Avoiding the Medical Rabbit Hole for an Aging Loved One

The “Medical Rabbit Hole” (and Why It Happens)

The medical rabbit hole is a situation I see often when dealing with the clients I come in contact with. It seems that loved ones are trying very hard to do the right thing for their elder loved one, but there are times when one thing leads to another, and then yet another. When this happens, the elder often does not benefit from going down all of these rabbit holes and, in fact, can sometimes be harmed by trying to do too much.

A Real-Life Example: When Preparation Becomes the Problem

Here is one example of a real-life situation that came up. Please understand that I’m not saying you should not pursue medical procedures, but rather to carefully consider the risk versus reward, what you will do with the findings of the procedure, and whether the elder will have a better quality of life by going through it.

This is the story of an 85-year-old woman we’ll call “Grace.”

Grace had impaired mobility, used a walker, and lived in Assisted Living. She went to a routine doctor’s appointment with her daughter, where the MD mentioned she was due for a colonoscopy. Wanting to follow the doctor’s advice, they scheduled the procedure.

Grace had several health conditions but overall was functioning fairly well in Assisted Living. As the colonoscopy date approached, she followed the instructions carefully. This included restricting her diet and drinking the solution that cleans out the digestive system.

That preparation requires many urgent trips to the bathroom. One night, while trying to move quickly to the toilet, Grace became lightheaded and fell.

She had left her call-button necklace on the nightstand and could not reach the pull cord in the bathroom. About an hour later a caregiver heard her yelling and came to help.

Grace was taken to the hospital, where doctors determined she had fractured her right humerus and had a head laceration requiring staples. Fortunately, there was no brain bleed.

However, the fracture dramatically affected her mobility. Because the humerus cannot easily be casted, she had to wear a sling and could no longer use her walker. She was placed in a wheelchair for several weeks while the arm healed.

When someone in their mid-80s stops walking for that long, muscle strength and coordination decline quickly. By the time her arm healed, walking had become much more difficult.

Her colonoscopy was postponed indefinitely because the preparation process was no longer practical while she was recovering from the injury.

This example doesn’t mean we should ignore routine medical advice. But it does highlight why it’s important to consider the full impact of a procedure, including the preparation and possible risks.

Situations like this are why it’s helpful to pause and ask an important question: what will this test actually change about the care plan?

The Hidden Costs (for the Elder and the Family)

As you might guess, Grace’s fall in the bathroom created a real-life burden not only for Grace, but for her daughter and her daughter’s family as well.

Grace now needed much more help each day. Her Assisted Living rates increased dramatically because she now required help with dressing, help with showers, and help with toileting.

Sometimes the process of chasing answers can create its own set of challenges.

The Filter Question: “What Will This Change?”

The goal of the colonoscopy was to ensure that Grace did not have any cancerous growths in her colon. If the colonoscopy found small growths, they could usually be removed during the procedure and sent for testing if they appeared suspicious.

But if cancer were found, what direction would Grace want to take?

Would she choose treatment? Would she undergo surgery, chemotherapy, or radiation?

All of these procedures can take quite a lot out of an 85-year-old person. It is worth considering whether any of these treatments would improve her quality of life.

With every situation that comes up, it is helpful to ask your doctor, yourself, and your loved one a few key questions:

• How will this procedure help us determine what future decisions to make?

• What happens if we pass on this procedure? What is the downside of doing nothing?

• How will this procedure improve daily life in the next 1–3 months?

A Simple Framework to Decide: When to Lean In vs. Back Off

When a new medical treatment or procedure is suggested, it can help to think about a few key factors.

• Ask yourself, your loved one, and the doctor:

• Will this treatment reduce pain?

• Will it improve mobility?

• Will it help with performing the basic Activities of Daily Living (ADLs) such as walking, eating, sleeping, toileting, or communicating?

Next, consider the burden of the procedure.

• How difficult will it be to travel to appointments?

• What type of preparation is required beforehand?

• What does the healing time look like?

• What follow-up care will be needed?

For example, will there be physical therapy or occupational therapy afterward? Where will those visits take place?

Lastly, consider the time horizon.

How soon will your loved one experience the benefit of the treatment or procedure?

A simple rule of thumb is this: if the burden is high and the expected benefit is small or far in the future, it may be reasonable to pause and think carefully about whether to proceed.

Choosing “Slow, Chronic, Best-Life” Care (Without Giving Up)

Most of us deal with some type of ache, pain, or discomfort in our daily lives, and we learn to adapt and adjust our lifestyles accordingly.

When thinking about medical procedures for older adults, it is important to weigh the pros and cons—the risks versus the rewards.

Remember that anytime anesthesia is involved, or even a small surgery with local anesthesia, there is some level of risk.

I do not want readers to think I am against procedures. There are certainly times when they are absolutely necessary.

For example, if your loved one falls and fractures a hip, it is generally essential to repair that hip. Life without a functioning hip would mean severe immobility. In that case, the potential reward of surgery is very high and the risk is relatively low.

But other procedures may require more thought.

For example, bunion surgery for someone in their late 80s might be a poor choice. Mobility will be very limited for several weeks, which means deconditioning can happen quickly in someone in their 80s. Even after the surgery, swelling and pain can last 6–12 weeks.

Someone in their 20s through 50s might recover quickly and return to normal activities. But someone in their 80s may never regain their previous level of activity.

The bottom line is this:

Is there a less invasive and safer option that may accomplish good results?

If the answer is yes, it may be best to start with the least invasive approach.