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Director's Message

On Being Mortal

Director’s Message March 2015:   Being Mortal

I recently read Dr. Atul Gawande’s book “Being Mortal” and I highly recommend it.  You may have seen him on the book-promotion circuit on Frontline morning talk shows or on the Daily Show, or perhaps you have watched his TED talk.  He is a surgeon at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School as well as a writer.  Through research and stories, Gawande describes how we—both people and medical professionals—avoid dealing with death, resulting in high cost and great discomfort.  Reading the book prompted me to commit to doing more at PSRC to engage in conversations about quality of life and death.

Gawande reviews the relatively rapid changes in how we handle aging and death in the U.S.   As recently as 1945 most deaths were quick, precipitous and occurred at home, but by the 1980’s, 83% died in hospitals.  U.S. life expectancy in 1900 was under age 50; today it is past 80.  Thirty years from now we will have as many people over age 80 as are under age 5.   There aren’t enough people choosing geriatric medicine to treat this growing population.  Gawande points out that in 1900, 60% of those over age 65 lived with family and by 1975 that number had dropped to less than than 15%. A quarter of Medicare spending is on the 5% of patients who are in the last year of life; most for the last couple of months but with little effect.

Societies respond slowly to such rapid change.  Gawande describes the often-unintentional evolution of elder care from the 19th Century, when poor houses were where people went when they did not have family caregivers and their funds ran out.  Care moved from home to hospital to nursing home to assisted care, continuing care and Eden Alternatives, and back home with homecare and village networks. Now, much care is provided by families once again.  It has been exciting and challenging for me to observe these evolving transitions and develop PSRC’s role as a resource center to help people make the right choices for them.

I think we are on the brink of the next sea-change.  Gawande is determined to change the way we manage end of life.  He describes what he learned from geriatricians, hospice workers, and his patients about the critical need for patients and doctors to be able to talk about the end of life and to shift the focus.  “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that.  It is to enable well-being. And well-being is about the reasons one wishes to be alive (p. 259).”

Gawande quotes one geriatrician: “The job of the doctor is to support quality of life: as much freedom from the ravages of disease as possible and the retention of enough function for active engagement in the world (p. 41).  As a culture we value independence above all else.  Gawande argues that what older adults really want is autonomy, the ability to make decisions; often choosing autonomy with some risk over safety.  We seek purpose and worth throughout the lifespan.  We want to avoid being so diminished that who we are becomes disconnected from who we were or who we want to be (p. 141).  Hospice workers focus on helping a person have the fullest possible life right now.  Surveys of critically ill people indicate their top concerns include not suffering, not being a burden on others and achieving a sense that their life is complete (p. 155).

“Endings are not controllable...No one ever really has control, but we are not helpless…courage is the strength to recognize both realities.  The sick and aged have priorities beyond being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives (p 243).”

It excites me to think about PSRC’s role in this change.  I believe PSRC can help Princeton move toward what La Crosse WI did in the 1990s, where more than 85% of residents who died had written advance directives (p. 179) All admitted patients wrote one.  One doctor noted that this has made his job easier, not because the specifics are written (they change over time and with changing circumstances), but because people have had conversations that helped them accept their mortality, navigate their anxiety, and identify what their definition of “quality of life” is. Professionals need to sit down and listen carefully and then provide information and guidance.  Gawande shares the questions a palliative care specialist taught him:  what do you understand your prognosis to be, what are your concerns about what lies ahead, what kind of trade-offs are you willing to make, how do you want to spend your time if your health worsens, who do you want to make decisions if you can’t (p. 182-3).  He reports studies that indicate that people who had discussions with their doctors were more likely to die at peace and in control of their situation and to spare their family anguish. Those who chose palliative care actually lived 25% longer! (p. 177).

PSRC professional staff will listen to you if you want help working through these questions so you can begin the conversation with your family and doctor(s).   We will help you complete an advanced directive.  And this month we will start a new discussion group: Conversations on Being Mortal.  We will discuss the concepts raised in the book, explore what quality of life means to each of us, and work on conquering our discomfort talking about death and dying, and follow where that takes us.  Join us on Monday March 23 at 2 pm.

 

Susan W. Hoskins LCSW

   Open DOCX file ( 18.79KB) . . .

