Article on aging and "slow medicine"

[ladelfina]

http://www.nytimes.com/2008/05/05/health/05slow.html

 

[Rich_by_the_Bay]

http://www.nytimes.com/2008/05/05/health/05slow.html

I was intrigued by the article, since it gives a name to what many uh...senior physicians do, while fewer young doctors do, in my experience.

I first came to this phenomenon when I was doing intense medical decision analysis in my research. "Slow medicine" actually turns out to be highly suitable to the geriatric patient not only from a humanistic standpoint, but also it brings the best outcomes.

A given life-sustaining or life-prolonging procedure has more to offer the younger the patient since the number of survival year reclaimed is greater. Furthermore, patient values change predictably with age, favoring comfort and dignity over raw survival (there is some question as to whether the boomers might temporarily reverse this trend, since a fair number equate acceptance of mortality or disability to be "giving up"). Of course you wouldn't withhold a treatment just because a patient is old, but you certainly would weigh its ups and downs accordingly.

It is a highly affirming to see this approach validated. BTW, a healthy dose of "slow medicine" is not such a bad idea for the younger set, either.

 

[shoe]

My 84 year old mother is a proponent of slow medicine although unaware of the terminology. She is fit and feisty and has all her marbles. Last October she went to a doctor at the Cleveland Clinic near our home. After doing blood work, it was found that she had elevated liver levels. The doctor, a great guy, ordered a cat scan and she refused him saying that she felt fine and thought it was a waste of good money when she wouldn't do anything even if he found something. I think the good doctor was hurt. A couple of weeks ago, she went back for a checkup and blood work and this time her liver levels were normal with absolutely no care of any kind. Of course she "told him so". I think slow medicine is a great idea for the elderly who want control of their lives.

 

[Khan]

A given life-sustaining or life-prolonging procedure has more to offer the younger the patient since the number of survival year reclaimed is greater. Furthermore, patient values change predictably with age, favoring comfort and dignity over raw survival

This reminds me of the question I sometimes ask the veterinarian: "How much better is he going to get?"

 

[unclemick]

I am going thru this now with a friend of 35 yrs, aged 68. I won't elaborate but my opinion of the American medical system is even lower than it was before - and I would probably be banned from this forum if I voiced my 'true' not calmed down opinion right now.

Sooo - you visit a lot of 40 something Doc.'s who get paid thousands from Medicare for cutting vs maybe a hundred bucks at most for an office visit and a prescription for pain meds(yet another area).

In five docs since New Orleans - have yet to get a perceived unbiased opinion, give any indication of hearing the patient's opinion or even reading the Doctor's records developed since 1973 via some scary trial and error in New Orleans.

heh heh heh - I hope I have the courage/opportunity for a bottle of vodka/Michigan snowbank when my time comes. .

 

[CuppaJoe]

Interesting, I downloaded a sample of the book they refer to. For my mom, a triple bypass at 83 was a great idea but a hip replacement at 89 was iffy. Her dentist, perhaps wisely, didn't complete a root canal at age 91, a few months before her death. It's hard to know which way to go.

 

[Moemg]

I'm a big believer in this approach. My Mom did have a knee replacement at 91 because her pain was intolerable but passed on treatment when they saw something on her kidney . She would probably not survive chemo so why torture her with it .

 

[simple girl]

We currently have a resident (I work in a nursing home) who recently was diagnosed with leukemia. He is refusing chemo and everyone is trying to convince him otherwise. When I asked his nurse if the chemo would cure him or just prolong his life, she didn't even know the answer. People just have a hard time with this "slow medicine" concept. I certainly would want a choice if it were me.

 

[Notmuchlonger]

My mother in law who in here 80s. Cant stand the dentist anymore. It drives her crazy as she put it. Since her chemo the drills and the scraping they do just really tears her up.

So she just goes less often. Hell I cant blame her.

 

[unclemick]

Hmmm - what if it's you?? How does one make a rational decision between:

If you're wrong(the doc) - you're sorry and I'm dead or

If I do this I'm guaranteed X more years at Y quality of life.

Sort of like my forum joke about living to precisely 84.6 because I read it in an IRS distribution table back in the 90's.

heh heh heh - I don't think the question can be answered - you place your bet and take your chances. .

 

[Khan]

Hmmm - what if it's you?? How does one make a rational decision between:

If you're wrong(the doc) - you're sorry and I'm dead or

If I do this I'm guaranteed X more years at Y quality of life.

Sort of like my forum joke about living to precisely 84.6 because I read it in an IRS distribution table back in the 90's.

heh heh heh - I don't think the question can be answered - you place your bet and take your chances. .

What is the downside of being dead?

 

[REWahoo]

What is the downside of being dead?

You mean other than you missing me?

 

[Moemg]

Hmmm - what if it's you?? How does one make a rational decision between:

Well it was pretty easy with my 91 year old Mom . If she can not live with the pain the procedure needs to be done . Anything else is a maybe .

 

[Khan]

Is it possible to check into a hospice and starve oneself (with painkiller assistance) at age 80 or so, without a terminal illness?

 

[Rich_by_the_Bay]

Is it possible to check into a hospice and starve oneself (with painkiller assistance) at age 80 or so, without a terminal illness?

No, I don't think that would be feasible under today's culture.

There are means for ethically ceasing the prolongation of life; a patient can simply not eat or drink at home, but that is not free from suffering (especially the thirst); there is terminal sedation designed to keep a patient in a state of unawareness once the desired level of life support is agreed upon, etc. And when there is pain in the face of no hope, increasing doses of opiates are often given to the point where the doses needed to control pain begin to suppress respiration. This is a gray zone, but I think there is wide discretion in such situations.