Skip to main content

Aspects of Aging

End of Life Issues

 

Being Mortal  Atul Gawande - Medicine and What Matters in the End (Book review)

New York Times

November 30, 2014

Atul Gawande's new book, “Being Mortal,” is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death. It is also a call for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.”


Dying Shouldn't Be So Brutal 

New York Times

January 31, 2015

People who are approaching the end of life deserve the security of confident, skillful attention to their physical comfort, emotional well-being and sense of personal dignity. Their families deserve respect, communication and support. Exemplary health systems and healthy communities deliver all of this today. But they are few and far between.

  

PBS Newshour
April 10, 2015
 

Who speaks for you if you are not able to speak for yourself? Who determines what kind of care you want at the end of life, how your finances are handled, how your estate will be distributed? You do … but only IF you’ve prepared ahead of time. This article, outlines the types of documents that are needed to ensure that your wishes are respected.  The documents are fairly straightforward, yet many people postpone taking action to complete them. It isn’t easy to think about your own incapacity or death. But these important legal and health care decisions not only protect your own interests, they protect your family and loved ones by clarifying the kinds of care you would like to receive if you are seriously ill. After completing the legal paperwork, the next very important step is to sit down and talk with your family about the decisions you’ve made and why.

 

PBS Newshour
April 2, 2015

As medical advances have lengthened our life spans and can improve quality of life as we get older, many people remain reluctant to have end of life conversations with their physicians and loved ones.  Pulitzer-prize winning journalist Ellen Goodman confronted this situation firsthand when her mother’s health began to deteriorate unexpectedly.  “I think we all have this fantasy that we’re gonna live to 90 and then, Kaboom! You know? But in fact the reality is that many of us will face a long period of being frail and declining,” Goodman said.  Today, Goodman has turned her personal experience into a mission to make death part of popular conversation. In 2010 she co-founded The Conversation Project, a non-profit to urge people to express their end-of-life desires before it’s too late. 
For a related article, see How to Talk About Dying (New York Times, July 1, 2015)

 
PBS Newshour
January 29, 2015

Promoting independence and “successful aging” is a laudable goal for many and a common media headline. But it’s not the reality for people caring for anyone diagnosed with a terminal illness or a relative who struggles to manage day to day as a result of debilitating health conditions and growing frailty. Most people would prefer to talk about wellness rather than illness, so we tend to avoid planning for advanced illness and ultimately death. One valuable, often overlooked, and generous Medicare benefit for those caring for a family member or friend is hospice care.  Some say that if they bring up the subject of end-of-life planning, their parent will think they want to “push them aside” or “be done with them.” Spouses say that they worry that even thinking about it will somehow hasten death or cause their partner to die sooner. The reality is, given the right opportunity, those living with illness and frailty often welcome the opportunity to share their preferences about their end-of-life choices. Listening without judgment to the individual’s worries or advice can be a gift to them. Researching what is available to help care for a family member living with advanced illness relieves the individual from having to do the work themselves.


PBS Newshour
December 24, 2014
When caring for an older parent, ailing spouse or sibling struggling with a devastating diagnosis, denial is often a place caregivers dwell. They may be driven there because they feel overwhelmed or angry, or because they don’t understand “medical speak” and want to tune out.  And while an initial state of denial is neither uncommon nor unhealthy, according to Dr. Ira Byock, a leading palliative care physician and author of Dying Well, it’s not a place to stay for the long haul.  

The author contends that providing quality care requires conversation. And caregivers should start the talks, even though doing so is scary.  “We are a deathophobic society,” he says. “For many health care professionals, the conversations around illness and death are clinical and cold, they are not personal.”

As a caregiver, you must find out about your loved one's wishes and needs.  You need to talk with the health care team so everyone in it understands your advocacy role. You should have conversations with your family and friends to let them know that your life has taken a detour as you provide care and that you may need help or understanding yourself.  Caregivers who exist in chronic denial prevent these essential conversations from happening.

 

Association for Phychological Science
March 2015, Vol. 10(2) 227–237
Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic
review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine
possible moderators. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.
 

New York Times
February 14, 2016
Death goes in and out of fashion. The topic lingers behind euphemisms for a few years, and then someone calls it forth again, e.g., Elisabeth Kubler-Ross with her disciplined "On Death and Dying" in 1969 and Atul Gawande (see above) with his humane, "Being Mortal" in 2014. Time and again, we must clarify our individual and collective beliefs about how the last chapter changes the rest of the narrative.
 

Looking Death in the Face
New York Times
December 26, 2016

We tend to defer the question of living or dying well until it's too late to answer. We avoid it because we can. 


Death Is Inevitable. Financial Turmoil Afterward Isn't
New York Times
January 13, 2017

Advice on the kinds of financial and estate plans and documents needed to help your heirs.


Is Your Digital Life Ready for Your Death?
New York Times
January 18, 2017

What happens to your email, Facebook, Twitter and other accounts when you die? How to plan ahead.


First, Sex Ed, Then Death Ed
New York Times
February 18, 2017

We need to start learning about and talking about death from an early age. The author suggests starting with high school or younger students.


What Our Cells Teach Us About a "Natural" Death
New York Times
March 13, 2017

Microscopic study of how and why cells die may offer a challenge to the common understanding about the artificial extension of life.


The Patients Were Saved. That's Why the Families Are Suing
New York Times
April 10, 2017

Unfortunately, even patients with clear Do Not Resuscitate (DNR) orders and/or Medical Orders for Life-Sustaining Treatment (Molst) sometimes receive CPR or other procedures. Families are suing and winning "wrongful life" lawsuits.


We're Bad at Death. Can We Talk?
New York Times
May 10, 2017

We need to talk with family and caregivers and make clear our desires about end of life care. Those who are clear are less likely to receive aggressive medical care at the end, more likely to receive palliative care, and more likely to die at home.


The Symptoms of Dying
New York Times 
June 20, 2017

The symptoms indicating a person is dying can be frightening for that person and for those who love them. Here, reassurances and ways the symptoms can be relieved. There are also The Gentler Symptoms of Dying, as outlined in a July 11 follow up.


Should I Help My Patients Die?
New York Times
August 5, 2017

A palliative care physician writes of the difficulties associated with new physician assisted death laws and regulations from the doctor's perspective.


Nearly 1 in 5 Hospice Patients Discharged While Still Alive
National Public Radio
August 11, 2017

Hospice is designed to care for those in the last 6 months or so of their lives. Some hospice agencies, particularly for-profit ones, are discharging patients who live "too long."




                                                                     Copyright © VILLAGEintheVillage.  All rights reserved.