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Maximize Quality of Life til the end?
Old 04-12-2017, 08:18 AM   #1
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Maximize Quality of Life til the end?

He's been very fortunate all in all, but watching my 95 year old Dad's quality of life ebb away piece by piece has me thinking about it. We'd all like to maximize our quality of life, and then go poof without going through a period of poor quality of life nearer the end - and we know that's not in our control. But what can we do to improve our odds?

Eat right, drink in moderation, annual physical, be social (at least somewhat) and remain active body, mind and soul. But what else?
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Old 04-12-2017, 09:14 AM   #2
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That's a good question. Afraid I don't have the answer, but I think about it a lot. I watched my wife's parents go, very quickly...Him just before 70, and her at 82. He did very well until a year or so before death and then declined very quickly. Living longer, she had more aches and pains, and no dementia to speak of until maybe a little in her last 2 years. She died of a stroke while having a bath...cause of death was drowning, but doc said she would have most likely died from the stroke anyway. My folks are in better shape at 80-81. Dad works on his yard daily...gives him exercise. Mom is morbidly obese, but no diabetes. We all used to advise her to lose weight, but at this point, I just keep quiet and tell dad to let her do what she wants. She does have a pacemaker, and he has had afib flares.

Sometimes I do wonder if we've gone too far with medical advances that keep us alive, but with a very poor quality of life. Maybe its just better that our spouse lets us go when God calls us home than to exert superhuman heroic measures that keep our spirit in our body unwillingly. As for us, my wife and I have already agreed that if we are in need of medical intervention, and if the doc says we still have a great shot at a normal life, then please, do the intervention. If the intervention will just keep us alive, but it would barely be called living, we have agreed to let each other go. We'll be waiting for each other beyond the veil of death. Some will not agree with this, or believe as we do, but to each his own.
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Old 04-12-2017, 09:17 AM   #3
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1) Sometimes I do wonder if we've gone too far with medical advances that keep us alive, but with a very poor quality of life.
2) As for us, my wife and I have already agreed that if we are in need of medical intervention, and if the doc says we still have a great shot at a normal life, then please, do the intervention. If the intervention will just keep us alive, but it would barely be called living, we have agreed to let each other go.
My Dad, a retired ortho surgeon would agree wholeheartedly on both counts.
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Old 04-12-2017, 09:24 AM   #4
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My dad lived an active life until he died at the age of 92. My mom just passed at 102, but her quality of life for the lat 5 years was not good. Toward the end, she had to have 24 hr care and that sucked every penny she had. I never hoped for a dime from them.
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Old 04-12-2017, 09:29 AM   #5
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Sometimes I do wonder if we've gone too far with medical advances that keep us alive, but with a very poor quality of life. Maybe its just better that our spouse lets us go when God calls us home than to exert superhuman heroic measures that keep our spirit in our body unwillingly. As for us, my wife and I have already agreed that if we are in need of medical intervention, and if the doc says we still have a great shot at a normal life, then please, do the intervention. If the intervention will just keep us alive, but it would barely be called living, we have agreed to let each other go. We'll be waiting for each other beyond the veil of death. Some will not agree with this, or believe as we do, but to each his own.
+2
I couldn't agree more!
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Old 04-12-2017, 09:54 AM   #6
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Accept... without regret.

Maybe easier said than done, but we've had enough experience now, dealing with many older folks in our CCRC to see the ones who are still enjoying life, and those who have given up, and have become negative and unhappy.

You would think that those who are the healthiest would also be the happiest. Yeah, to some extent, but it's really more of how well the happier people can accept their infirmities and disappointments.

I'm reminded of the story about the study of the two boys who are placed in a one way mirrored room.

The first boy is in the room with all sorts of toys and fun things to do. He sits in the corner for an hour and touches nothing. When he comes out the psychologist asks him why he didn't play. "Because I was afraid that if I touched anything, I'd break it and then I'd be in trouble."

