Cranking down the intensity of care at age 75

[Midpack]

Amazing how many people still want to argue whether age 75 is too young or not - completely missing the point. Age 75 was deliberately chosen to provoke you to read the article, and it did exactly that as the editors intended. Hopefully some folks actually read the article and grasped the larger point...

 

[NW-Bound]

Amazing how many people still want to argue whether age 75 is too young or not - completely missing the point. Age 75 was deliberately chosen to provoke you to read the article, and it did exactly that as the editors intended. Hopefully some folks actually read the article and grasped the larger point...

+1

People often do not bother to read the referenced articles, and prefer to attack their favorite strawman with vigor and conviction.

 

[redduck]

<large snip>My Mom is 92, still drives, just put up her Christmas tree and goes to Panera bread every Sunday to have coffee with her friends. She is still handling the care of a friend that is younger but has Alzheimer's and needs to have her accounts managed to pay for her assisted living, so my Mother meets with the attorney and CPA to care for her friend. I hope to be as healthy as her in thirty more years!

So, you are not really "rdy2go".

 

[H2ODude]

DW and I are a few months from medicare and will welcome gladly monthly costs cut in about half. As far as what it won't cover, I don't have a clue. MIL died at 89 and the hospitals and doctors loved her to the tune of probably $200,000 her last few years and she never paid any deductibles or copays thanks to ~$200 a month supplemental. Going to the doctor was like a welcome chance for social interaction (beyond DW and me who were caregivers). I was always amazed at how willing the medical establishment was to go to any lengths to serve her despite obviously deteriorating chronic conditions.

It's no wonder mc is in trouble given the incredible benefits offered to those who are nearing end of life IMO. Three out of four of our parents definitely had the bulk of their healthcare monies spent in the last few years of their life and I'd argue that their quality of life was pretty poor. Their attitudes towards assisted suicide varied from my father (bring it on!) to MIL who believed until her last breath that if she could only find the right doctor and the right medications....

 

[sengsational]

There was a thought exercise I went through that helped add a little clarity for me.

It helps if you actually do this, rather than just read about it: Take a pencil and draw a horizontal line on a paper representing the entire duration of your life. Now draw a vertical mark on where you think you are in your progress. For instance, a young, healthy, safe person would put a mark toward the left, whereas an old, unhealthy, unsafe person would put a mark toward the right.

Now, immerse yourself in the idea that time has passed and you are nearing the end of the line. Pretend that's where you really are, right now. You're getting closer and closer to the end, to that last grain of graphite. What would you be willing to spend to add a few more grains? You can't take it with you. And, as indicated above, with a supplemental policy, everything is "free" anyway, so you might as well keep things going.

Right now, if you compare your quality of life with someone who's quality of life has been declining a long time, it's easy to say "by the time I get there, I'll call Kevorkian!" But by the time you get there, you'll be comparing quality of life with yesterday or last week, and it won't seem as bad. Maybe you need 24 hour care, but you can still watch TV. That might be enough.

 

[NW-Bound]

...MIL died at 89 and the hospitals and doctors loved her to the tune of probably $200,000 her last few years and she never paid any deductibles or copays thanks to ~$200 a month supplemental. Going to the doctor was like a welcome chance for social interaction (beyond DW and me who were caregivers)...

My sister once accompanied my mother to her doctor's appointment, although my mother is still capable of driving herself (she gets out of the house every single day, while we ourselves do not if there's no need). My sister told me the same thing you said, after she observed elderly patients in the doctor's office.

... It helps if you actually do this, rather than just read about it: Take a pencil and draw a horizontal line on a paper representing the entire duration of your life. Now draw a vertical mark on where you think you are in your progress. For instance, a young, healthy, safe person would put a mark toward the left, whereas an old, unhealthy, unsafe person would put a mark toward the right.

Now, immerse yourself in the idea that time has passed and you are nearing the end of the line. Pretend that's where you really are, right now. You're getting closer and closer to the end, to that last grain of graphite. What would you be willing to spend to add a few more grains?..

When people get near the end of the line, I think most would grab the pencil and try to extend the end of that line. And once they run to the edge of the paper, they will glue on another page and want to keep drawing.

