Saturday, April 30, 2016

Danger Zone

My mother-in-law, age 93, is happy to be back in her own home after a hospitalization of a couple of weeks followed by nearly six weeks in a rehab place.

But the transition from hospital to rehab or skilled nursing is a danger-filled time, and the transfer to home care is likewise worrisome.  See this article in the Washington Post by Jordan Rau:

Medication errors can occur.  There's no longer a heart monitor or nurses nearby in case of emergency.

Usually the care-giving is transferred from a team to one person doing round-the-clock care and trying to sleep when the patient sleeps.  A tremendous responsibility rests on that one person's shoulders.

It's better if home care can be provided by several aides, each working an 8- or 10-hour shift, with days off each week.  But these things are expensive.  If the person has long-term care health insurance, it can take weeks to activate that policy to fund or partially fund the care.

"Old age is no place for sissies," said Bette Davis (1908-1989).

But my friend Brenda Holguin doesn't like to hear people complain about getting old.  

"Not everyone has that privilege," she notes.

Saturday, April 02, 2016

Gracious Aging

Living into the 90s and experiencing ups and downs as health declines and fails is quite a trial.

I'd like to report, however, that I have one friend who is negotiating these ups and downs with relative good cheer.  

She's 99% ready to leave this earth but also very patient with the day-to-day indignities.  I'm amazed that she is not angry or sad.

Most younger people look at the problems of extreme old age and hope their lives will end earlier.

Perhaps because I spent four years accompanying my mother on this journey, I myself view being in an assisted living residence with equanimity.  It's a peaceful life surrounded by others without the kinds of worries and pressures that plague earlier years.  (A skilled nursing facility, on the other hand, is not good news.  It's more of a warehouse where people are pieces of meat, showered roughly, wheeled in and out of meals whether or not their false teeth may be in their mouths.)

What seems unendurable today--such as wearing Depends--can become just another event later if one lives in a cheerful place with kind caregivers.

When I was in my twenties, in the 1970s, I was close to my grandmother and observed her dealing with cataract surgery.  It seemed awful to me to have a surgeon cutting into one's eyes.

Today my perspective has changed.  I'm 67 and starting to feel the effects of growing old.

I didn't feel old when I got my Medicare card, or when I started collecting Social Security or began noticing increasing wrinkles and gray hair.   

Yesterday, however, when I sat in my ophthalmologist's office and scheduled a cataract surgery, it happened.  I'm where my grandmother was, and now I know I am old.

End-of-Life Choices

Should someone who has Alzheimer's--especially the early-onset kind--have the right to end his or her life before it gets to the point of being placed in a Memory Care floor with assistance for daily life tasks such as bathing and dressing or even eating?

The prospect of wearing Depends and needing personal assistance is humiliating.

How can we respond when a friend or loved one expresses a wish to die before this point?  

No one wants a long period of wasting away.  On the other hand, no one wants to die in a car accident or plane crash.  Ordinarily we don't get a lot of choice in how or when our life ends.

Nevertheless, I want to affirm someone who expresses the wish to avoid long-term care, possibly when unable to recognize friends and family.  It's important to share our feelings with friends and family and to cry out to God.

In a post on December 6, 2014, I rather flippantly said "Why bother to make such wishes?  The bottom line is that we don't get to choose when to clock out... unless we oppose both law and custom."

I'd like to say now that I respect the decision to end life through physician-assisted suicide in a case of terminal illness, even Alzheimer's.

There needs to be a way to express this wish on paper, legally, before one gets to the point where one's decisions are impaired by dementia and one is seen as not competent to make this choice.

On the other hand, treatments to halt and even reverse impairment with Alzheimer's are already being tested.  See the February 11, 2016, issue of Time Magazine with this cover story by Alice Park:

I have a friend who has said he would shoot himself first if he were on the verge of being put on an Alzheimer's care.  Is it a blessing that he has since had two strokes and one ablation surgery for atrial fibrillation?  Despite having one parent who died of Alzheimer's, it looks as if he is not headed for a Memory Care floor--unless by stroke.  

Hi Anne.

Your Dec 6, 2014 post ends by saying:

As for Ekekiel Emanuel's essay about preferring to die at 75 yrs. rather than waste away later, why bother to make such wishes?   
The bottom line is that we don't get to choose when to clock out... unless we oppose both law and custom. 
As a Biblical Feminists do we not both oppose law (in the past) and custom (always)???

So why do you say "why bother" re:  Ekekiel's preference to die at 75 and let custom and law prevail in his case?

This is too personal for me.  It is entirely possible that I will not know you at 75. Or maybe I will have the good fortune re: my cognitive impairment and it will level off at some point before it gets too bad.