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Cranking down the intensity of care at age 75
12-07-2015, 12:17 PM
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#1
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Moderator Emeritus
Join Date: Feb 2006
Location: San Francisco
Posts: 8,827
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Cranking down the intensity of care at age 75
__________________
Rich
San Francisco Area
ESR'd March 2010. FIRE'd January 2011.
As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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12-07-2015, 12:24 PM
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#2
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Moderator
Join Date: Dec 2007
Location: Eastern WV Panhandle
Posts: 25,346
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Much depends on the quality of life and what the medical care is doing for the recipient. If it will allow them to continue independent living and so on then I see no reason to refuse it.
But if all it's going to buy is a few more months in bed gasping for air, I'd pass.
__________________
When I was a kid I wanted to be older. This is not what I expected.
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12-07-2015, 12:28 PM
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#3
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Administrator
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,726
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Quote:
Originally Posted by Walt34
But if all it's going to buy is a few more months in bed gasping for air, I'd pass.
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You can as long as you stay in your bed. Problem is, once you leave it and go to a hospital, other people make decisions based on their priorities, and they may not give you the option to pass.
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12-07-2015, 12:32 PM
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#4
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Moderator
Join Date: Dec 2007
Location: Eastern WV Panhandle
Posts: 25,346
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Quote:
Originally Posted by MichaelB
You can as long as you stay in your bed. Problem is, once you leave it and go to a hospital, other people make decisions based on their priorities, and they may not give you the option to pass.
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Well, we both do have health care directives and that is one of the issues addressed in them. There has to be a "reasonable expectation" that any treatment given will be effective. While I know that there is some wiggle room in that phrase DW is the primary and a nephew is the secondary decision maker. We've had that discussion and I've made it clear what I want. After that one can only hope they'll honor the wishes.
__________________
When I was a kid I wanted to be older. This is not what I expected.
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12-07-2015, 12:46 PM
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#5
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Thinks s/he gets paid by the post
Join Date: Feb 2014
Location: Williston, FL
Posts: 3,925
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Quote:
As he sees it, he will have accomplished most, or all, of what he hopes to do in life by age 75. His children will be married. His grandchildren will have been born. All that would remain is the long downhill trip that we call old age. He would choose to avoid it.
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I think as healthcare gets more scarce, pain management will be the preferred choice given to many older people, rather than surgery.
If insurance quits paying for dialysis, BP meds, hip, knee and heart surgery, cancer and other routine but expensive care for people after 75, it would free up a lot of resources to go to people that are still productive (or at least younger)
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FIRE no later than 7/5/2016 at 56 (done), securing '16 401K match (done), getting '15 401K match (done), LTI Bonus (done), Perf bonus (done), maxing out 401K (done), picking up 1,000 hours to get another year of pension (done), July 1st benefits (vacation day, healthcare) (done), July 4th holiday. 0 days left. (done) OFFICIALLY RETIRED 7/5/2016!!
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12-07-2015, 01:17 PM
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#6
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Moderator Emeritus
Join Date: Oct 2007
Location: Portland
Posts: 4,946
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Quote:
Originally Posted by Senator
If insurance quits paying for dialysis, BP meds, hip, knee and heart surgery, cancer and other routine but expensive care for people after 75, it would free up a lot of resources to go to people that are still productive (or at least younger)
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I hope the insurance plans mandate some sort of alternative care if they go this route. You really don't want to be telling the grandkids "Grandpa turned 75 today. He's going to be living on a farm upstate where he can run and play."
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12-07-2015, 01:20 PM
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#7
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Moderator
Join Date: Feb 2010
Location: Flyover country
Posts: 25,362
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Quote:
Originally Posted by Walt34
one can only hope they'll honor the wishes.
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This is the crux of the matter.
When my dad went in the hospital for his terminal stay I gave them a notarized copy of his advance directive, which they ignored.
"How could you do that when his advance directive specifically said he didn't want it?" I asked.
"We don't accept those" said the chief resident. The poor guy had to live through about four extra months of misery as a result.
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12-07-2015, 01:22 PM
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#8
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,148
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I guess it depends on the care. I wouldn't want to be denied cataract surgery if I needed it. And if I had a joint fail, I would want to have it replaced if it meant I was still mobile. But I could imagine telling my doctor - no more routine meds (if I were on any).
We'll have to see I guess.
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Retired since summer 1999.
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12-07-2015, 01:40 PM
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#9
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Thinks s/he gets paid by the post
Join Date: Mar 2010
Location: Kerrville,Tx
Posts: 3,361
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Quote:
Originally Posted by braumeister
This is the crux of the matter.