 

[walkinwood]

Let's see if someone posts here after making a decision to stop extending life and seeing it through completion.

 

[2017ish]

Let's see if someone posts here after making a decision to stop extending life and seeing it through completion.

Now that is something that would make me seriously reconsider some of my operating assumptions!

 

[kaudrey]

I am probably jaded by my limited family experience, but I feel like 85 would be fine for me. One set of grandparents both died around that age and were pretty healthy until the end. My other grandmother went into a nursing home with Alzheimer's at 80 and lived miserably with no memory until she finally passed at 94. My uncle, who is 86, has 24 hour care at home (my aunt won't put him in a home), and on the few ocassions he is lucid, he tells her he wishes he had the strength to kill himself. It is awful for them both. No thanks.

 

[audreyh1]

I don't see why people are saying 75 isn't the point. Seems like Dr. Emanuel spends a lot of time explaining that specific target and saying that he hopes to die then, not just that he doesn't intend to get any more care.

I can't identify with the Dr. Emanuel target of 75 as an ideal time to die, even though he has a boatload of statistics that are meaningful to him to back his arguments. To me - there is a lack of imagination. It reminds me a bit of those people who see retirement as useless and can't get beyond the work ethic. He is so focused on creativity, originality, productivity. Why can't someone just take it easy for the last decade of their life and enjoy watching the sunrise and sunset, and occasional family visits. What's wrong with that?

Know too many vigorous people in their 70s, still enjoying life, family, etc., especially being grandparents. It would be a tragedy for those folks to blink out so soon, IMO.

Most people do slow way down in their 80s. But I have known a few still vigorous. Hike 10 miles up several thousand feet with someone 80 one. An 82 year old on a recent trip had not trouble keeping up even at 10 miles a day walking historical sites.

At 75, if I am still healthy, that's the time I'll be looking at assisted living and transition planning for moving into assisted living (if unhealthy - this will have already happened). In my 80s I will definitely pull back on the routine preventative medical care. Hopefully by then I will have already had any joint replacements if needed, or eye operations. I only hope I can talk the doctor at the assisted living place/nursing home not to give me all sorts of pills other than vitamins.

 

[meierlde]

What I expect is that the default kind of treatment will change to pallative after a certain age, so you have to ask for aggressive treatment. In particular I could see this before the go for research level drugs to treat a disease.

 

[NW-Bound]

I don't see why people are saying 75 isn't the point. Seems like Dr. Emanuel spends a lot of time explaining that specific target and saying that he hopes to die then, not just that he doesn't intend to get any more care.
...

I did not read his article that way. He might have sounded ambivalent at some points, but I understand him as saying that if something happens to take his life after 75, he will not regret it as not having a full life. And if he stays healthy and alive after 75 with no help from medicine, he will be happy with that too. In other words, if he makes it to any age past 75, nobody should say that he dies young.

Emanuel cited the following statistics.

Eileen Crimmins, a researcher at the University of Southern California, and a colleague assessed physical functioning in adults, analyzing whether people could walk a quarter of a mile; climb 10 stairs; stand or sit for two hours; and stand up, bend, or kneel without using special equipment. The results show that as people age, there is a progressive erosion of physical functioning. More important, Crimmins found that between 1998 and 2006, the loss of functional mobility in the elderly increased. In 1998, about 28 percent of American men 80 and older had a functional limitation; by 2006, that figure was nearly 42 percent. And for women the result was even worse: more than half of women 80 and older had a functional limitation. Crimmins’s conclusion: There was an “increase in the life expectancy with disease and a decrease in the years without disease. The same is true for functioning loss, an increase in expected years unable to function.”​

What modern medicine has done is to give longevity, but not the quality of life to go with that longevity. Many posters here express a desire to live long, then drop dead with a sudden and catastrophic illness. Me too. But the statistics show that our chance of getting that is slim, compared to a drawn out and miserable end of life. It is the same as not all of us will beat the stock market.

Most people do slow way down in their 80s. But I have known a few still vigorous. Hike 10 miles up several thousand feet with someone 80 one. An 82 year old on a recent trip had not trouble keeping up even at 10 miles a day walking historical sites.
...

