Mercury and his Caduceus
This is my second installment on the theme of successful elderhood and its obstacles.
In this post, I am revisiting the theme of “a good death.” I first wrote about this in 2013 and recounted my experience with my father’s death at his home in 2010. As I write this post, I am reminded that this theme is picking up more attention.
Perhaps I will start with the practical first – how does one, with her or his own planning or good fortune, as well as with the assistance (and sometimes this is a difficult term to use in this context) of loved ones or others – pull off a good death?
Let’s start with some numbers here.
Here are some recent (released 4/16) figures from the U.S. Centers for Disease Control and Prevention which shed light on older persons’ health and mortality. Looking at the data in NCHS data brief No. 182, from January 2015 – it states:
From 2000 through 2010, the number of adults aged 85 and over in the United States rose 31%, from 4.2 million to 5.5 million, and in 2010, this age group represented almost 14% of the population aged 65 and over (1). It is estimated that by 2050, more than 21% of adults over age 65 will be aged 85 and over (2). Given this increase, adults aged 85 and over are likely to account for an increasing share of hospital utilization and costs in the coming years (3).
This is an interesting report – it offers a solid basis for my concern when I hear of one of my old (85+) clients being hospitalized! When we look at hospital admissions for the old of the old (folks 85 and over), we see the top six causes (for 2010) for hospitalization as: congestive heart failure, pneumonia, urinary tract infection, septicemia, stroke, and fractured hip. The likelihood of hospitalization for any type of injury for the 85 and over cohort was higher than the rate of either of the 65-74 or 75-84 groups. The same group of 85 and over was also the least likely to be discharged to home and the most likely of the three groups to be discharged to a long-term care facility or to die in the hospital. Of note here is the 6% figure for deaths, which is double that for the 65-74 group.
How many septuagenerians and octogenarians plan for or talk with others (from whom they will need support for their decisions and choices) about “a good death?” Well, I haven’t seen any real statistics on that! Keep in mind that Medicare recently (in January of 2016) started paying doctors for having an end-of-life consultation with their patients, so that seems like a good start. But there may be a glitch to that simplicity, as information used in a recent Forbes article shows that almost a third of doctors say that they don’t really have a formalized system of talking to patients about such matters and the same percentage (29%) they haven’t had any training on how to talk with patients and their families about such topics.
So with this rather bleak picture of the status quo before us, how is it that we can better come to grips with forging a better – more humane and dignified – path to death? Where are the sources of this helpful information? Well, we can start by listening to the dying! Keep in mind that dying isn’t simply a medical process, a failure of intervention or curative measures – it is a physical process which is inevitable for every living being. Palliative and hospice care offer means toward that end in the medical context, but as we know there are often a number of emotional, legal, financial, psychological and cultural obstacles which can appear at the end of one’s life.
I liked this article from The Greater Good which offered the following points under the subtitle “how to die well:”
- Experience as little pain as possible;
- Recognize and resolve interpersonal conflicts (it lists Dr. Ira Byock’s Four Things here) to say – I love you; thank you; I forgive you; and please forgive me;
- Satisfy any remaining wishes that are consistent with their present condition;
- Review their life to find meaning;
- Hand over control to a trusted person, someone committed to helping them have the kind of death they desire;
- Be protected from needless procedures that serve to only dehumanize and demean without much or any benefit; and
- Decide how social and how alert they want to be.
These seven means seem simple enough – but remember the big difference between simple and easy! Can any of us really know when death is near, when the dying part of our life or another’s is taking place? If we start considering the possibility, then we see opportunities. But these questions obviously don’t have definitive answers! For all of our talk about health care self-determination, we – not just the individuals making the advance directives, but also upon those on whom the dying rely for assistance, have precious little experience with really thinking through the “what happens if” and the “what happens when” scenarios.
So I will close this post with two challenging questions –
How difficult will it be for someone over 85 to not be transported to a hospital for treatment at the end of a long and difficult illness – particularly if the trip to the hospital is for the treatment of an injury that is not related to the terminal or chronic illness?
How difficult is it for us to adjust our thinking about these things as we age and become more frail and less able to withstand the medical interventions which were more likely to be restorative or curative in our younger years?
PS Don’t forget that Friday is Denver’s Senior Law Day! The morning event is scheduled for the PPA Event Center and you can buy your tickets here.
© Barbara E. Cashman 2016 www.DenverElderLaw.org