GlassHospital

Demystifying Medicine One Week at a Time

Category: aging (page 1 of 8)

End of Life Rallies

Let’s say your loved one is at the end of life. She’s 84, with advanced cancer that is no longer treatable.

A decision has been made to put her in hospice–which is a level of care more than an actual location. [Most hospice actually occurs at home.]

The patient waxes in and out of consciousness, sometimes lucid, but mostly not.

While no one is ready for her to die, this end-of-life process brings some solace–it’s what your loved one has indicated she wants, and the time at home without aggressive, often fruitless, medical treatment, allows other friends and family members to make visits and share stories.

One afternoon, she perks up and asks for a sandwich. This is surprising, because she’s barely eaten anything in the last ten days. But we get her that sandwich!

She nibbles at it, happy, but doesn’t eat much of it.

That afternoon, she’s talkative and engaged with others in a way that she hasn’t heretofore seemed able to muster.

Is she making a comeback? Healing from her illness?

More likely, this is what is called “rallying,” and while there’s ample anecdote of its occurrence in situations like this, we have very little understanding of it.

How does it happen? As a recent NYTimes article stated:

Physiologically, experts believe that the mind becomes more responsive when a hospice patient is taken off the extensive fluids and medications such as chemotherapy that have toxic effects. Stopping the overload restores the body to more of its natural balance, and the dying briefly become more like their old selves.

It’s deceiving because we think our loved one is getting better. And while she’s more like her old self, unfortunately, it’s not bound to last. Which is why it can be upsetting for some.

Spiritually, some suggest that the dying loved one is simply readying for transition–making sure that earthly concerns will be attended to in her absence and that final goodbyes may be uttered.

I’ve seen it–and especially in elders afflicted with dementia, it can be heartening to see them rally and seem to know what’s going on–accepting their impending death, and engaging with their loved ones before drifting off.

Minister of Loneliness

U.K. Minister of Loneliness Tracey Crouch

The United Kingdom has appointed a Minister of Loneliness, according to several news reports this month.

In announcing the appointment, British Prime Minister Theresa May said

I want to confront this challenge for our society and for all of us to take action to address the loneliness endured by the elderly, by carers, by those who have lost loved ones — people who have no one to talk to or share their thoughts and experiences with,

As more people live longer than ever, loneliness is compounded by physical infirmities that make social interactions difficult.

As a doctor, I consider loneliness a genuine risk to good health, even if the title of said minister reminded me of Monty Python’s famed “Ministry of Silly Walks.” (Apparently, I was not alone in this thought.)


@GlassHospital

How to Age Better: Live somewhere that combats Loneliness, Helplessness, and Boredom

At GlassHospital we strive to bring you interesting ideas about improving health and health care from places far and wide:

An article in the Saskatoon (Saskatchewan) StarPhoenix features Suellen Beatty, CEO of the Sherbrooke Community Centre in Canada.

Sherbrooke is a community centre, but it also is home to more than 250 residents — the kind of place we might call a ‘nursing home’ in the U.S. I love that in Canada they’re called Community Centres. That’s what any facility or neighborhood should strive for.

Suellen Beatty rejects the idea that nursing homes are places where people go to await death. Her team’s philosophy is to make old age more fun. Sherbrooke readily acknowledges the big three elements that compound the infirmities of aging: Loneliness, helplessness, and BOREDOM.

By loading up the day with activities, by listening to their residents and families, and by hosting hundreds of volunteers who see their job as providing fun and emotional sustenance to resident and day-visitor elders, Sherbrooke attracts visitors from all over the world who marvel at its success.

It reminds me a of a piece we ran a few years ago about a pretty special elder care facility in Arizona–one that put its residents’ happiness and comfort above all else — even when it means deviating from ‘standard’ protocols of elder care like eating bland food.

Take a look at what’s going on in Saskatchewan. We can all learn.

Marching for Science

Another piece I recommend: This time from Vox, in their First Person section.

It’s an essay by someone close to me who appreciates the scientific advancements which will help her survive the breast cancer she’s just been diagnosed with.

In Medicine, Less is Often More

Dr. Rita Redberg at #Lown 2016

Dr. Rita Redberg at #Lown 2016

Fewer visits.

Fewer tests.

Less harm from what we find, and less harm from any subsequent treatments.

Less cost.

More engagement with your own health, and what you can do to make it great. You can do it yourself.

Medical Me-Tooism

mediacalmetooism4b_wide-cf5d190b9eea4633b75292465de7ecb0d66a1bcf-s800-c85My father turns 78 in a few weeks. Though in my medical (and filial) opinion he’s aging well, he begs to differ — seeing his own aging as the piling on of indignities and infirmities.

Everything is relative, though, as he’s often taught me. When he compares himself to his peers, he often wonders if he should be undergoing the same medical routines and procedures that they are. My advice when he feels that impulse: Take a heavy dose of caution.

I wrote about this in an essay for NPR, accompanied by a wonderful collage by Katherine Streeter. Please click on the picture and take a look.

Older posts

© 2018 GlassHospital

Theme by Anders NorenUp ↑