Dr. Cranquis' Mumbled Gripes

First, I would like to give you a little background:

My grandfather was diagnosed with Chronic Obstructive Pulmonary Disease about 5 years ago. He is a very bad patient. His doctor told him that he can never recover from the disease. (My grandfather also suffers from selective hearing and thus did not hear the part about slowing the progress by taking medications.) He refuses to take medications (Advair, specifically), fearing that he’ll end up taking oxygen treatments. He will be 74 in March and up until the time he was diagnosed he stayed active working in his garden and keeping his farm up. Since that time he rarely works outside and spends most of his time watching the News. I have tried to get him to go for walks with me but he says that he can’t, that he “doesn’t have the wind”.  My question is this: do you know of any way I can convince (encourage) him to either take the Advair or to be more active? How do you typically deal with “bad patients”?  

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It sounds like Grandpa has a few factors working against him right now:

1. His “selective hearing” — I have seen many patients like this. It’s almost as if they’re incapable of actually listening to what’s being said by the doctor. Lucky for your grandpa, he has YOU: someone who is aware of the nuances that he has overlooked. He needs you to translate and re-emphasize the doctor’s instructions in ways that he may actually “hear”. (Such as, “Taking Advair doesn’t cause you to need oxygen later, Grandpa — it’s a way of delaying the need for oxygen as long as possible!”) (Oh, and — what if he has ACTUAL hearing problems? Has Grandpa had a hearing evaluation?)
2. He’s not ready for change. As I’ve referred to in prior posts about “the stages of change”, change is a process. Sounds like Grandpa is aware that things need to change, but also feels hopeless about the outcome — so he’s decided to just play the “martyr” and not try. If you can stay on his “side” in the process, being encouraging without nagging, being educational without lecturing, he may eventually decide to try some of the options available to him. (And you yourself may need to go through a similar process of change, accepting that perhaps Grandpa isn’t ready to totally change, but that he DOES need your unconditional love if he is to have any hope to changing someday.)
3. He’s depressed! Soon as he got the diagnosis, he quit doing things that he used to do before. He’s lost interest in pleasant hobbies. He’s assuming the worst. He’s not willing to try (relatively) simple interventions to maintain his current state of being. He over-magnifies his symptoms, claiming to be unable to go on walks when he used to be able to do that before. I think Grandpa might benefit from some therapy/treatment focused on his depression; can you help this discussion happen with his doctor or a counselor, perhaps?
4. He’s deconditioned. 5 years of sitting and watching TV would make it hard for ANYONE to suddenly start going for walks again, even if you didn’t have COPD! So perhaps you could find ways to get Grandpa doing tiny bits of exercise first? Perhaps a pair of 2-pound hand-weights to use during commercials? A “seated bike pedaling” device to use from his recliner? And maybe he could use an exercise buddy/motivational coach for short work-outs in the home? Either you, or another family member, or a friend who also needs to exercise?

The approach to “bad” “non-compliant” “stubborn” patients always has to be individualized, because each one has their own reasons for their behavior. But common “obstructing” factors among elderly patients include those items above. I hope those ideas give you some more ideas of your own! 

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