The second boy is placed in a room filled with two feet of horse manure. To everyone's surprise, he dives and for an hour crawls around, tossing the manure up in the air, laughing all the way. When they drag him out, the amazed psychologist asks why the boy seemed to have so much fun in such an awful situation.
"With all that horses**t, there's gotta be pony in there somewhere and I'm gonna find him."
.................................................. ...........................

And so it goes in our real life situation. With the aches and pains and illnesses of old age, and the steady decline of the mind and body in later life, it isn't always health that leads to happiness, but acceptance of what will naturally happen.

So there are happy people and sad people, and most think that they are born that way. That's where I differ. I think acceptance and happiness can be learned.
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Old 04-12-2017, 09:57 AM   #7
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Originally Posted by imoldernu View Post
Accept... without regret.

Maybe easier said than done, but we've had enough experience now, dealing with many older folks in our CCRC to see the ones who are still enjoying life, and those who have given up, and have become negative and unhappy.

You would think that those who are the healthiest would also be the happiest. Yeah, to some extent, but it's really more of how well the happier people can accept their infirmities and disappointments.

I'm reminded of the story about the study of the two boys who are placed in a one way mirrored room.

The first boy is in the room with all sorts of toys and fun things to do. He sits in the corner for an hour and touches nothing. When he comes out the psychologist asks him why he didn't play. "Because I was afraid that if I touched anything, I'd break it and then I'd be in trouble."

The second boy is placed in a room filled with two feet of horse manure. To everyone's surprise, he dives and for an hour crawls around, tossing the manure up in the air, laughing all the way. When they drag him out, the amazed psychologist asks why the boy seemed to have so much fun in such an awful situation.
"With all that horses**t, there's gotta be pony in there somewhere and I'm gonna find him."
.................................................. ...........................

And so it goes in our real life situation. With the aches and pains and illnesses of old age, and the steady decline of the mind and body in later life, it isn't always health that leads to happiness, but acceptance of what will naturally happen.

So there are happy people and sad people, and most think that they are born that way. That's where I differ. I think acceptance and happiness can be learned.
Great post, imoldernu!
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Old 04-12-2017, 10:04 AM   #8
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Originally Posted by Midpack View Post
He's been very fortunate all in all, but watching my 95 year old Dad's quality of life ebb away piece by piece has me thinking about it. We'd all like to maximize our quality of life, and then go poof without going through a period of poor quality of life nearer the end - and we know that's not in our control. But what can we do to improve our odds?

Eat right, drink in moderation, annual physical, be social (at least somewhat) and remain active body, mind and soul. But what else?
Probably nothing else, short of doctor-assisted suicide when the time has come where life is nothing more than joyless existing. I'd guess for most elderly folks, the final few years of life constitute over 50% of the suffering they experience during their entire lives.

If I manage to live past about age 85, I certainly hope society will have advanced enough to allow people the rational, compassionate choice of whether to end their lives in order to escape further pointless suffering. It's frankly astonishing and shameful that anyone of sound mind suffering from an incurable, painful disease is not allowed that choice already. And certainly, extreme old age is often times pretty much equivalent to an incurable, painful disease.
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Old 04-12-2017, 10:19 AM   #9
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With the aches and pains and illnesses of old age, and the steady decline of the mind and body in later life, it isn't always health that leads to happiness, but acceptance of what will naturally happen.

So there are happy people and sad people, and most think that they are born that way. That's where I differ. I think acceptance and happiness can be learned.
Hmmm... not sure I agree with this. I am still in my 40s, but I have seen plenty of older relatives in their 80s and 90s experience the ravages of "end of life" situations. Seeing those wonderful people endure such awful suffering -- some for several years before the end mercifully came -- was terribly sad. I don't think anything as simple as "accepting what will naturally happen" makes it any better, for the people going through it or for their loved ones. The stark, brutal reality of many end-of-life situations is that there is more or less constant suffering, complete lack of joy and happiness, and nothing more than the most basic, rudimentary, biological existence. I've seen this over and over again with elderly relatives, and it is tragic and heartbreaking. You can take the Pollyanna approach, I guess, and say that it's all about having a positive attitude and finding happiness through acceptance, but I'd have to disagree based on what I've seen.
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Old 04-12-2017, 11:26 AM   #10
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Great post, imoldernu!
+1
So much is out of our control, except how we choose to react.

