The Inevitable Aging Process

[J Patrick]

....no doubt genetic predisposition has a heck of a lot to do with it....but it can turn on you....my wife’s dad and his sister were two of the healthiest old folks I ever knew....they hardly ever saw a doctor....were never on any meds and into their 80”s were in great shape...they both looked 15 years younger than they were...it seemed as though they were destined to live past 100.... except they both developed Alzheimers...big time game changer...

......they withered liked summer flowers and were gone long before they would have been but for the dreaded affliction.....needless to say my wife who is now 59 and is also blessed with fantastic health is concerned....

[buddyhu]

Originally Posted by AX17609

I had to go back to the OP to understand what we're talking about here. I think it's the possibility the modern medicine has extended lives past their more natural conclusions.

My mother, who never wanted to be committed to a nursing home, died in a nursing home. During the last years of her life she mutated into an entirely different person, one who I didn't even recognize. Mean. Had a list of medications that was a full page long.

My father died in the same nursing home after losing his mental faculties. He didn't know who I was. Accused me of hoarding all the ketchup at the dinner table.

My uncle, a proud atheist who claimed he'd shoot himself before going into a nursing home, recently died in a nursing home after turning into an entirely different person and finding religion. The presiding priest at the funeral didn't know who he was.

My daughter is currently dying of Stage 4 brain cancer. She's barely conscious. What's left of her isn't her, but she takes anti-seizure meds and gets chemotherapy regularly.

People ask my why I push myself so hard physically. It's not because I'm trying to stay healthy. It's because I'm hoping to die of a stroke.

Sorry to read of the difficulties your loved ones faced, and that your sister is facing.

A key question is, What is “the natural conclusion” of a life? All of us have choices to refuse many medications and medical treatments that prolong our lives. At what age should we refuse them? When does it become clear that the promise of more good days is an empty promise? If we lose mental capacity before we choose to refuse medical treatments (we have an accident or a stroke that abruptly changes our ability to think and communicate) who should decide for us?

Whether unfortunate or not, most people want to squeeze every good moment out of life, and that often means that they/we wait too long to decide to stop squeezing. Happens ALL THE TIME with cancer patients: so often, they spend their final months or years chasing treatments, chasing more time, and neglecting to fully value the quality of the time they have. And, on the flip side, some people pursue aggressive or unusual treatment, “beat the odds” and have a number of good years effectively given to them. And each patient is trying to predict what no one can accurately predict: when to allow life to end. Some think euthanasia is the answer...have it the right to choose how and when to die.

it is much easier to watch someone else and think they made the wrong decision and stayed past the natural conclusion of their life. It is VERY difficult to make an optimal decision for oneself as treatments and interventions are offered, and we don’t know which wobbles in our day-to-day fulfillment will endure, and which will pass after a day or a week or a month.

God help us all when we face such decisions, that we may choose wisely.

[AX17609]

Originally Posted by buddyhu

Sorry to read of the difficulties your loved ones faced, and that your sister is facing.

A key question is, What is “the natural conclusion” of a life? All of us have choices to refuse many medications and medical treatments that prolong our lives. At what age should we refuse them? When does it become clear that the promise of more good days is an empty promise? If we lose mental capacity before we choose to refuse medical treatments (we have an accident or a stroke that abruptly changes our ability to think and communicate) who should decide for us?

Whether unfortunate or not, most people want to squeeze every good moment out of life, and that often means that they/we wait too long to decide to stop squeezing. Happens ALL THE TIME with cancer patients: so often, they spend their final months or years chasing treatments, chasing more time, and neglecting to fully value the quality of the time they have. And, on the flip side, some people pursue aggressive or unusual treatment, “beat the odds” and have a number of good years effectively given to them. And each patient is trying to predict what no one can accurately predict: when to allow life to end. Some think euthanasia is the answer...have it the right to choose how and when to die.

it is much easier to watch someone else and think they made the wrong decision and stayed past the natural conclusion of their life. It is VERY difficult to make an optimal decision for oneself as treatments and interventions are offered, and we don’t know which wobbles in our day-to-day fulfillment will endure, and which will pass after a day or a week or a month.

God help us all when we face such decisions, that we may choose wisely.

Actually, you often don't have the ability to refuse treatment. If you enter a hospital thru the Emergency wing, you or someone who represents you will sign a piece of paper that allows them to perform any treatment they feel is necessary. If you refuse, you risk insurance coverage for all treatments. That piece of paper opens tap to your checkbook, and you have no say in the matter.

