In my view, everyone over the age of 18 ought to have appropriate health care and financial documents that will assign a trusted person to speak for them should they, for whatever reason, be unable to speak for themselves. But most people wait until they’re well into middle age before taking care of this important legal work. For those who die young, or are disabled because of an unexpected event such as a car accident or ill-fated dive into an unfamiliar lake, it’s too late. Their families may have to fight in the courts and in hospital wards in order to carry through with the decisions that they believe this young person would have wanted them to make.
“There is a great deal of focus today on nutrition and eating well,” says Kim English, BScN, MN, professor at the Trent/Fleming School of Nursing in Peterborough, Ontario. “We hear about no carb vs. whole carb, low fat vs. full fat, and ketogenic diets vs. paleo diets. However, what is often missing from this discussion is the necessity of vitamins in our body, particularly as we age.”
An amazing book of stories that will touch your heart and encourage you, especially if you are a caregiver. Carol Bradley Bursack also has an excellent website devoted to the elderly and their caregivers. - Carol Heilman
Dear Carol: My mother, who was in her early 80s, was doing well except for arthritis and high blood pressure. Then she fell and broke her hip. After surgery, she seemed not just foggy but completely irrational. The doctor said that this wasn’t unusual for someone her age considering what she’d been through and that she’d get better. Mom spent several days in the hospital and was then moved to a nursing home to recover and receive physical therapy. The staff was terrific with Mom. When I asked them if Mom would recover mentally, they were non-committal. They didn’t want to say that she wouldn’t but they seemed less sure than the doctor. As the weeks went by she didn’t improve mentally, though she was doing okay physically. The, five weeks after the surgery, she suddenly died. It’s hard to accept. How common is this? – Terri
...Now her parents are getting frail. Nancy had been through a lot of therapy so she could learn to cope with her childhood issues. She's come to terms with the fact that her father did what he thought he was supposed to do. She rightly felt, as a child, that he should recognize and stop the abuse her mother was doling out. Through therapy, she has learned to forgive her father for his lack of involvement and the fact that he didn't stop the abuse.
She's learned that he likely didn't know about a lot of it. She's also learned that he probably was in denial about what he did suspect, because he really didn't know what to do. He was wrong, but she's managed to forgive him for what he didn't know, and for what he didn't do about what he did know. Part of this is that her father recognizes where he failed. As he ages – and he's the one who is showing the need for care at this point – she feels she is capable of caring for him, in some "hands-on" capacity.
A study has shown that sedentary people face a similar risk of developing Alzheimer’s disease to those who carry a genetic risk for the disease. To me, this information is startling. It should provide enough incentive to get those of us who have a thousand excuses for not exercising, to get in the game. The study’s researchers at McMaster University in Hamilton, Ontario came to their conclusion after following the health of more than 1,600 Canadians over a period of five years. According to the abstract, physical exercise may be an effective strategy for preventing dementia.
The stories in this fine book showed us how others have gone through similar things with their families and that is somehow reassuring. There are some helpful suggestions but mostly there is the recognition that others went through the same thing. All we can do is our best. That is greatly reassuring during these difficult emotional times. If you are a caregiver, this is a must read. - Delores Edwards
...I am aware that many people under age 65 need assistance from their adult children or other sources because of health problems. That being said, having arthritis or heart issues, for example, doesn’t make a person cognitively impaired. Therefore, when we offer to help in these situations, the elders’ opinions and wishes must be taken into consideration. I know only too well that watching our parents get older is difficult. Ideally, they were once our anchors. No matter how difficult life became, there was comfort in knowing that our parents were around, even if they were half way across the country. Now, when we see their joints needing replacement, their skin wrinkling, perhaps even their memory recall slowing, we cringe. Whether or not we wish to admit it, we are afraid. We know that our parents are not immortal. One day we will be without them.
Many adults sit by the side of their dying loved ones, sometimes for days, working on accepting the loss of their physical presence and what this loss means in their lives. Then, a spouse, parent, child or friend suddenly rallies, becomes more stable and in some cases wants to talk. We grasp at what seems to be a turnaround and sigh with relief. They are going to hang on for a while; or are they?
This is National Healthcare Decisions Week (formerly "Day"). This book is a wonderful guide for deciding what you would want in the future. (Full disclosure: I wrote the foreword to the second edition).
"Code Blue!" A voice cries out in the Emergency Department. "Is there a doctor who can 'tube' a patient in Cardiac Cath Lab?"
These beginning lines of "Wishes To Die For: Expanding Upon Doing Less in Advanced Care Directives," by Dr. Kevin J. Haselhorst, prepare the reader for an adventure in self-examination.
The first chapter, titled "Self Determination," describes the author's own internal battle to balance his training as a doctor who cures at all costs with the wishes of his patients. Through his book, Haselhorst gently encourages us, the potential patients, to examine our right to decide how and under what circumstances we will be allowed a natural death.
In "Wish 10: Pre-Stamp Three Coins in the Fountain," Haselhorst writes, "I cannot remember the last time that I wished for a feeding tube, dialysis or ventilator." The author is not negating the importance of these treatments, but he is stressing that we must keep a record of our wishes up to date. He challenges us to examine what we really want at each stage of life. Any of the above efforts to increase our chances for survival may be a correct choice under some circumstances, but there often comes a time in our lives where less treatment is in our best interest. Unless our current wishes are made known, we may not be able to choose the manner in which our life comes to a close.
While reading the book I highlighted, underlined, and clipped colored markers on pages, thinking to myself that I must include this quote or that paragraph as I wrote. Before long, I realized that scores of quotes would be needed to do this work justice. The complete book with everything in context is needed before the reader can grasp the manner in which Haselhorst guides readers through their own journeys of self-examination.
That being said, what Haselhorst writes toward the closing of his book comes close to summing it up. He says that, "Death with dignity is only realized through the empowerment attained from engagement (of the patient)."
To address this belief, Haselhorst has designed a wristband similar to the well-known Livestrong Foundation wristband. The difference is that this band is bright yellow on one side and embossed with the words "Alpha care," meaning that the patient wishes doctors to keep trying all routes to keep him or her alive. The reverse side is a subdued blue and embossed with the words "Omega care" indicating the patient's wish to be allowed a natural death. With a twist of the wristband, a patient can communicate his or her current thoughts.
"Wishes To Die For" is an intellectual book, best-absorbed chapter by chapter. In my opinion, it's well worth taking this journey with the author to help us clarify our own beliefs. For more about Haselhorst and his work, visit www.wishestodiefor.com. The book "Wishes To Die For" is available at Amazon.com.
Previously published as a Minding Our Elders column for the Forum: Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at firstname.lastname@example.org.
Dear Carol: As my parents aged, we all thought that we were taking care of the legal issues necessary so that I, as Durable Power Of Attorney (DPOA) could handle anything that came along with their finances. Dad died two years ago, and Mom and I got through it. Now, Mom’s health is failing. She wanted me to change the account where her Social Security is deposited, so I called and found out that the DPOA would not allow me to do that. Fortunately, Mom’s memory is still good, so she was able to go to the attorney with me and she had me assigned as Representative Payee. The attorney told us that if Mom had a health issue where she couldn’t have answered the questions needed, I wouldn’t have been able to make the necessary changes. For us, that would have been merely inconvenient, but some people could have more important reasons for making these changes. Your column seemed to be the best way that I could think of to get the message out. Thanks for providing a great service. Janice
Bathing issues can be one of the most frustrating parts of dementia care, but a caregiver can lower stress with flexibility and insight. Here are some expert caregiver tips to consider when planning out bathing times for your loved one.