Great. Those are the people who may live to 100 and beyond. But if I will be sitting in a wheelchair or being bedridden at 80, I don't think I will wish to last till 100. YMMV.

 

[razztazz]

My other grandmother went into a nursing home with Alzheimer's at 80 and lived miserably with no memory until she finally passed at 94. My uncle, who is 86, has 24 hour care at home (my aunt won't put him in a home), and on the few ocassions he is lucid, he tells her he wishes he had the strength to kill himself. It is awful for them both.

It's this kind of stuff that actually makes me reconsider how much I should exercise or watch what I eat. Not being funny here. It must be terrible and beyond frightening to be totally incapacitated or nulled out by Alzheimer's but under the hood still quite robust and in no immediate danger of dying.

I'd rather just have the heart attack while mowing the lawn or be told I have six months to live and just make the arrangements and fade out in a hospice all doped up.

 

[audreyh1]

Great. Those are the people who may live to 100 and beyond. But if I will be sitting in a wheelchair or being bedridden at 80, I don't think I will wish to last till 100. YMMV.

I think it's just as likely those folks are one a sudden decline trajectory. I remember the 80 year old hiker joking that he had three stents. I could see both people being active a few more years then poof.

 

[NW-Bound]

OK. These people are lucky either way. I hope I will be like that. By the way, if I need a stent at 75, I will go for it, if the rest of me is still good. Same with a new knee or hip.

I think it is the same as with an old car. Do you want to do an engine rebuild on a 1980 Malibu that has all fenders and floor board rusted out, seats all torn, and dashboard all cracked up?

 

[jfn111]

My son and I go to a neighborhood bar once a week and play $20 bucks worth of pull tabs. My son was playing partners with an 85 year old friend of mine that is a regular there. He goes there 6 days a week and has his 3 CB 7's. I only dream of being in as good a shape as him IF I reach that age.

 

[walkinwood]

...
What modern medicine has done is to give longevity, but not the quality of life to go with that longevity.

Can't blame it all on medicine. People have to take responsibility of the quality of their life - all through their lives.

2/3rd of the US population above 20 is either overweight or obese. I think modern medicine has failed to convince people to internalize exercise and good diet. I think we need drugs that make people exercise and eat well

I have friends who are overweight, have high cholesterol and blood pressure, but are still sedentary and have bad eating habits. However, meds keep their blood pressure and cholesterol under control, so they think they're fine. And these are pretty smart people in other aspects of their lives.

FastStats - Overweight Prevalence

 

[NW-Bound]

Yes, what you said jibes with the statistics right above the sentence that you quoted from my post. I just did not want to bring it up.

 

[harley]

Can't blame it all on medicine. People have to take responsibility of the quality of their life - all through their lives.

2/3rd of the US population above 20 is either overweight or obese. I think modern medicine has failed to convince people to internalize exercise and good diet. I think we need drugs that make people exercise and eat well

I have friends who are overweight, have high cholesterol and blood pressure, but are still sedentary and have bad eating habits. However, meds keep their blood pressure and cholesterol under control, so they think they're fine. And these are pretty smart people in other aspects of their lives.

FastStats - Overweight Prevalence

They/we are just doing our best to live a life we enjoy, followed by sudden (hopefully later) death without long years or decline. Somebody has to try to lower the costs of long term care. It's the "healthy" ones that hang around and up the costs.

 

[NW-Bound]

So, which group of people die a lingering costly death vs. a nice, quick, and cheap death? The "healthy" people or the unkempt? Does anybody have some statistics?

I recall that my former boss used to say that cigarette smokers did not cost much for healthcare, because lung cancer killed fairly quickly (no, he was not a smoker, and lived to the 80s). I don't know if he was right or not.

 

[youbet]

While that may be all Medicare will pay for, you can have all the tests you want as long as you're willing to foot the bill.

Routine blood tests are cheap.

Or, if your doc is monitoring an "issue," the blood test is not considered to be routine and therefore can be done more frequently with Medicare paying.

 

[youbet]

... even though it is hard to spend that SS money on something enjoyable when you are bedridden and poked full of holes where they insert tubes.


.

