An elderly patient may be depressed. Is it appropriate for her eyecare provider to get involved?
This article originally appeared in the April 2015 edition of INVISION.
The town of Valley View, OR, was enjoying a beautiful spring afternoon. Valley View Eyecare’s waiting room was empty, except for one elderly woman slumped in a reception chair. “Good afternoon, Mrs. Abbott!” cheered Wendy, an optometric technician. The woman looked up timidly. “Please take my arm, we’re going to head in to see Dr. Shaw now,” Wendy said.
Wendy knew Mrs. Abbott well; she had been a teacher and was also a gifted oil painter. She’d been diagnosed with wet macular degeneration eight years ago; now 81 and widowed, she was losing her central vision, and Wendy had noticed her becoming increasingly withdrawn. Today, Mrs. Abbott did not smell clean and her clothes were shabby.
As Mrs. Abbott struggled through her Amsler Grid test, a man entered. “Ma, didn’t you tell them to wait for me?” he barked.
“I’m Ed,” he said. The man reeked of cigarettes and needed a haircut. “I take care of my mom. She can’t see so well, and when I got divorced last year I figured I’d move home so she’d have someone.”
“It must be nice to have someone in the house with you now!” Wendy said to Mrs. Abbott. The frail woman smiled but avoided eye contact.
Wendy went to let Dr. Shaw know his patient was ready. “Her son is here,” she said with a tone of warning. Dr. Shaw raised an eyebrow and took Mrs. Abbott’s chart from Wendy. “OK, thank you Wendy,” he said.
After the exam, Dr. Shaw spoke to both Mrs. Abbott and her son. “As you know, the macular degeneration is worsening your eyesight. I’ve been talking with your ophthalmologist, and we would like to get you a low vision evaluation. You might benefit from task-specific tools to augment your remaining vision,” he said. “That means you can start painting again.”
Mrs. Abbott’s face lit up, then she looked at her son. “Does insurance cover that?” he asked.
“They will likely cover the exam, but the equipment will probably be out of pocket,” said Dr. Shaw. “The low-vision aids are typically a few hundred dollars, but it would drastically improve your mother’s quality of life.”
Ed whistled. “Maybe next year. Ma, I’ll read to you,” Ed chuckled. He looked at Dr. Shaw. “Anything else?”
Dr. Shaw turned to Mrs. Abbott. “Is this something you would be interested in?”
Ed stood up and spoke to his mother. “You don’t have that kind of money, Ma. Can’t we just use the grocery store glasses, doc?”
“No, I’m afraid your mother requires something more complex than that,” replied Dr. Shaw, not looking at Ed. “Mrs. Abbott?”
The elderly woman looked conflicted, then replied, “My son manages my finances now, I’m not really sure ...” and trailed off.
Dr. Shaw helped Mrs. Abbott up. “I hope you consider it,” he told her. “I know how isolating it can be to lose your vision.”
Later, Wendy approached Dr. Shaw. “Mrs. Abbott is depressed. I know that painting would really help. She needs those low vision aids!”
Dr. Shaw shook his head. “We don’t know her financial state. I’d be willing to work out a payment plan if she were prescribed a device, but beyond that, it’s really up to her.”
Wendy crossed her arms. “The thing is, I don’t think it is up to her. Her son isn’t caring for her. Can we report this to someone?”
“Who?” asked Dr. Shaw. “She didn’t tell me she was abused or scared. What would I report? That her son is keeping her from buying a low-vision aid?”
“I don’t know,” sighed Wendy. “I just feel like she needs help.”
T H E B I G Q U E S T I O N S
1. What would you have done differently in this scenario if you were Dr. Shaw?
2. Is it appropriate to call an agency if the patient isn’t making any complaints?
3. What are the pros and cons of getting involved in Mrs. Abbott’s situation?
R E A L D E A L R E S P O N S E S
Dr. G.R. M.
Lake Charles, LA
Ballston Lake, NY