As a veterinarian, I took an oath to “use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare.” In veterinary medicine, welfare and health go hand in hand. This is the basis of our standard of care for any companion, livestock or working animal.
The dictionary defines welfare is “the health, happiness and fortunes of a person or group.” The combination of the level of physical, emotional and environment determine welfare. To focus only on physical or emotional health does not provide good welfare. Both conditions must be considered to deliver compassionate, balanced care.
As a veterinarian, I must consider the ability for an animal to function through reduction of pain and express natural behaviors as I treated any condition. Clients would be clear they did not want their pets to be in pain or endure extended treatment or diagnostic exams unless this process relieved pain and distress.
No matter the age of the animal, there was always a balance of welfare, diagnostics and treatment for health. As the pet aged, there would be a stronger focus on welfare. Often, diagnostics and treatment would be declined if it might create stress or discomfort. As I matured as a veterinarian, I learned the importance of embracing this approach, as it emphasized the quality of life for the animal over the completeness of care.
I was the responsible adult child for my father before his death in 2014. Fortunately, he did not have chronic health problems, but he was having aging troubles.
When he would have flare-ups with his digestive tract or urinary issues, it was rare that a doctor would discuss how to prevent this from happening or manage it early. Often, I would press for a check on B-vitamin levels, or a urine recheck.
If a bigger problem happened, such as a fall, it was rare that anyone asked about what the furniture arrangement was, or how he used his walker to avoid a future fall. Rarely did any medical provider advise for leg exercises or instruct him on how to use the arms of the chair and plant his feet to get up when his legs were tired. Again, I had to ask about physical therapy before his hip fracture.
My veterinary clients would express their concern that their pet was not able to do what they loved — like get up on the bed or chase a ball. No one asked my father what he loved to do and if he could do it. I never heard a medical provider say “John, are you able to sit comfortably and paint as you love to do?”
Painting, photography and getting to the lounge areas at Jarman Center Senior Living to play Scrabble and bingo brought my dad joy. But no one asked about this or seemed to think about whether they could be sure Dad could do it. The staff at Jarman would think of some things, but the medical community did not.
Recently, I have become a liaison to the adult children of the Jarman Center residents. I am seeing a lot of elders receiving advanced medical care, but how they are functioning is rarely considered. Many problems are addressed as individual problems, not incorporating all the other aspects of health and life to manage in the face of these problems.
Lots of advanced care, such as vascular surgery, is given to immediately address problems, but the preceding preventative or managed care was not present. I myself have experienced medical providers challenging me as uncaring when I rejected surgery options for my dad, echoing his decision.
It is rare that our elders are considered for what makes them happy. If an adult child refuses a surgery or invasive testing after considering the impact of risk or stress, they are often challenged by the medical community.
We can help our elders receive health care that puts comfort first. At your elderly parent’s next doctor visit, ask exactly what they should eat, how many grams of fiber or glasses of water to drink each day to be as strong as possible. Ask where you can buy a heated mattress pad to decrease back pain, or shoes that are easy to get on and off swollen feet, and easy-to-use compression wraps to help with circulation problems. Ask how often urine should be checked to catch an infection before it causes dementia, dehydration or other problems.
In short, treat your elder like a beloved old dog that you bought a heated bed for, give medications to decrease pain and provide comfort while watching for side effects, and set up runners to prevent falls. This is good welfare. And when life gets difficult, accept that we cannot cure these problems, but we help each day be the best that it can be.