While Alzheimer’s specific drugs may help slow symptoms for some people, they also may increase the risk of hip fractures, fainting, urinary problems and other health issues. Most researchers now think that a time comes when many medications for the elderly are no longer beneficial and may be harmful.
Dear Carol: My dad is 79 and has suffered from aggressive prostate cancer for several years. What could be done has been done, so far, but the cancer has now spread to his liver and bones. We want Dad to have chemotherapy but his doctor says that he’s not a candidate for this treatment. Dad says he doesn’t want to go through it anyway. I think that they are just giving up. Shouldn’t the doctor be encouraging Dad to fight the disease? I thought that doctors were supposed to do everything to save lives. I think if the doctor insisted, Dad would agree. What can we do so that Dad gets all of the treatment possible? FMC
...Unlike these other serious illnesses, Alzheimer’s disease (AD) and dementia are extremely difficult to categorize into neat stages of progression that are typically used to determine whether hospice care is appropriate. Life expectancy is difficult, if not impossible, to pinpoint for a patient affected by AD and related conditions like vascular dementia, Lewy Body dementia, and frontotemporal dementia.
Forgiveness nearly always changes lives for the better, even if one of those lives is about to end. Whether we are the forgiver or the person being forgiven, the blessings flow both ways. To me, forgiving one another for being flawed human beings is an important key to a reasonably serene life. However, this mutual understanding is not always easy to come by.
Dear Carol: My husband is seriously ill with lung disease. He also has crippling arthritis and neuropathy. His children from a previous marriage have been grown adults during our 15 years together and we used to get along fine. They don’t live in our community and don’t visit often, but now that my husband is so ill they feel that they must control his care. All three want aggressive care for their dad even though my husband decided years back that when he got to this stage he wanted comfort care. The kids consider palliative care giving up and blame me for their dad not wanting to “keep fighting.” I’m tired of being the recipient of their anger over their dad’s health. Virginia
Last year, I reviewed the first edition of "Wishes to Die For" for my newspaper column. The review can be read below. I was later asked to write the foreword for this second edition. It was an honor to do so because I still consider this the best book available for people who want to learn how to take control of living until they die. - Carol
“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 Kevin J. Haselhorst, MD prepare the reader for an adventure in self-examination...
Our culture is steeped in language that makes accepting the terminal diagnosis of ourselves or a loved one more difficult to accept than it needs to be. Doctors say, “I’m sorry, there’s nothing more we can do. You might want to look into hospice care.” Patients tell their doctors that they want “aggressive treatment,” until there is nothing else that can be done, then they will go on hospice care. The crux of these conversations is that medicine will do everything possible and then when you give up you will go on hospice care.
...Many of us start our caregiving career by assisting an elder in his or her home, or we have a spouse who declines and we become the default caregiver in our own home. This care expands to a point where we need some type of respite, often in the form of in-home care agency help. Eventually, the move to assisted living or even a nursing home may become necessary for everyone's health and wellbeing. Whatever happens, we remain caregivers. Many of us continue to see our care receiver daily. Most of us continue to be involved as advocates and support throughout the time of need. When our loving attention and care is no longer needed, we can, indeed, feel lost.
Dear Carol: My mother is in a nursing home and has been on and off of hospice care twice, since improvement in her health has disqualified her for the program each time. This should be good news, but with or without hospice she is still very ill with lung disease. She also suffers from the effects of past chemotherapy and her mind is increasingly foggy. She says she wants to join Dad, who died years ago. This back and forth business is tearing me apart and, to be honest, it’s wearing me out to a point that I can hardly function. I need a vacation, but I’d never forgive myself if she died and I wasn’t there. I sometimes wish she could just die now, as she wishes, and get it over with. How do I get over the guilt of having these terrible thoughts? EMB
Hospice care is palliative care, but palliative care is not hospice. The difference between these two types of care is something that I have found difficult to clarify myself let alone explain to others. However, this care is a fundamental part of treating any chronic or terminal illness.
With that in mind, I contacted Kimberly Angelia Curseen, M.D., Associate Professor of Internal Medicine at Emory School of Medicine and Director of Outpatient Supportive/Palliative Care Clinic Emory Healthcare. Dr. Curseen has a passion for palliative care and was happy to clarify this important type of medical care that seems to pass under the radar.