I decline to discuss euthanasia. The original question was whether modern medicine has the ability to extend life past the point at which life has any quality. My answer was "yes", and I offered four personal examples. That's the end of it.

[The Watchman]

Originally Posted by AX17609

Actually, you often don't have the ability to refuse treatment. If you enter a hospital thru the Emergency wing, you or someone who represents you will sign a piece of paper that allows them to perform any treatment they feel is necessary. If you refuse, you risk insurance coverage for all treatments. That piece of paper opens tap to your checkbook, and you have no say in the matter.

Everyone at any age should have a healthcare directive. Put it in the hands of someone who you want to decide your care if you cant. If you go into a hospital conscious, and its your wish, tell them you want a Do Not Resuscitate note in your file. Young people who think they dont need one should think about a car accident that leaves you in a permanent coma. It happens.

[Mr. Jelly]

All this discussion is well and good. But how many here have pulled the plug on a loved one and felt good about it? Being a person who has had ALLOT of family members die over the first thirty five years of my life I have yet to have found the answers. There will always be questions.

[J Patrick]

Originally Posted by Mr. Jelly

All this discussion is well and good. But how many here have pulled the plug on a loved one and felt good about it? Being a person who has had ALLOT of family members die over the first thirty five years of my life I have yet to have found the answers. There will always be questions.

...I have done it and felt that I absolutely did the right thing....did I feel good about it....yes in that it was what my mother told me she wanted long before the time came to make the decision.....she drew her last breath as I held her in my arms and the lightness of being that I felt goes beyond what any words could describe or explain....I only hope that I can pass such a feeling on to my loved ones when I go....

[Earl49]

I recall talking candidly with a 72 year old friend years ago. He was going in for round two of stem cell replacement for lymphoma. Round one had bought him 2½ extra years of decent quality life, but the cancer was back again. As he prepared to relocate from Anchorage to the Seattle Cancer Center again for six months, I asked him if he thought it was worth going through all that again, and expressed my doubts as to my decision. He replied saying, "Your perspective looks VERY different when you are staring down the barrel of the gun". Conclusion: after extensive testing he was cleared to start round two. The night before the radiation protocol was to begin, he had a massive heart attack right in the hospital and was gone instantly, before the trauma team could resuscitate him. I took that as a positive - he died with hope, but did not have to endure months of in-patient treatment again, all for an uncertain future.

I have a DNR on file and directives with my hospital and primary care doc, and my wife is pre-forgiven if she one day has to pull the plug on me. I have made my wishes very clear - when my quality of life is gone, marking time is not a viable or useful option. We take the practical attitude (from experience) that we would not unduly prolong the life of a beloved pet, making them suffer for our sentimentality, so why should I be any different? YMMV, and I see good points in many of the thoughts expressed here. This thread is almost a course in philosophy all by itself.

[FLRon]

Originally Posted by Mr. Jelly

All this discussion is well and good. But how many here have pulled the plug on a loved one and felt good about it? Being a person who has had ALLOT of family members die over the first thirty five years of my life I have yet to have found the answers. There will always be questions.

I was placed in the position of having to do this. My mother had POA over her last surviving sibling and he went into the hospital and it soon became clear he wasn’t coming out alive. My mother absolutely refused to “pull the plug”.

Having discussed such a scenario with my uncle on several occasions, I knew his wishes were to never be kept alive by machinery. So, I did what I knew he wanted to have done, which was to be allowed to die. After the necessary paperwork was signed with the lawyers, I had him disconnected from any machines keeping him alive.

Did I feel good about it? Yes and no. Yes, I honored his wishes so that he would not be kept alive when his body said it was time to stop. No, I felt like I had no “right” to do such a thing to any living person. My uncles wishes conflicted with my own personal views on the matter, yet I chose to honor what he wanted instead of my own conscience.

After well over 25 years since this happened, I still do not know if I did the “right thing”, which is why this is always a very personal issue.

[tinnitus]

Lost my mommy to Alzheimer's Disease last year. Well into her 80s, she was an empty shell for her final 5 years, luckily/mercifully sleeping more than actively suffering.

Now another dear acquaintance, also elderly, is slogging deeper daily into the quicksand of dementia. Still physically strong (potential flight risk), she is angry, jealous, circular, paranoid, combative and accusatory. She's a prime candidate for fraud and ID theft, and incompetent with personal hygiene. And that's just ops normal.

