If you've ever talked to an aging parent or friend about their health care and heard comments such as I can live with it, it's not that bad, it ain't broke don't fix it, or all I do is go to doctor appointments, it can be frustrating and even heartbreaking.
Many adult children can compare stories of how their mom won't have her knee replacement surgery or their dad won't get hearing aids. But Dr. Martin Gorbien, director of Geriatrics and Palliative Medicine at Rush University Medical Center, says the issue is not so much about aging, but about their health care becoming a topic of family conversation.
Gorbien says putting off care related to health is a component related to any age, but the focus narrows as parents age.
"Health becomes more public in the family," he says.
There may not be that many differences in how they care for themselves now and how they were caring for themselves when they were younger, Gorbien says.
What's the hold up?
Fitting hearing aids for 35 years Susan Rogan, owner of Susan Rogan Hearing in La Grange Park and Westmont and a doctor of audiology, says how to get anyone to listen to reason is the golden question.
"No one ever comes into my office and requests hearing aids," she says.
With 1 in 10 adults with hearing impairment only 1 percent will choose to correct their hearing, Rogan says.
Rogan says it is typically seven years from the time concerns about hearing loss are mentioned to the time someone will have their hearing checked.
John Ellis, 62, says for about two years his wife and children were always on his case saying 'dad, you can't hear anything.'
Ellis says at first he didn't want to admit his hearing was getting worse.
"A lot of it was pride," he admits.
Diagnosing a problem and finding a solution seems like an obvious equation, but for most it isn't that simple.
Gorbien says people of all ages delay health care but for different reasons. Some are too busy and can't take time off work or are busy raising their children, but it's much more private when you are 50 years old.
"It's more common to be involved in someone's health care as they age," he says.
Gorbien says among reasons for not seeking health care is fear of the unknown or what a doctor might find.
In cases where there is memory or hearing loss, Gorbien says the person may not even be aware of problems that are noticeable to concerned observers.
He says older adults may also be getting information from sources that aren't reliable.
"We still run into a lot of suspicion that younger people may not have," he says. "They've grown up in a different medical world."
For example, older adults may be unaware of advancements in anesthetic or the number of surgeries that are now minimally invasive.
Gorbien says for some, cost may be a factor and it may be growing with more health care cuts.
"There's always been incredible gaps in services for the elderly," he says.
Rogan says cost can be a factor because hearing aids are not covered by Medicare or most insurance plans, but she believes it's more an issue of vanity.
"With 99.9 percent it has nothing to do with cost. I could give them away and people wouldn't take them," she says.
What can you do?
Gorbien says explaining that if your dad won't take his medicine and take care of himself he may have a stroke or heart attack isn't always helpful.
"The intellectual approach often doesn't work," he says.
Instead Gorbien asks patients what their goals are and focuses on safety. Once they can state their goal whether that's continuing to live independently or living with less pain it is easier to get to what can be done to help make that happen. This makes it less about judgment and more about achieving a goal.
Gorbien recalls a patient who needed elective surgery for a joint replacement and for 15 years refused until age 89 when she agreed to have the surgery done.
"She wanted to dance at her 90th birthday party," he says. "She wanted to meet her goal. That's what made her decide to go ahead."
That said, despite Gorbien's expertise and notoriety in his field, he says his own parents, who are in their 80s, have little interest in listening to what he has to say regarding their health.
"I am completely unable to help them. It's an ironic situation," he says.
Even after a doctor conducts tests or tells a patient what is recommended, patients of sound mind can refuse treatment, Gorbien says.
"We nervously send people home into situations that we potentially know are unsafe," he says of when older adults refuse treatments, home care or supervision. "That happens all the time."