Day 329 of 365 - The Final Act
It should come as no surprise, that the final section of the Elderhood book by Louise Aronson is about end of life care and death.
How we will approach death is an individual process, based on many factors. In the last century, with all the advances in medicine due to new applications of science, death became very medically oriented. There has been a tendency to keep offering treatments or surgeries to fix acute problems until those are no longer feasible. One hundred years ago, most people died in their homes. In the past fifty years, most people have died in hospitals. It's only in recent years that the pendulum seems to be swinging back to home based end of life care or at least care in a hospice setting.
There is no doubt that we will all become more frail and infirm as we age. Interpretations of quality of life as our physical abilities decline is variable from person to person, and family to family. However, most of us would consider that our ability to function, engage with others in relationships and achieve a reasonable level of comfort, physically and mentally are important factors.
We can't really predict what we will be willing to tolerate, until we are in a position to face such a decision. Surveys of healthy people usually report they would rather not have medical intervention to prolong low quality of life. (My hand is raised on that one.) Dying people often say they would accept any interventions to prolong their life. We all have to reach our own tipping point.
As we move into our aged years, our decline is mostly gradual. 'There's a disconnect between the reality of old age and our beliefs about it - at least for the young-old'. For example, as an almost 65 year old, I have my share of aches and pains, insomnia, fatigue, days of low energy and mood, times when I can't remember names or find words, but I'm not yet ready to die, on most days. I do admit though, there are times when I think I'm done here, to be honest. I share that, because I think it's very likely others feel the same.
If we were describing the same symptoms of decline about someone twenty or twenty five years my senior would I assess their quality of life differently? I probably would. We think of 'old' as all those things, and more.
Unfortunately, with the medical science model of health care which is so widely embraced, many frail and chronically ill elders experience undue suffering in their last stage of life, when treatments which only give a short term relief but worsen chronic conditions are continued. They may no longer be in a position to give directives about their care when senescence has worn them out in so many ways. Family members are placed in a position where their own needs may supersede those of their ailing relative. Or worse, as conveyed to me as a personal story of a friend, whose mother in a nursing home suffering from late stage dementia, was force fed after refusing food for days because the nurse in charge of the unit felt it was her ethical responsibility to do so. Her life was unnecessarily prolonged.
A positive trend is that in recent years palliative care is being embraced more for the elderly as a way to manage suffering when the balance of concerns has tipped. Someone still needs to make the decision and direct it happening, but it seems a more caring way to minister to the needs of someone at the end of their life. Also, when the medical community has the courage to acknowledge and tell families that their patient is dying, the excessive interventions can more easily be discouraged.
For most of us, dying is a scary prospect, if we've never faced it before. When the time comes, may we receive the tender and caring consideration that we deserve.
How we will approach death is an individual process, based on many factors. In the last century, with all the advances in medicine due to new applications of science, death became very medically oriented. There has been a tendency to keep offering treatments or surgeries to fix acute problems until those are no longer feasible. One hundred years ago, most people died in their homes. In the past fifty years, most people have died in hospitals. It's only in recent years that the pendulum seems to be swinging back to home based end of life care or at least care in a hospice setting.
There is no doubt that we will all become more frail and infirm as we age. Interpretations of quality of life as our physical abilities decline is variable from person to person, and family to family. However, most of us would consider that our ability to function, engage with others in relationships and achieve a reasonable level of comfort, physically and mentally are important factors.
We can't really predict what we will be willing to tolerate, until we are in a position to face such a decision. Surveys of healthy people usually report they would rather not have medical intervention to prolong low quality of life. (My hand is raised on that one.) Dying people often say they would accept any interventions to prolong their life. We all have to reach our own tipping point.
As we move into our aged years, our decline is mostly gradual. 'There's a disconnect between the reality of old age and our beliefs about it - at least for the young-old'. For example, as an almost 65 year old, I have my share of aches and pains, insomnia, fatigue, days of low energy and mood, times when I can't remember names or find words, but I'm not yet ready to die, on most days. I do admit though, there are times when I think I'm done here, to be honest. I share that, because I think it's very likely others feel the same.
If we were describing the same symptoms of decline about someone twenty or twenty five years my senior would I assess their quality of life differently? I probably would. We think of 'old' as all those things, and more.
Unfortunately, with the medical science model of health care which is so widely embraced, many frail and chronically ill elders experience undue suffering in their last stage of life, when treatments which only give a short term relief but worsen chronic conditions are continued. They may no longer be in a position to give directives about their care when senescence has worn them out in so many ways. Family members are placed in a position where their own needs may supersede those of their ailing relative. Or worse, as conveyed to me as a personal story of a friend, whose mother in a nursing home suffering from late stage dementia, was force fed after refusing food for days because the nurse in charge of the unit felt it was her ethical responsibility to do so. Her life was unnecessarily prolonged.
A positive trend is that in recent years palliative care is being embraced more for the elderly as a way to manage suffering when the balance of concerns has tipped. Someone still needs to make the decision and direct it happening, but it seems a more caring way to minister to the needs of someone at the end of their life. Also, when the medical community has the courage to acknowledge and tell families that their patient is dying, the excessive interventions can more easily be discouraged.
For most of us, dying is a scary prospect, if we've never faced it before. When the time comes, may we receive the tender and caring consideration that we deserve.
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