Then she goes completely insane with regular UTIs (Urinary Tract Infections - also a cleanliness issue), VERY common for women, rare for men. Seriously, if your mom, aunt, sister, wife derails abruptly, she might have a UTI. Simple to diagnose with a urine sample and treated with antibiotics.

Bottom line, she no longer presents as the loving mother and grandmother we knew. Frustrations occur daily as her family works hard to keep her from harm. It's a good thing there are four cooperative siblings watching out for their mom, and I help too. She seems to know I'll call her out on BS and behaves for me when I take her to medical appointments. Big bonus for the available retired guy, and always a hoot at the urologist/gynecologist! As her behavior becomes increasingly outrageous and ugly, we practice deep breathing and calm ourselves/each other with this mantra:

Love the Patient, Hate the Disease.

[The Bard Rocks]

My mother died of Alzheimer's just after her 101th birthday.. For the last 6 moths to a year she was just existing. But before that, was happy. Yes, her quality of life was was down from where it had been, bur she was still happy with it. Not everyone would be, I know.

My wife is a nurse and says that while we are living far longer now, we die harder and in more pain.

[rokdog49]

Originally Posted by The Bard Rocks

My mother died of Alzheimer's just after her 101th birthday.. For the last 6 moths to a year she was just existing. But before that, was happy. Yes, her quality of life was was down from where it had been, bur she was still happy with it. Not everyone would be, I know.

My wife is a nurse and says that while we are living far longer now, we die harder and in more pain.

From my observations of my own family and being around assisted living facilities a lot, I would have to agree. This applies to mental as well as physical pain.
When you get to a place where you need meds to offset the bad side effects of other meds and meds for those meds and subsequently you are literally taking more than a dozen pills a day, something has gone awry.

[buddyhu]

Originally Posted by rokdog49

From my observations of my own family and being around assisted living facilities a lot, I would have to agree. This applies to mental as well as physical pain.
When you get to a place where you need meds to offset the bad side effects of other meds and meds for those meds and subsequently you are literally taking more than a dozen pills a day, something has gone awry.

I agree...the proliferation of medications given to the elderly does reflect something gone awry.

To keep this in a bit of perspective: most people in nursing homes have Alzheimer’s, and that will most frequently be the designated cause of death. This is VERY different from the frequent causes of death in the general population: cardiac issues/illness , pulmonary illnesses, renal failure, cancers, infections, and accidents.

Also a small percentage of people end up in nursing homes: the census pegs it at around 5% of the population over 65.

Perhaps the issue is how to better address Alzheimer’s disease? My own experience with Alzheimer’s suggests that it is usually impossible to keep Alzheimer’s patients at home once they get past the first few years of decline (and many Alzheimer’s patients live many years....when I was studying this in the 1980’s, the average amount of time between a diagnosis of Alzheimer’s and death was a bit more than 8 years). So it is not a challenge that is going to be easily addressed....even before we start factoring all the ethical and moral perspectives of how to deal with such conditions.

[tinnitus]

Speaking of meds, especially lots of them, they can become a real challenge for elderly patients, and sometimes dangerous depending on what they are.

Once a patient (any age) is taking many different meds, they are often prescribed in different amounts, 1-3 times a day, before meals, after meals, right before bed, etc. Many pills look almost identical to others, tiny, same colors, hard to handle, and a general pain in the buttocks to manage effectively. Add fumbling hands and dementia to the mix, and it gets frustrating/dangerous in a hurry. Imagine someone you care about bawling and cussing, on the floor, trying to pick up 6-8 kinds of spilled medications.

One solution that seems to help is a round plastic battery-powered pill dispenser, advancing a circular tray under a plastic lid so the appropriate medication(s) will appear under an opening at the appropriate time, then dumped into the patient's hand. The slots are labeled and can be set to advance daily, twice a day or more. Healthy, vigorous and super busy at 65, I'm still tracking just fine (knocking on wood). But I became curious and took over my mom's "pill spinner" after she died. It sits on the counter in my bathroom and reminds me I haven't taken my morning or afternoon pills yet. I load it up every 2 weeks. Super handy.

As a society that tends to "warehouse" our sick and elderly, the care facility industry ranges from stark and modest with minimal care, to total luxury with stand-alone condos, gardens, restaurants, happy-hours, shopping, culture and casino buses, visiting entertainment, wood-working shops, theaters, etc.

