By Sally Foote
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 definition of welfare is “the health, happiness and fortunes of a person or group” (1) The combination of the level of physical, emotional and environment determine welfare. To focus only on physical health, or emotional health does not provide good welfare. Both conditions must be considered to deliver compassionate care, balanced care.
As a veterinarian, I must consider the ability for an animal to function, through reduction of pain and, consider the ability to express natural behaviors as I treated any condition. Clients would be clear they did not want their pets to be in pain, endure extended treatment or diagnostics 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 diagnostic and treatment would be declined if it might create stress or discomfort. As I matured as a veterinarian, I learned the importance to embrace this approach as it emphasized the quality of life for this 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 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 a check on b vitamin level, or 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 how to use the arms on the chair, plant the feet to get up when one’s lags fatigue. Again, I had to ask about physical therapy before the hip fracture. My clients would express their concern that their pet was not able to do what they loved – like get up on the master bed or chase a ball. No one asked if my father what he loved to do and if he could do it. I never heard a medical provider say “John, are your able to sit comfortably and paint as you love to do?” Painting, photography, and getting to the lounge areas at Jarman to play scrabble and Bingo brought my dad joy. But no one asked about this or seemed to think about this to be sure dad could do it. The staff at Jarman would think of somethings 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 is given such as vascular surgery, to immediately address problems, but the preceding preventative or managed care was not present. I have experienced myself medical providers challenging me to be uncaring when I rejected surgery options for my dad, echoing what my father’s decision. It is rare that our elders are considered for what makes them happy. If an adult child refuses a surgery or invasive testing considering the impact of risk or stress going through these things, they are often challenged by the medical community.
We can help our elders receive health care that puts comfort care first. At the next doctor visit, ask exactly what your parent 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 purchase 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 the 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 purchased a heated bed for, give the 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.