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Cranking down the intensity of care at age 75
Old 12-07-2015, 01:17 PM   #1
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Cranking down the intensity of care at age 75

Scott Burns on backing off the amount of medical care you want to receive after age 75.

Food for thought.
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Old 12-07-2015, 01:24 PM   #2
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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.
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Old 12-07-2015, 01:28 PM   #3
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But if all it's going to buy is a few more months in bed gasping for air, I'd pass.
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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Old 12-07-2015, 01:32 PM   #4
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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.
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.
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Old 12-07-2015, 01:46 PM   #5
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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.
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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Old 12-07-2015, 02:17 PM   #6
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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)
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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Old 12-07-2015, 02:20 PM   #7
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one can only hope they'll honor the wishes.
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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Old 12-07-2015, 02:22 PM   #8
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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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Old 12-07-2015, 02:40 PM   #9
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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.
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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Old 12-07-2015, 02:48 PM   #10
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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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Old 12-07-2015, 03:14 PM   #11
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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."
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...
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Old 12-07-2015, 03:14 PM   #12
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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 "Hope to Die at 75".

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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Old 12-07-2015, 04:35 PM   #13
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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.
It would have been pointless since the action had already been taken, so the issue was moot.
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Old 12-07-2015, 05:12 PM   #14
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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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Old 12-07-2015, 05:30 PM   #15
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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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Old 12-07-2015, 05:30 PM   #16
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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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Old 12-07-2015, 05:41 PM   #17
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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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Old 12-07-2015, 06:15 PM   #18
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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.
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...
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Old 12-07-2015, 06:30 PM   #19
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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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Old 12-07-2015, 06:30 PM   #20
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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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