According to research published recently in the Journal of American Medical Association, not only do physicians under prescribe for pain, 50 percent of nurses under-administer the pain medication does get ordered.
This aversion to treating physical pain carries over in spades where the treatment of emotional pain is concerned.
Many doctors have a hard time realizing just how painful it is to be anxious and depressed. Guess they’ve never been 80 and severely infirm, humiliatingly dependent on near-strangers for even the most basic and private personal needs, absent caring family and with only death to look forward to.
One such physician I work with was asked for something to help a patient who was so anxious and depressed she pulled huge clumps of hair 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 over sedate her and instead prescribed 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 the wind. This particular medication is not given on an as-needed basis (“PRN”) but routinely, in order to build up a therapeutic 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 PRN basis (to avoid over-sedation) but a routine medication to address the self-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 she returns but it’s hard to argue with success: Our patient is no longer suffering. 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 rightly called patient abuse. Stringent state and federal regulations of all psychoactive drugs are aimed at prevented misuse in this way.
But refusing to acknowledge and treat the depressive ravages of the 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 under-treated illness in the geriatric population. Unlike the profile of diseases that go along with aging, it does not show up on lab tests, or EKGs. It is silent and invisible except for its effects.
If in doubt, go to your nearest nursing home or assisted-living facility and look around.
People slumped in wheelchairs, seeking the solace of sleep, line the halls in even the best homes. Pale and withered men and women trying very 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 getting old, and arthritis, congestive heart failure, diabetes, chronic obstructive pulmonary disease, kidney failure and pressure sores from bad circulation are not even the worst of it.
The unrelenting deterioration of the physical body is insult enough to make anyone despondent but the real traumas are those inflicted on the spirit by bruising emotional losses peculiar to old age: loss of a spouse, family members, friends, home, independence, and self-esteem.
The cumulative stress of a lifetime compounded by the rapid devastations of old age can crystallize into acute emotional distress. Because of decreased levels of serotonin and other neurotransmitters vital to mental and 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 anxious, depressed elderly through a judicious, compassionate use of medications. When we have the means to ease their suffering, even just a little, it is truly shameful to refuse to do so.