When my dad went in the hospital for his terminal stay I gave them a notarized copy of his advance directive, which they ignored.
"How could you do that when his advance directive specifically said he didn't want it?" I asked.
"We don't accept those" said the chief resident. The poor guy had to live through about four extra months of misery as a result.
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That sounds like a situation where a letter from a lawyer is in order. Citing the relevant parts of state law. That letter will go to the general counsel to the hospital which may make a difference.
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12-07-2015, 01:48 PM
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#10
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jan 2007
Location: New Orleans
Posts: 47,500
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I have been thinking for some time about how to respond to this post, and how I could communicate my feelings about old age, and death, and bravery, and giving up, and what we should expect of ourselves as human beings. Suddenly it occurred to me that what I was wanting to verbalize, had already been beautifully articulated in a poem years ago. So here it is, and I hope that those reading pause to think about it.
"Do Not go Gentle Into That Good Night", Dylan Thomas, 1952
Quote:
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.
Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.
Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.
Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.
And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.
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Already we are boldly launched upon the deep; but soon we shall be lost in its unshored, harbourless immensities. - - H. Melville, 1851.
Happily retired since 2009, at age 61. Best years of my life by far!
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12-07-2015, 02:14 PM
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#11
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Thinks s/he gets paid by the post
Join Date: Feb 2014
Location: Williston, FL
Posts: 3,925
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Quote:
Originally Posted by M Paquette
I hope the insurance plans mandate some sort of alternative care if they go this route. You really don't want to be telling the grandkids "Grandpa turned 75 today. He's going to be living on a farm upstate where he can run and play."
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It is almost a given it will happen at some point. Euthanasia is legal and practiced in other countries. It may start like this "Gramps, why not just take these pills so you can pass on your assets to us"
At least if you are in the 'right' state, you can smoke medical marijuana to help...
__________________
FIRE no later than 7/5/2016 at 56 (done), securing '16 401K match (done), getting '15 401K match (done), LTI Bonus (done), Perf bonus (done), maxing out 401K (done), picking up 1,000 hours to get another year of pension (done), July 1st benefits (vacation day, healthcare) (done), July 4th holiday. 0 days left. (done) OFFICIALLY RETIRED 7/5/2016!!
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12-07-2015, 02:14 PM
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#12
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jan 2008
Location: NC
Posts: 21,305
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Some may want to refer to the discussion that took place here when the Atlantic article came out a little over a year ago http://www.early-retirement.org/foru...5-a-73750.html.
Not surprisingly some believe the longer they live the better come what may, while others were not keen on more poor quality years at the end. Unfortunately it's easier to speculate while we're far from our last years.
My 93-year old parents didn't enjoy their last few years at all, and they were still living independently at home. And my MIL spent a few years in assisted living then nursing homes - and hated almost every minute of it. She passed away bitter, unable to recognize her own family. That's not living to me. I know I will be looking for the exits if I'm ever institutionalized with no expectation of release at all. To each his/her own...
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No one agrees with other people's opinions; they merely agree with their own opinions -- expressed by somebody else. Sydney Tremayne
Retired Jun 2011 at age 57
Target AA: 50% equity funds / 45% bonds / 5% cash
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12-07-2015, 03:35 PM
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#13
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Moderator
Join Date: Feb 2010
Location: Flyover country
Posts: 25,362
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Quote:
Originally Posted by meierlde
That sounds like a situation where a letter from a lawyer is in order. Citing the relevant parts of state law. That letter will go to the general counsel to the hospital which may make a difference.
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It would have been pointless since the action had already been taken, so the issue was moot.
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12-07-2015, 04:12 PM
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#14
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Moderator Emeritus
Join Date: Sep 2007
Posts: 17,774
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Scott Burns is saying in the OP's link that unlike Dr Emanuel (now 58) who feels his usefulness in life will be over at age 75, he wants to live a long life in a world where the elders are respected and their experienced perspective is cherished. Burns is now 75 and obviously feels he is still valuable in that he continues to write his columns, etc. I don't think Burns really addresses forgoing any healthcare beyond saying he is closer to Emanuel's philosophy than to Kurzweil's (Burns's article links to Kurzweil as well as to Emanuel).
Yesterday I started chatting in a restaurant lobby with the sweetest woman standing next to me while we were waiting for people; we just talked about life in general for about ten minutes. She is 85, quite active, and was meeting her 30-something granddaughter for brunch. I wish I had exchanged phone numbers with her, she made such an impression on me. I think she still has a lot to offer the world. Perhaps she is an example of what Burns is talking about. And I'm certain Rich-by-the-bay is too.