Of course financial resources and needs will very from case to case, but two things stand out to me as important, sometimes overlooked in the rush to get someone squared away in a safe, healthy environment.

- Is the food varied and delicious, or does it merely sustain life?

- Is progressive onsite care available as health declines and needs increase?

Back to pills. One of the handiest things I can think of for elderly, invalid patients and those suffering from dementia, is to have a qualified individual show up at the right time(s) daily, with the correct medications in a cup and a glass of water.

While some facilities won't have a staffer like that, many allow private contractors to spend the entire day onsite seeing to the various needs of several patients. For a price of course. Might be a convenient solution to explore while considering where to move next based on one's progressive needs.

[gfirob]

First of all, ask not for whom the bell tolls…

Death waits for us all, there is just no way around it. I don’t fear the grave, I fear the Intensive Care Unit. Anybody who has been in an ICU knows why.

My father had four college degrees, two of them from Harvard, and he wrote up a very clear advance directive living will, specifying no intubation, no resuscitation. At 89 he went into the emergency room with pneumonia and congestive heart failure. I was his legal guardian. In the emergency room I was asked if he had an advance directive and I told the physician that he did. At that point the emergency room doctor very aggressively began to insist that they could bring my father back with oxygen under pressure, special treatments and so forth. She said if I sent him up to the ICU, they would let him die without treatment. A very hard thing to face with your dying father in an emergency room.

I made the very bad mistake of listening to her, and he spent another three weeks in an ICU with tubes coming our of every orifice until I was able get him out of there and into a hospice, where he died. It was a terrible struggle. Once the hospital has their hooks into someone, it is very hard to get out.

But these terrible stories of our aging parents difficult end are just foreshadowing of our own walk down that same pathway.

[rokdog49]

Originally Posted by tinnitus

Speaking of meds, especially lots of them, they can become a real challenge for elderly patients, and sometimes dangerous depending on what they are.

Once a patient (any age) is taking many different meds, they are often prescribed in different amounts, 1-3 times a day, before meals, after meals, right before bed, etc. Many pills look almost identical to others, tiny, same colors, hard to handle, and a general pain in the buttocks to manage effectively. Add fumbling hands and dementia to the mix, and it gets frustrating/dangerous in a hurry. Imagine someone you care about bawling and cussing, on the floor, trying to pick up 6-8 kinds of spilled medications.

One solution that seems to help is a round plastic battery-powered pill dispenser, advancing a circular tray under a plastic lid so the appropriate medication(s) will appear under an opening at the appropriate time, then dumped into the patient's hand. The slots are labeled and can be set to advance daily, twice a day or more. Healthy, vigorous and super busy at 65, I'm still tracking just fine (knocking on wood). But I became curious and took over my mom's "pill spinner" after she died. It sits on the counter in my bathroom and reminds me I haven't taken my morning or afternoon pills yet. I load it up every 2 weeks. Super handy.

As a society that tends to "warehouse" our sick and elderly, the care facility industry ranges from stark and modest with minimal care, to total luxury with stand-alone condos, gardens, restaurants, happy-hours, shopping, culture and casino buses, visiting entertainment, wood-working shops, theaters, etc.

Of course financial resources and needs will very from case to case, but two things stand out to me as important, sometimes overlooked in the rush to get someone squared away in a safe, healthy environment.

- Is the food varied and delicious, or does it merely sustain life?

- Is progressive onsite care available as health declines and needs increase?

Back to pills. One of the handiest things I can think of for elderly, invalid patients and those suffering from dementia, is to have a qualified individual show up at the right time(s) daily, with the correct medications in a cup and a glass of water.

While some facilities won't have a staffer like that, many allow private contractors to spend the entire day onsite seeing to the various needs of several patients. For a price of course. Might be a convenient solution to explore while considering where to move next based on one's progressive needs.

The assisted living facility my dad is currently in and it’s ranking by category IMHO on a scale of ten:

Quality of facility and campus. 8.5
Quality of rooms. 8.5
Cleanliness. 10
Caregivers. 9
Administrative Staff. 8.5
Quality of care. 9
Food. 6
Responsiveness to family’s concerns. 10

Overall Score. 8.7

Nobody seems to like the food all that much. I’m not sure you could make them happy in any case.

I didn’t include the cost of this, but all things considered, it’s a 10.