Why Ill Elders Fool Their Doctors and What to Do About It
Caregivers or children of elderly patients often experience the same frustrating phenomenon: the elderly person for whom they care who’s been complaining of pains, has been forgetful, short-tempered, confused, and showing troubling signs of serious diseases and comorbidities, seems suddenly and inexplicably fine upon arrival at the doctor’s office. Their pains are gone, their forgetfulness is erased, and they’re as sharp and charming as they were decades ago. It’s a far too common occurrence, and it’s highly frustrating: ultimately, the patient “fools” the doctor and none of their troubles or concerns are actually addressed. But why does it happen?
There are a handful of reasons why an elderly patient might want to fool their doctor into believing that they’re just fine. One is the loss of independence: if a doctor were to suspect that a patient is struggling with vision, memory, or general cognition, that person might lose their driver’s license, might need to stop working (if they still do), and could even risk losing the ability to live independently. For many it’s a terrifying thought, and one worth avoiding at all costs (even if that means more serious diseases and their symptoms go unaddressed).
It could also be somewhat inadvertent. Some elderly patients spend a lot of time and energy thinking about and prepping for time spent with their doctors: they know it’s an important occasion and they tend to linger on it. That build-up of energy can sometimes mean that a patient who’s otherwise dealing with early onset Alzheimer’s, dementia, or chronic pain might subconsciously “rise to the occasion” for the doctor’s appointment that they’ve been thinking about for so long. This is not an unusual occurrence, especially among those dealing with Alzheimer’s or dementia. Caregivers who see these patients on a regular basis often note that they put on their best performances when family, friends, or physicians are present, and they’re back to their usual selves (with usual symptoms) when the visitors are gone.
Finally, elderly patients might put on a performance for their doctors out of denial or even fear. To admit that a serious disease or comorbid condition is plaguing them is terrifying: anyone would want to avoid that situation if they could. So by pretending that nothing is wrong, an elderly patient may convince themselves (even for just a short while longer) that they really are fine. These performances aren’t just frustrating for the caregiver and for family, but ultimately for the patients as well. Necessary treatment gets pushed off and debilitating symptoms are allowed to fester. So, is there anything that can be done about the situation?
Fortunately, there is. Caregivers and family need to take an active role in ensuring that doctors are privy to the display. If you have documented medical power of attorney over your charge or loved one, call the doctor ahead of time: explain to them the symptoms you’re witnessing and that you worry about the patient being honest during their appointment. Or write the doctor a letter forewarning them of the potential for dishonesty. You can also keep a diary or record of the patient’s behaviors and symptoms over the course of several weeks prior to the appointment. This will serve as a handy piece of evidence during the appointment if the patient is less than truthful about their condition. Finally, make sure that the appointment itself is as fruitful as it can be. Be sure to ask questions and voice your opinion if you feel your loved one is not being sincere. Doctors are not unfamiliar with this charade put on by ill elders: they just need to be made aware of it when it is occurring.
And don’t be afraid to talk with the loving and talented staff at Main Line Adult Day Center about your concerns. We’re here to help make sure your loved one is getting the most out of their life. To that end, we can help prepare both you and your loved one for upcoming doctor visits and discuss the potential of possible “performances” with you.