Stay in charge at the end of life

Gone are the days when Mom or Dad, Grandma or Grandpa would quietly accept whatever their children planned for their once-called “golden years.” Though sons and daughters tend to become parents to their parents, the tide is turning. As chronologically older adults seem to be younger and healthier, they want to stay independent and self-sufficient as long as possible. To do this, it’s necessary to learn what’s required and have a plan for the future. 

As part of The Greens at Cannondale’s Community Education Series, Dr. Alan Radin, a geriatric specialist who has been treating patients for 36 years, recently shared his knowledge and personal experience with a large and eager audience. Staying in charge of your life takes effort. There are specific choices to be made and documents to possess: living wills, health care representatives, decisions about life support procedures. Though they may be referred to only when spoken communication is impossible, they are key to staying in charge.

Do you want cardiopulmonary resuscitation (CPR)? Do you want to be fed artificially if  you can no longer eat on your own? Do you want everything possible done to keep you alive, even if you are ready to die? These can be rather grim subjects, but Dr. Radin handled them with his characteristic practicality. His talk gave an inside view of medical and legal practices as they affect older adults.

“Advance directives” is the overall designation of personal decisions regarding end-of-life care. Unless they are provided, in writing, to your own doctor, hospital, nursing home, or assisted living residence, and to your health care representative, your choices won’t be known.

Each person in the audience received a packet: “Connecticut Advance Directives: Planning for Future Health Care Decisions.” It answers questions from “What is an advance directive?” to “Can I revoke an anatomical gift (organ donation)?” The helpful pamphlet is from the Connecticut Department of Social Services Bureau of Aging, 25 Sigourney Street, Hartford CT 06106.

Dr. Radin clarified some misconceptions. For instance, there’s a general understanding that feeding tubes will prevent aspiration pneumonia. “Not true,” said Dr. Radin. “They can cause pneumonia. CPR can save lives, but when a person is old, fragile and sick, CPR  doesn’t always work.” He also called the Internet “treacherous. They always list the worst things first.”

The doctor shared his own experiences with his parents.

“My mother was in Norwalk Hospital, where I know just about everybody and they know me. But my father was in a Long Island hospital, where I was a stranger. If it wasn’t for my Dad’s full range of advance directives, and my identification, in writing, as his health care representative, I don’t know what might have happened.”

When asked whether a spouse is automatically considered the health care representative, the answer was, “No. And that’s good. It’s very hard for a spouse to be objective.

“Unfortunately, medicine has been so chopped up with physicians assistants, hospitalists, nurse practitioners, that your own personal doctor, the one who knows you best, may not be on the scene making sure your decisions are followed. That’s why the documents with your choices are so important,” he said.

“When you can speak for yourself, nobody can override your wishes. When you can’t speak for yourself, you need all the essential equipment to make sure you’re the one who stays in charge. Probably the largest amount of money will be spent on your care during the last months of your life. When making end-of-life decisions, ask yourself whether you want a long, miserable life or a shorter, better one?”

The next in The Greens education series is on May 21.