Previous Messages

On Being Mortal

Mentoring

Leaving A Legacy

October 2014 An Age Friendly Future

September 2014 Annual Report

July - August 2014

June 2014 - Romance After 50

May 2014 - Your Virtual Estate

April 2014 - Memory and Forgetting

March 2014 - Aging in Community

Observational Stay

February 2014 - Family Caregiving

January 2014 - Attitudes about Aging

December 2013 - Giving

November 2013 - Healthcare Marketplace

October 2013 - Annual Report 2013

September 2013 - Total Brain Health® Fair

July - August 2013 My cat, My Father and Me

June 2013 - Age Friendly Communities

May 2013 - Navigating a Changing HealthCare Landscape

April 2013 - Becoming Visible

March 2013 - Navigating Life’s Transitions

February 2013 - Partners in Caring Princeton

January 2013 - Men as Caregivers

December 2012 - The Safety Net

November 2012 - Going Solo

October 2012 - Documenting Your History

September 2012 - A Journey of Transformation

July - August 2012 - Gratitude & Moving

June 2012 - Diversity

May 2012- Aging in America

APRIL 2012 - TEN YEARS

March 2012 - Patient-centered Care

February 2012 - Can you Spare an Hour?

January 2012 - Challenges & Opportunities

December - Are you Prepared for Emergencies?

November - We need YOU!

October - Chocolate for Memory

September- Looking Back and Looking Forward

July - August 2011; Ageism

June 2011 - Accessibility

May 2011 - Paper retention

Knit Wits, April 2011

Lessons and Legacies, March 2011

Independent Living February 2011

Home Safety January 2011

Witness to my Life December 2010

Elections, benefits and open enrollment November 2010

Retire in 3D!

Strategic Planning September 2010

Am I Old? July 2010

Memory Clutter June 2010

Aging In America May 2010

Volunteering April 2010

Spirituality March 2010

Estate Planning February 2010

Encore Careers January 2010

Hiring Home Care December 2009

Annual Giving by Sharon Naeole November 2009

Flu Pandemic 2009 October 2009

Healthy Memory, Healthy Mind September 2009

A Personal Perspective on Caregiving July/August 2009

TRANSPORTATION May 2009

Wei Ji: Crisis, Danger and Opportunity April 2009

Write your own obituary March 2009

Hobbies February 2009

Hope and Vision in Challenging Times
January 2009

Medicare Changes 2008: Take A Look! December 2008

Scams, Frauds and Rip-offs November 2008

Engaged Retirement: Beyond Financial Planning October 2008

September 2008 Caregiver Dilemmas

Finding Rhythm and Purpose July/August 2008

Spring Cleaning II June 2008

V + OA = ER (Volunteering + Older Americans=Engaged Retirement)May 2008

Spring Cleaning April 2008

Have You Had the Talk Yet? March 2008

Get Moving with FitRhythms™! February 2008

My Condolences January 2008

Advocacy December 2007

What Are Social Services? November 2007

Sensitive Topics October 2007

Plan for the Future September 2007

The Up-side of Aging Summer 2007

Volunteering June 2007

Strategic Plan May 2007

National Conference on Aging: Let's ReThink Aging April 2007

Brain Health March 2007

Resiliency February 2007

Transportation January 2007

Season of Giving December 2006

Medicare Part D November 2006

April Hill McElroy October 2006

Civic Engagement September 2006

Change June 2006

White House Conference on Aging May 2006

Hearing Loss April 2006

GrandPals March 2006

Lets Talk February 2006

Eldertopia January 2006

Hoarding December 2005

Annual Report: November 2005

Are You Prepared? October 2005

Planning Ahead October 2005

Watch Your Language September 2005

Medicare Part D Summer 2005

Sue Tillett June 2005

The End of the Journey May 2005

Clutter March 2005

New Dietary Guidelines February 2005

Transitions January 2005

Funding December 2004

Caregiving November 2004

Civic Engagement with GrandPals October 2004

A New Look September 2004

Safe Driving Summer 2004

Food Safety June 2004

Communication June 2004

The Challenge of Giving Care May 2004

Seniors On The Move April 2004

Depression March 2004

McGreevey February 2004

Medications January 2004

Random Acts of Kindness December 2003

Civic Engagement November 2003

Reverse Mortgages Oct 2003

Emergency Preparedness, Jan 2003


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