Most grocery days I see a gentleman about 70 going through the store. He's had some type of condition(perhaps stroke?) that makes it incredibly difficult for him to walk. One slow planned step, followed by another of perhaps 6 inches. It must take him two hours to go around the store.

Whenever I have made eye contact or chatted he's been very cheerful. I am sure there's a lot of things he can't do, but not from lack of effort on his part.
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Old 04-12-2017, 12:54 PM   #11
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Look into palliative care. It's not hospice, although that can be included if you wish. It's a way of planning what care you want when you have those chronic conditions that make you linger longer. You don't get swooshed into the hospital from the ER automatically when something flares up.... A step that can make your condition easier for that day, but long term, a lot worse. You also will have a better idea of what to expect symptom wise, and how your quality of life will probably play out. It helps the family or case manager organize the care you will need. A Dr Kervorkian solution sounds lobely but our religious society will never let that happen. Ever hear of "redemptive suffering" at the end of life? If you do, run from the person saying it...
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Old 04-12-2017, 02:51 PM   #12
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I love the stories, quips and wisdom of imoldernu - Keep them coming !

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Old 04-12-2017, 05:02 PM   #13
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Probably nothing else, short of doctor-assisted suicide when the time has come where life is nothing more than joyless existing. I'd guess for most elderly folks, the final few years of life constitute over 50% of the suffering they experience during their entire lives.



If I manage to live past about age 85, I certainly hope society will have advanced enough to allow people the rational, compassionate choice of whether to end their lives in order to escape further pointless suffering. It's frankly astonishing and shameful that anyone of sound mind suffering from an incurable, painful disease is not allowed that choice already. And certainly, extreme old age is often times pretty much equivalent to an incurable, painful disease.


Wouldn't it also be great if society can advance to the point where I can request in a health care proxy that I should be put permanently to sleep if I ever develop Alzheimer's where I no longer recognize myself or my loved ones and this is certified but at least two doctors? When will there be such a right?
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Old 04-12-2017, 05:11 PM   #14
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Originally Posted by imoldernu View Post
Accept... without regret.

Maybe easier said than done, but we've had enough experience now, dealing with many older folks in our CCRC to see the ones who are still enjoying life, and those who have given up, and have become negative and unhappy.

You would think that those who are the healthiest would also be the happiest. Yeah, to some extent, but it's really more of how well the happier people can accept their infirmities and disappointments.

I'm reminded of the story about the study of the two boys who are placed in a one way mirrored room.

The first boy is in the room with all sorts of toys and fun things to do. He sits in the corner for an hour and touches nothing. When he comes out the psychologist asks him why he didn't play. "Because I was afraid that if I touched anything, I'd break it and then I'd be in trouble."

The second boy is placed in a room filled with two feet of horse manure. To everyone's surprise, he dives and for an hour crawls around, tossing the manure up in the air, laughing all the way. When they drag him out, the amazed psychologist asks why the boy seemed to have so much fun in such an awful situation.
"With all that horses**t, there's gotta be pony in there somewhere and I'm gonna find him."
.................................................. ...........................

And so it goes in our real life situation. With the aches and pains and illnesses of old age, and the steady decline of the mind and body in later life, it isn't always health that leads to happiness, but acceptance of what will naturally happen.

