn't go, he happily signed the release slip. It is his life and I have to respect his decisions. He was mad at me because I called 911. I just let him know he had the rest of his life to get over his mad and I will do it again if I feel the need.
Is it the blood draw she objects to? As already mentioned, this can be made less painful. But it's never pleasant, esp. if frequent.
The medication? Some blood pressure meds, can make one feel lightheaded or dizzy (which, incidentally, increases chances of a fall). If this is the case, the doctor may adjust the dose, try a different medication or stop medication entirely.
If she is like many 87 year-olds, she would tell you, in all seriousness, that she would rather DIE than go into a "nursing home". This seems to be the greatest fear of people her age.
Virtually nothing will guarantee she stays out of a nursing home. And, as she well knows, there are many possible fatal outcomes at her age. She should be urged to at least discuss her preferences with you and her physician so that you can all be on the same page.
It may not be "stubbornness" on her part, but simply a sense of resignation, a willingness to face what is inevitable. Some elders simply grow weary of being analysed, treated, scanned, medicated, and subjected to various therapies. She might just consider your company the therapy of choice.
Legally, unless declared incompetent, it is her right to choose.
We found Mom no longer needs prescription blood pressure meds simply by giving her magnesium.
400 mg of magnesium dropped her blood pressure about 15 points
Magnesium citrate--if tends towards constipation
Magnesium glycinate--if loose stools
I hope you find peace I have with this approach.