Navigating Care Decisions for Elderly Patients with Gastrointestinal Issues

Q: Navigating Care Decisions for Elderly Patients with Gastrointestinal Issues

To MustLee： Honestly, as a doctor with many years of experience, I can say that in cases similar to your grandmother's, there are numerous human factors involved behind modern medical practices. <br>No one has the right to force a patient to undergo treatment. <br>When facing you

Hello, doctor. I would like to ask for your advice?

Hello Doctor, my grandmother has generally been in good health, but due to her age (currently in her 80s), she can only consume liquid foods (milk and carrot puree).
She often expresses feelings of hopelessness, saying things like she can't eat anything and questioning the meaning of life, which deeply concerns our family.
Over time, she has started to isolate herself from others and rarely goes out, let alone visit a doctor or undergo health check-ups.
Although the family has tried to persuade her, she remains unwilling, and we have to respect her wishes.
In the past year, she has begun to experience periodic abdominal pain, which has become more frequent.
Initially, she would buy over-the-counter pain relief, but eventually, those medications became ineffective, and we had to somewhat forcefully take her to see a doctor (which was very difficult for us).
After undergoing ultrasound and colonoscopy at Hsinchu Mackay Memorial Hospital, it was discovered that there are tumors in her intestines, and there seem to be signs of metastasis to other organs.
I am not clear on the details, as the adults advised me not to inquire too much (but I assume the family is struggling).
The recommendations from Hsinchu Mackay Memorial Hospital are:
1.
Surgical removal of the tumor, but my grandmother's health condition may not be suitable for this, so it is not highly recommended.
2.
Creating a stoma near her abdomen to allow for the passage of stool and gas, which could alleviate the pain and discomfort caused by bloating.
The suggestion from Taipei Veterans General Hospital was that they could not provide recommendations based solely on the reports from Hsinchu Mackay Memorial Hospital; she must visit the hospital in person, but my grandmother is unwilling to do so.
She is also reluctant to go to other hospitals (I can understand her desire to avoid further examinations).
Currently, the family can only choose to take her to the emergency room for pain relief when she is in pain, but it seems to have limited effectiveness.
Every time I visit her, she is always holding her stomach and wearing a pained expression, growing more frail day by day, which truly saddens me and leaves me unsure of what to do.
I once heard the thoughts of the elders in the family, who feel that since Grandma has lived a long life, making her happy for even one more day is worthwhile...
However, seeing Grandma still adhere to the medications prescribed by the doctor and follow dietary recommendations (now liquid food made from spinach and small fish), and even being able to go out for walks every day, even during the cold wave around the New Year, makes me feel bittersweet.
Grandma has not given up; how can we hastily make decisions for her?
I wonder if the doctor has any relevant suggestions regarding this situation:
1.
Should we force her to accept treatment or maintain the current situation?
2.
Are there any other related medical resources available?
3.
Any other advice?
Thank you for your patience in reading this.
Thank you.

mustlee, 20~29 year old female. Ask Date: 2008/03/11

Dr. Zhang Siyuan reply Gastroenterology and Hepatology

To MustLee: Honestly, as a doctor with many years of experience, I can say that in cases similar to your grandmother's, there are numerous human factors involved behind modern medical practices.
No one has the right to force a patient to undergo treatment.
When facing your grandmother—a senior patient who may have colon cancer with metastasis—not only does the patient endure the suffering of the disease, but the family also bears the pressure of making difficult choices and the burden of responsibility.
Furthermore, what is termed "forced treatment" in medicine is not without risks; encountering complications can lead to permanent regret.
Therefore, whatever choice your family makes is valid, as you all love your grandmother! Dr.
Chang, Gastroenterology, Lesheng Nursing Home.

Reply Date: 2008/03/11

More Info

Navigating care decisions for elderly patients, especially those with complex gastrointestinal issues, can be incredibly challenging for both the patient and their family. In your grandmother's case, it appears that she is facing significant health challenges, including the discovery of a tumor in her gastrointestinal tract, which may have metastasized. This situation is compounded by her age and her reluctance to undergo further medical interventions.

Firstly, it is essential to recognize that elderly patients often have unique needs and preferences when it comes to their healthcare. Many elderly individuals may prioritize quality of life over aggressive treatments, especially if they perceive those treatments as burdensome or painful. In your grandmother's case, her desire to avoid further medical procedures is understandable, given her previous experiences and her current health status.

1. Respecting Patient Autonomy: It is crucial to respect your grandmother's autonomy and her wishes regarding her treatment. While it is natural for family members to want to intervene and seek aggressive treatment options, it is equally important to consider her perspective. Engaging in open and honest discussions with her about her feelings, fears, and desires can help you understand her viewpoint better. This dialogue can also help her feel more supported and less isolated in her decision-making process.

2. Palliative Care Options: Given her condition and the potential for significant discomfort, exploring palliative care options may be beneficial. Palliative care focuses on providing relief from symptoms and improving the quality of life for patients with serious illnesses. This approach does not necessarily mean giving up on treatment; rather, it aims to manage pain and other distressing symptoms effectively. A palliative care team can work with your grandmother to develop a care plan that aligns with her goals and preferences, providing support for both her physical and emotional needs.

3. Managing Pain and Symptoms: Since your grandmother is experiencing periodic abdominal pain, it is essential to ensure that she has access to effective pain management strategies. This may involve adjusting her current medications or exploring alternative therapies that can help alleviate her discomfort. Regular follow-ups with her healthcare provider can help monitor her symptoms and make necessary adjustments to her treatment plan.

4. Supportive Resources: There are various resources available for families navigating similar situations. Support groups for caregivers and families of elderly patients can provide emotional support and practical advice. Additionally, consulting with a geriatrician or a specialist in elderly care can offer insights into managing her condition and improving her quality of life.

5. Making Informed Decisions: If your grandmother is open to it, consider seeking a second opinion from another specialist who may offer different perspectives on her treatment options. This can empower her to make informed decisions about her care. However, it is crucial to approach this delicately, ensuring that she feels comfortable and not pressured.

6. Quality of Life Considerations: Ultimately, the goal should be to enhance your grandmother's quality of life. This may involve balancing her medical needs with her personal preferences. Encouraging her to engage in activities she enjoys, even if they are limited, can help improve her overall well-being.
In conclusion, navigating care decisions for elderly patients with gastrointestinal issues requires a compassionate and patient-centered approach. By respecting your grandmother's wishes, exploring palliative care options, managing her symptoms effectively, and providing supportive resources, you can help ensure that she receives the care that aligns with her values and enhances her quality of life. It is a difficult journey, but with open communication and a focus on her well-being, you can make a meaningful difference in her care experience.

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