My Grandma and her self-management (Twin Blog with QISMET)

This is part of a twin blog with QISMET. Read the other part of this blog here.

We had my grandmother staying with us for Christmas, and I was lucky enough to help her celebrate her 92nd birthday just a few days later. She is very remarkable woman. She has brought up a family on a different continent, supported her local community, had a range of different jobs and has as my mother says ‘never lost her sense of curiosity and interest in the world around her”. Although since she now has arthritis, high blood pressure, eye sight problems, that world around her has shrunk somewhat.
Whenever I try to think about different people accessing the NHS as patients, I often think of her – how would Grandma cope or what would she make of this fangled new NHS initiative? I tend to come to the conclusion that we want very different things from our NHS and behave very differently as patients – call it the generation gap.

But spending time with her over Christmas after a few conversations in 2014 about self-management in older generations made me realize that we were quite similar after all as patients – we are both active self-managers!


So what did I notice my Grandma doing that was active self-management (even though she would never call it that!)?

Watching TV or sitting quietly listening to Carols from Kings, she would quietly be doing her foot and wrist exercises, which mean rotating them each way and lifting them up and down. Although the creaking sounds that accompany this have increased, it is clear that like me, she gets a bit of psychological satisfaction of knowing she is doing something to help herself. I’m sure if we hadn’t have been watching the Queen on iPlayer at 8pm after dinner and a glass of wine, she would have be doing them then!

Knowing a little of my professional interests, she takes great delight in sharing with me her routine for her morning and evening Dossett boxes of various tablets. Interestingly, she struggles with swallowing now, and a persistent cough, which make swallowing tablets hard so she makes sure that she has water to hand and takes her time. All good little things that help (although what would really help would be less tablets… or smaller ones….). There is one tablet that causes slightly more trouble, “the pesky ones” (the diuretics) and she has become confident in delaying them by an hour or two depending on car journeys and trips out planned, as she finds having to go to the toilet a real pain. I have no idea about the pharmacological impacts of this, but to me, it sounds like for her the importance of lower blood pressure isn’t as important as not having to worry about finding a loo in time when out and about. I wonder if that is a question her (lovely) GP has ever asked?

She knows intrinsically that keeping up with going to church and social clubs in her village is part of her general well-being, and bar cold, rain or wind, she makes every effort to get to these. She has previously commented on how much better (albeit tired) she feels in herself after these afternoons.

She does set herself goals, in a informal way. She uses a wheelchair when out and about, but always insists when with family or close younger friends, that she can walk a little, and pushes herself to walk a little each time, up to that bench and knows her limits when its time to get back in the chair. These things are important to her!

Grandma monitors any changes in her health in a non-obsessive but helpful way, taking care of her thin skin on her legs and feet that is vulnerable to ulcers. And she has mastered one of things I find most difficult and many others I work with – asking for help! Almost too much sometimes!

She has problem-solved her way past many obstacles, and adapted with a range of physical kit, like a wheely trolly and stair lift, and assistance with tasks like showering and shopping. These have meant that she is still feels independent, even though in practice, she is very dependent on help. I get the impression that because they are conscious decisions she has made herself rather than imposed on her by others, she doesn’t feel she has lost out through them.

None of the above have removed her pain, increased her mobility, eyesight or hearing, but she has taken care to look after herself mentally. She has a positivity that astounds me, and a mental resilience to keep positive and appreciate what she does have (and has had).

She also has an appreciation for her role in the NHS as a whole system, telling me at length of how she is signing up to be a member of the local Foundation trust, because “its important”. She also had a brilliant experience at her local eye department and told me that she wanted to make sure this good feedback got back to the service. I mentioned that I could tell them via the internet (Patient Opinion), and less than a fortnight later, a seven page letter arrived for me to type up and pop on Patient Opinion for her! She was truly committed to feedback! Now, regular readers of this blog and my followers on Twitter, will know how I think feedback is good, but just a start in a spectrum that includes co-production and co-design. She is aware of the rest of the spectrum, but feels that feedback is manageable for her.

It took me a little while to realize that my grandmother was self-managing, because she does all these things out of habit. She totally subscribes to the ‘doctor knows best’ school of thought, and is compliant as her frailty allows of all her treatments etc.  She doesn’t see her various health problems as long term conditions, even though they are – she just sees it as part of growing old and perhaps for other older people, the inevitability of that provokes a passive approach.

She is a role model for me in many ways, but I have recently been reflecting how much I admire the way she manages her health and wellbeing. 

This is part of a twin blog with QISMET. Read the other part of this blog here.