So there are happy people and sad people, and most think that they are born that way. That's where I differ. I think acceptance and happiness can be learned.
You have a great way with words and getting your thoughts expressed. I wish I had your talent.
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Old 04-12-2017, 05:25 PM   #15
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I'm with imoldernu and those who agreed with him on this. No Pollyanna here. Just a lot of clear eyed experience from nearly 25 years of hospice volunteering with my pet therapy teams. Even in the worst of circumstances (worst when one only looks at the physical and sometimes mental deterioration while vigorously ignoring the very real emotional and spiritual progress, for both residents and their family/friends), there is much beauty and satisfaction, even in the midst of suffering. Hospice, be it in a facility,one's own home or in a nursing/assisted living facility, many of which now also offer hospice care, has done wonders to mainstream this truth.
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Old 04-12-2017, 05:26 PM   #16
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Probably nothing else, short of doctor-assisted suicide when the time has come where life is nothing more than joyless existing. I'd guess for most elderly folks, the final few years of life constitute over 50% of the suffering they experience during their entire lives.

If I manage to live past about age 85, I certainly hope society will have advanced enough to allow people the rational, compassionate choice of whether to end their lives in order to escape further pointless suffering. It's frankly astonishing and shameful that anyone of sound mind suffering from an incurable, painful disease is not allowed that choice already. And certainly, extreme old age is often times pretty much equivalent to an incurable, painful disease.
Some states such as Oregon (where I live) offer a "death with dignity" option under certain conditions https://public.health.oregon.gov/Pro...quirements.pdf
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Old 04-12-2017, 06:24 PM   #17
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There is no guarantee that I'll be able to achieve it, but my goal is to strive for the "compression of morbidity" that Mark Sisson and others have written about. Here is link to a pretty good blog post on aging by Sisson, along with a couple quotes:

"In a society where aging too often coincides with the automatic surrender to preventable lifestyle diseases, we can get a grossly skewed impression. That said, when we take care of ourselves with a mind toward compressed morbidity (living as well and able-bodied as possible to the very end), our later decades can be some of our most satisfying.

If you expect your life to be a static continuum of the same activities and ventures, the same routines and figures with equal to increasing gratification, you’ll very likely be disappointed.
On the other hand, if you’re willing to trust your own life as an exploration through varying phases, interests and redirects, you’ll find that your later decades hold as much (if not more) capacity for depth, joy and enrichment as your younger years. Certainly good health can and will help, but attitude (I’ve so often said it) ultimately determines your course. And that (more than health) is always a choice.


6 Reasons to Look Forward to Growing Old | Mark's Daily Apple
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Old 04-12-2017, 06:44 PM   #18
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I'd say die of the right disease. DH died at age 78, 4 months after being diagnosed with acute myeloid leukemia, and with no extraordinary measures because they had little chance of success. While he grew progressively weaker and was down to 117 lbs. before he died because he could eat so little, we kept the quality of his life as good as it could be. The month before he died we drove from KC to Myrtle Beach for my mother's funeral. It wore us both out in different ways but we were so glad to be together. Three days before he died he wanted to go for a drive. I had to wrestle his wheel chair down 3 shallow steps and get him into the car without tipping hm over, but what a wonderful memory. He had a banana milkshake at DQ on the way home. Similarly, my mother decided not to treat her metastatic breast cancer at age 85. She was gone 6 months later and died at home with hospice care.

DH's stepsister, OTOH, nursed her husband through 3 years of throat/esophogeal cancer during which they just kept trying to remove more of the cancerous parts until they couldn't do anymore. My Uncle was diagnosed with Alzheimer's 8 years ago but was showing signs of it earlier than that. He's now in a nursing home but taking care of him took a real toll on my Aunt. Those are my nightmares. I can do everything I can to keep myself healthy, but still meet with a long, ugly departure from this world.
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Old 04-12-2017, 07:15 PM   #19
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+2
I couldn't agree more!
Agree as well! I'm watching my dad's quality of life rapidly diminish at 88 - after his recent stroke (and associated fall), he says there is nothing enjoyable left. He has made sure everyone around him knows that he doesn't want to be resuscitated under any circumstances.
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Old 04-14-2017, 04:04 PM   #20
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One idea discussed in care of elders is "slow medicine", that is limiting use of highly invasive procedures and treatments in late life.

Dartmouth Medicine Magazine :: Grand Rounds : Slow medicine
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