ANDREW MILLER: Medical labels can change the way some elderly are treated

Last week, on a sunny, rainy, windy morning, Mum and I rugged up for an outdoor coffee at a boomer cafe.

There were lots of overflowing superannuation accounts pouncing on complimentary newspapers, and loudly discussing a recent trip to Spain — not that there’s anything wrong with that.

“We had to have lunch at three in the afternoon!”

They earned it, no doubt, but they may be the last generation that can pay off a house on one income while supporting their offspring.

The cost-of-living maths is no longer mathing, as the kids would say.

“We were supposed to go to Barcelona, but by then I was sick of them, so we made some excuse...”

Mum rubbed her hands together. “Ooh, trouble in paradise, hee hee!” she whispered too loudly.

Heading out is not as onerous as it would have been a few months ago, as Mum is no longer wheelchair dependent. Her rehabilitation from the hip fracture proceeds apace, in part because she has mostly forgotten the injury now.

Her carers are excellent — no thanks to any mandatory online modules, but because they care. They are not faking their affection as they chide and cajole her into moving again — into being part of the whole. You can see they were brought up this way — it can be taught.

“Come on, Mama, let’s go,” they say.

She does not remember having a sore leg, or de-conditioned muscles, so when it comes time to rise from her chair and cover the ground, she sees no reason why not.

And off she goes, flourishing a light aluminium walking-frame in front of her, half walking aid, half weapon.

Cognitive decline is complicated; it is perhaps a library, where some books are progressively stored on the wrong shelves.

The functional severity of the condition depends on how many books have been misplaced, and also which ones — reference or fiction. Some memories can be found easily, others after a bit of searching — which takes time. Patience is not abundant in the modern world.

As the reliability of recall declines, confidence can suffer, but the person remains. On that we must stand. If any of us can be dehumanised, everything is up for grabs.

Not being “who we once were” does not disqualify us from society. It is not the privilege of anyone to label people as worthy or unworthy. Particularly when we live in a world where so many can still fly to Bali, Byron or Barcelona.

The Government’s well-meaning, expensive and fraught attempt to implement a unified electronic medical record — My Health Record — is ironically also affected by data reliability issues.

If someone wrote a differential diagnosis of Alzheimer’s disease, cognitive impairment, or dementia in my record, it would be very hard to have that label amended — whether or not it was correct. It would often be read without nuance — one caricature fits all.

Such broadbrush labels colour the lens through which real people are treated. They might even disqualify them from some types of care.

Geriatricians, GPs and many others work hard to optimise quality of life, whatever the labels, but there are some who become dismissive of anyone who lives on the spectrum of misplaced books. We see it in the justification of scandalously low vaccine booster rates for COVID-19.

“Well, she’s in her 70s ... 80s ... 90s...” is no excuse for mediocre services; for not trying to care. No excuse for the weeping sores that are ambulance ramps.

All people are worthy of our best efforts, even if the goals of care are not about prolongation of life, but comfort and reassurance. A bed in a room — not a corridor — and a hand to hold are rights, not privileges.

We enjoyed our coffee. I asked Mum if she might want to come back to overhear more innocent gossip next week.

“No reason why not,” she said.