For the past month I have been trying to organise one of our residents to attend hydrotherapy with a private physio company. Mr X got approval from DVA (Department of Veteran Affairs) and was considered a good candidate for such 
therapy. This decision was made by the practice manager over the phone after I had spoken with her at length about Mr X. I finally got him an appointment for an assessment at the hydrotherapy place, sent him off, and after an hour he was sent back.
I then received a phone call from one of the physio therapists, in a very distressed and angry tone she proceeded to tell me how Mr X was not a candidate for hydrotherapy. He was demented, confused and didn’t answer any of the questions she had asked him. She couldn’t see how we thought he was a suitable candidate, he had arrived in a wheelchair and was unable to get up on his own. I let the physio have her say and then calmly told her that Mr X in fact was not demented or confused, he is able weight bare and walk with assistance from 1 staff and a frame. This in itself makes him a candidate for hydrotherapy….. no?
When thinking back later that day it dawned on me that the reason she must have thought he was demented and couldn’t answer her was probably because he couldn’t hear her properly. This confusion happens more than we care to think about. Many residents are branded as demented, confused, depressed, and as having behavioural problems simply because they cannot hear properly.
How many times have we seen a diagnosis of dementia on a discharge summery yet there are no tests to substantiate this diagnosis? They arrive to the nursing home, we do our assessments, pick up the fact that they can’t hear properly, get an audiologist visit, arrange for hearing aids and all of a sudden the resident is a different person.
It makes me angry to think that people like this physio are so quick to judge elderly people. They don’t take the time to stop and think that maybe there is something else causing this communication barrier other than dementia. Elderly people are misdiagnosed all too often and it is because people cannot be bothered to look at the whole picture. The rate of elderly people being diagnosed with depression is unbelievably high. GP’s start them on anti-depressants and then staff wonder why the medications aren’t working.
Did it ever occur to anyone that maybe the resident is not depressed?
Did the GP bother to check the resident’s ears?
Could it be that there is a wax build up in the ears? Or the resident requires hearing aids?
What has happened to the concept of holistic care and comprehensive assessments of our patients? Or is it that the elderly don’t deserve our time.
The statement of “I just don’t have the time” just doesn’t cut it, we are all pressed for time these days but if we just spend that little bit of time assessing the elderly properly then we will save time and money in the long run.
Have you experienced an incident like this?
Have you suffered the same frustrations where one of your patients has been misdiagnosed purely because someone was quick to assume or didn’t have the “time” to find out what really is going on?
Tell us your story, and maybe, just maybe, we might change the culture of medical/allied health staff dismissing the simpler things that make all the difference to our treasured elderly people.
Photo source (http://www.fotosearch.com/photos-images/hearing-aid.html)
Perfect description of misconceptions in health care. Often in ED, and on wards, I run into patients who are reported to be ‘confused’, yet they are either deaf, or Lebanese, or Chinese. So easy to label as deaf someone simply because they can’t understand us or hear us. In addition, the stress of being in hospital in the first place, ofetn makes them give an incorrect answer, as they are confused in that they don’t want to be there, and really aren’t interested in what you are saying to them. Their minds are churning over with the possibility that their independence is about to be taken away.
Shouldn’t this persons hearing problems been addressed before making hydrotherapy appointments. Surely some kind of documentation was sent with this man that indicated he had a hearing problem. What about an escort??if this person was from an aged care facility. Why wasn’t he speaking???Hearing impaired people in my experience do not usually lose the ability to speak.This story sounds a bit odd.
In ED it is understandable that hearing problems and non english speaking people are over looked as if in an emergency they may arrive with out hearing aides or family but once in the wards – surely family members should have turned up with explainations and if the family have not organised interpreters or organised a family member to stay with the patient surely the social worker at the hospital should have organised one so that simple questions could be understood. As Australians and Nurses it is not up to us to be able to speak other languages but something must be in place for when this occurs – for the hearing impaired there are basis picture cards to assist until hearing aides can be located from home if they have any hearing at all – yes we may look a bit silly doing communication this way but think of the patients self esteeme to be able to get their point across
As for clients going to hydrotherapy – if it is the first visit one would think they would send an escort or at least an information document – but lets face it the nurses were possibly so happy to get one client off their hands for a while they possibly overlooked the paper work – aged care nurses like the rest of us work notoriously under staffed. BIG THUMBS up though for organising the hydrotherapy in the first place.It is easy to forget just because you can understand someone and know what they are capable of that other people may not know the same things. Easily over looked in the scheme of things
When I was organising the appointment we had discussed an escort, and both sides decided that an escort was not needed. This man is of sound mind, DVA was sending a car for him so the DVA car driver would wheel him in the facility and there would be someone on the otherside to recieve him and help him get changed etc. The was no need for an interpreter nor someone to speak for him, he is quite capable of speaking for himself and answering questions. As for why he couldnt hear? well that we don’t know he was wearing both of his hearing aids that afternoon. Perhaps the battery had gone flat or the hearing aids wern’t in properly who knows.