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“Would you like an adventure now, or would you like to have your tea first?” J.M. Barrie, Peter Pan
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12-07-2015, 04:30 PM
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#15
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: May 2014
Posts: 7,373
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So much depends on the circumstances. My grandfather turned down surgery for colon cancer when he was 95 and I thought that was wise; his mind was starting to fail, he'd buried two wives and couldn't live independently anymore. A woman in our church in her 80s decided to get an autologous bone marrow transplant (thank you, Medicare) when she developed non-Hodgkin's lymphoma and it didn't work out. That, to me, was an example of going way overboard for a slim chance at a longer life.
DH is 77 and the costs of keeping him going aren't that bad- some prescriptions and doctor visits, but no hospitalizations in the last 5 years (a couple in the previous 5 years, each for a subdural hematoma after a fall). He was healthy and active enough to thoroughly enjoy our trip to Iceland a couple of months ago.
I like to think that each of us would make reasonable decisions if we were frail and generally failing and some doctor proposed extraordinary and expensive means to keep us alive if we developed something serious. We don't want chemotherapy unless it has a good chance of sending cancer into remission, instead of slowly killing us.
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12-07-2015, 04:30 PM
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#16
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Moderator
Join Date: Oct 2010
Posts: 10,725
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Setting the number of years at 75 (or any number) seems kind of absurd to me; there are 85 year olds that have never been sick, get a lot out of life, and have a lot to give and 55 year olds that are consuming healthcare resources at a rate of a million a year and are just suffering. It would seem more logical to project quality of life and medical expenses, then make a go / no-go decision on that.
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12-07-2015, 04:41 PM
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#17
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Thinks s/he gets paid by the post
Join Date: Dec 2015
Location: Santa Paula
Posts: 4,077
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Not me
I am 77, and these have been the best years of my life. I remarried after my wife of 30 years passed away, and we have traveled a lot of the world together.
I fly for Angel flight and Pilots & Paws, volunteer on a tourist train, prepare taxes for low income people, and do data entry and data reduction for a local food bank. I also counsel widows and widowers on a grief recovery website.
"Come grow old with me, the best is yet to be"
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12-07-2015, 05:15 PM
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#18
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jan 2008
Location: NC
Posts: 21,305
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Quote:
Originally Posted by sengsational
Setting the number of years at 75 (or any number) seems kind of absurd to me; there are 85 year olds that have never been sick, get a lot out of life, and have a lot to give and 55 year olds that are consuming healthcare resources at a rate of a million a year and are just suffering. It would seem more logical to project quality of life and medical expenses, then make a go / no-go decision on that.
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It is absurd, but I assume the author/editors very deliberately chose a provocative age/title that would get people's attention to sell more magazines and generate more readers - journalism 101, and it seems it worked.
Many people in the other thread fixated on age 75 and never seemed to grasp the concept, as you noted - " it would seem more logical to project quality of life and medical expenses, then make a go / no-go decision on that." Age 75 is too young for some, but unfortunately it might be too old for others. Age 75 was not the point...
__________________
No one agrees with other people's opinions; they merely agree with their own opinions -- expressed by somebody else. Sydney Tremayne
Retired Jun 2011 at age 57
Target AA: 50% equity funds / 45% bonds / 5% cash
Target WR: Approx 1.5% Approx 20% SI (secure income, SS only)
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12-07-2015, 05:30 PM
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#19
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Full time employment: Posting here.
Join Date: Sep 2010
Location: Orlando, Fl
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This story is from August of this year. Gill Pharaoh was a 75 year old british nurse who was not ill, but chose to end her own life in order to avoid the difficulties of aging. She went to an accompanied suicide clinic in Switzerland, where assisted suicide is legal, and citizens of other countries are accepted.
Gill Pharaoh died at Swiss suicide clinic because she didn’t want to be a burden | Daily Mail Online
Switzerland has struggled with their own laws surrounding this, but is committed to continuing the provision of these services.
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"Some people describe themselves as being able to see things as a glass half full. For some, the glass is half empty. Me? I can't even find the f***king glass."
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12-07-2015, 05:30 PM
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#20
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Recycles dryer sheets
Join Date: Nov 2015
Posts: 206
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A physician friend once told me that a very large part of the total healthcare expenditures in the US are for patients in the last two months of life. I guess one of the problems is in deciding if the patient is really terminal or not. maybe it just turns out that the ones that don't make it were really sicker than those that recover.
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!
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