« The Dual Agenda: July 13, 2016 Issue

Eldercare Voices

Christine (Himes) Fordyce, M.D.

Hilde’s Story: Overcoming a Setback Through Person-Centered Care

As a family doctor and geriatrician, I’ve had the privilege of developing hundreds of close, long-term relationships with patients. Each one has shaped my thinking about the key elements of health care reform needed to improve overall quality of life for all of us, if we are lucky enough to be long-lived. I’d like to share one such story.

Mrs. Hilde R. is an 89-year-old retired high school teacher. She walks two miles a day and has been a very active hospice volunteer since her husband passed away last year. She had taken on increasing caregiver responsibilities as he struggled with Alzheimer’s disease over the course of several years.

She does a great job of controlling her diabetes and blood pressure. Everyone remarks how well she is doing at 89; her family can't imagine her in any other role than “mom,” taking care of kids and grandkids alike. Hilde had been thoughtful about her end-of-life care choices, which she discussed with me at length and made part of her medical record. According to Hilde, “my kids don't want to talk about me dying,” which has been quite worrisome for her. She is not certain all four of them will follow her advance directives without a family fight, especially if she develops dementia and is unable to advocate for herself.

One night, while rushing to the bathroom, she fell and broke her right wrist which required surgical repair and casting for three months. Since it was so difficult to manage at home alone after the surgery, she went to stay with her oldest daughter, about 30 minutes away, effectively removing her from all her usual activities and friends. She became afraid of falling and stopped walking. Some family members thought she should move into a retirement community nearby.

Hilde became increasingly depressed and isolated. She felt like she was a burden on her family for the first time in her life. At her follow-up with me in my office, the dramatic change was alarming. She had transformed from an independent, “amazing” woman, into one with depression, cognitive changes and frailty.

The longer she stayed with her daughter, the more depressed she became. She began to worry about her memory, and became very concerned she was developing Alzheimer's disease. She did not want to be a further burden to her kids but knew her financial resources had been depleted by her husband's long illness. What would be left for her?

As her wrist healed, depression, memory concerns and lack of physical and social activity became the issues threatening her quality of life. Our team social worker followed up with regular counseling for depression and helped her make connections to community organizations that offered services that could allow her to return to her home safely, if she desired. Once Hilde saw that returning to her own home might still be a choice for her, the depression and memory problems largely resolved. 

Within two months, Hilde had put enough supports in place to return to her own home safely; within three months, she was able to return to all her usual activities. She became more confident in her ability to remain in control through her remaining years and began sharing her story of the role health care and community supports had played for her with older adults at her church and with other groups. She returned to her hospice work with renewed vigor.

Hilde’s story illustrates the complex care needs of an aging population. Traditional health care settings cannot meet these needs alone. It requires consumers, caregivers, providers, health systems and community-based organizations each contributing to the overall health of their communities in an interdependent and dynamic partnership. And it is that partnership that needs to inform and be supported by health care policy makers and our community leaders. 

Dr. Christine (Himes) Fordyce has been a primary care physician and geriatrician at Group Health in Seattle since 1988. She has served in numerous leadership roles focused on the care of older adults at Group Health including Director of Geriatrics and Long-Term Care, Medicare Medical Director and Healthy Aging Medical Director, leading the work of integrating care systems for older adults. Most recently this work has focused on the Primary Care Medical Home (PCMH) model for both the Group Health Physicians group practice and the network Accountable Care Organizations. 

A passionate national, community and medical education speaker and writer on all aspects of healthy aging, Dr. Fordyce enjoys mentoring the next generation of leaders across the multidisciplinary team including outpatient primary and specialty, hospital, long-term and community-based health care providers. She serves nationally as a senior mentor for the John A. Hartford Foundation and The Atlantic Philanthropies-supported Practice Change Leaders initiative, is a member of the PCMH Network and as a Center for Consumer Engagement in Health Innovation Geriatric Provider Advocate. 

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