The point of staying alive to win the "take SS at 70" bet isn't to enjoy spending the money. It's to be able to post on the FIRE forum that you're still alive at whatever you calculated the breakeven point to be and boast to everyone that you won and it's "all gravy now!"

 

[NW-Bound]

What jumped out at me was that Dr.Ezekiel Emanuel was an architect of our new all-inclusive health laws and how quickly he appears to be attempting to turn the conversation to limiting life.

It is not so. Emanuel has been spending his career thinking about ethical issues in medicine and public policies, so his position has been published over the years. Medicine, as anything else in life, cannot be "all one can eat". For example, the source for liver transplant is limited, and a rationing system is needed because we cannot get more livers. Someone has to think about the policy.

I only learned about Ezekiel Emanuel from this thread, so looked for more info on Wikipedia.

The following is a brief summary of his credentials.

Ezekiel Jonathan "Zeke" Emanuel (born 1957) is an American bioethicist and fellow at the Center for American Progress. He opposes legalized euthanasia, and is a proponent of a voucher-based universal health care.

Emanuel completed an internship and residency at Beth Israel Hospital in internal medicine. Subsequently, he undertook fellowships in medicine and medical oncology at the Dana-Farber Cancer Institute, and is a breast oncologist...

Since September 2011, Emanuel has headed the Department of Medical Ethics & Health Policy at the University of Pennsylvania, where he also serves as a Penn Integrates Knowledge Professor, under the official title Diane S. Levy and Robert M. Levy University Professor.​

From Wikipedia, I cull the following points on where he stands.

... said that universal health care could be guaranteed by replacing employer paid health care insurance, Medicaid and Medicare with health care vouchers

... allow patients to keep the same doctor even if they change jobs or insurance plans

... supports Obama's plans for health care reform, even though they differ from his own

... end discrimination by health insurance companies in the form of denial of health insurance based on age or preexisting conditions

... reject a single-payer system, because it goes against American values of individualism

... distinguished between basic services that should be guaranteed to everybody from discretionary medical services that are not guaranteed
​

On euthanasia, Emanuel's position is found in the following points.

... said that the kind of legalized euthanasia practiced in the Netherlands would lead to an ethical "slippery slope" which would make it easier for doctors to rationalize euthanasia when it would save them the trouble of cleaning bedpans and otherwise caring for patients who want to live

... also expressed the concern that budgetary pressures might be used to justify euthanasia if it were legal

... said that claims of cost saving from assisted suicide are a distortion, and that such costs are relatively small, including only 0.1 percent of total medical spending
​

 

[happy2bretired]

Routine blood tests are cheap.



Or, if your doc is monitoring an "issue," the blood test is not considered to be routine and therefore can be done more frequently with Medicare paying.

So, if I'm reading this right, I can make an appointment with the lab, not the doctor, and get random blood tests? I'd be willing to pay for more frequent testing. I feel preventative testing is cheaper in the long run.


Sent from my iPad using Early Retirement Forum

 

[FUEGO]

Everyone should know that if there is no plan to take extreme measures to prolong life, they should not call the ambulance. They should call their local hospice organization. Medicare will cover 24 hour nursing, and a load of stuff the patient might need to be comfortable (given the patient qualifies, of course, but it's not real hard to qualify if the patient is really on the way out). The hospice teams deal with this all of the time and are usually really good at it. Last week my dad realized they just couldn't fix him this time; in and out of the hospital many times, and various systems teetering on the edge. Luckily he knew what was going on and was able to make the decision himself, along with my mom. I'm sure it would be harder if the advance directive had to be used. Anyway, after a few days of hospice at home, he left us. No beeping, not connected to a bunch of machines, in his own bedroom, no excitement, just family and the hospice nurse.

My grandfather chose his end about the same way. Fell over off the couch with a massive heart attack (not his first or second one) and told my grandma not to call the ambulance, that this was it, he was gone. I think he was in his mid to late 70's. He hated hospitals, hated the recovery process, and had probably spent more time in and out of hospitals and doctor's offices than he had actually living in the past couple years prior to his death.

Grandma chose hospice when her time came a couple years ago. No real chance of recovery if they were to do an operation to try to save her, and odds are she wouldn't even wake up from the procedure.