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What surprising facts did you discover about the physiology of aging? Did Dr. Gawande’s descriptions of the body’s natural transitions make you more or less determined to try to reverse the aging process? The biggest physiology of aging is that people fear losing their freedom. “Whatever the limits and travails we face, we want to retain the autonomy-the freedom-to be the authors of our lives. This is the marrow of being human (Gawande, 140).” Freedom can be lost due to a multitude of events that leads to our inability to drive, process financial logic, walk, eat, cook, memory loss, grooming, and medication.
I am neither more or less determined to try to reverse the aging process. I am more determined to prepare for the future that we must all face as we age to ensure that I have all the freedom that I am capable of having given the multitude of circumstances that humans face when dealing with are failing body.
Seeking out an insurance policy to assist with long-term care to ensure that my family does not have to worry about the financial implications that are involved with either home care requirements or the cost of a facility that may be needed. Seeking out alternative facilities is best when one is healthy, and this includes making sure that the family is aware of what you want for living conditions as well as wishes with regards to healthcare in the event that one is unable to make such decisions.
Have we gotten rid of “poorhouses”? Is there anything that resembles them in the US today? How much of an improvement are today’s nursing homes? Why do most people dread going into them? Poorhouses do not exist in the US today, but they exist in other parts of the world such as India where the aging are dealing with families that do not embrace the traditional honoring of their elders.
This honor would normally include living with family members as we age but just like the rest of the world these traditions were based on people not living into their 80’s. The closest resemblance to poorhouses in the US today would be nursing homes.
The nursing homes are an improvement over poorhouses due to all residents having safety, food, and medical care. That is the extent of the differences between nursing homes and poorhouses. “Most consider modern old age homes frightening, desolate, even odious place to spend the last phase of one’s life (Gawande, 65). People dread nursing homes due to their inability to control their own lives. They must eat when told, eat what they are given, sleep on the facilities schedule, and they are not allowed to have their own furniture, pets, or snacks that may deviate from the prescribed directive of the facility. Nursing homes are very similar to other institutional facilities such as prisons. People want freedom in their lives; freedom to choose when to eat, what to eat, how much to eat and they want to have the ability to make mistakes that may not be in their best interest. Stripping people of basic freedom of choice is against the grain of our great country and should not be accepted for our elderly or debilitated.
What does it mean to you to treat someone with serious infirmities as a person and not a patient? What do you think matters most when you envision eldercare? What can be done to encourage more doctors to specialize in geriatrics? To treat someone with serious infirmities as a person and not a patient can only be accomplished once we start with basic communications. We must listen to what people want instead of acting on what we think they need. Healthcare as a whole focuses more on addressing problems instead of providing options. A patient or family member must clearly ask questions about length of time the patient can gain from receiving treatment. Many times, the treatment cannot be justified when compared to the quality of life that may be more debilitated with treatment than if the patient just receives necessary assistance to live the best life possible. Eldercare should focus on how a person can have the best life possible for their remaining days. People should be enabled to do what they feel is important based on what they want to accomplish with their remaining days. Many elders want to leave a legacy or give back to the community and this is not possible if the person is stuck in a nursing home or debilitated due to treatment of a problem without thought of what is best for the patient.
Geriatrics and end of life situations should all be treated the same from a patient’s perspective. “Whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life (Gawande, 260).” Primary care physicians should be the focus and not specifically on geriatrics. Geriatric patient care can be addressed by educating all doctors and patients on how to deal with aging. Patients need to learn how to eat without choking and physicians need to learn how to heal without a cure.
Why do you think it’s so difficult for doctors and/or families to refuse or curtail treatment? What would you be willing to endure and what would you not be willing to endure for the possibility of more time? How should priorities be set? How can we avoid ICUs that turn out to be, as one doctor commented, “a warehouse for the dying”? How do tradition and spirituality influence your concept of what it means to be mortal? Refusing or curtailing treatment is giving up on life. We have spent our entire life focused on success, winning, and finding cures to all that ails us. As a society we have reached a point that we must address our own mortality for self and others. “In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality and created a new difficulty for mankind: how to die (Gawande, 158).” Society has sought solutions such as hospice and now palliative care. Only through education can we more objectively approach how to die and even better how to live the rest of our lives.
Endurance is relative to the situation. I would ensure great pain and suffering to have more quality time with my family and friends. The priority should be set around quality of life and not on just our length of life. Palliative care is a step in the right direction and should continue to expand with regards to terminal or end of life scenarios. More studies need to be performed to demonstrate the need for treatment versus care. “For some conditions, hospice care seemed to extend survival…you live longer only when you stop trying to live longer (Gawande, 178).” Being mortal is only the end of my bodily existence. I believe that we live forever through our Lord, Jesus Christ. This does not change the fact that I want to live many years longer and pass on my knowledge/experience to my children. I do not believe in suicide, but I do believe that people should be able to make their own choice, and this is where palliative care can really play a role with easing the end instead of it being pain experienced on an island.
What realities are captured in the story of Lou Sanders and his daughter, Shelley, regarding home care? What conflicts did Shelley face between her intentions and the practical needs of the family and herself? What does the book illustrate about the universal nature of this struggle in families around the globe? Do you think most American families can care for an elderly relative? Could you? I took care of my mom when she became terminally ill at 50. The reality is that home care is not an easy task for everyone involved. The elder becomes more like a child in the relationship. There is appreciation and resentment about the entire situation on all sides. We do what we must to give back to those we love but the never-ending needs of those that are at end of life wear on those involved.
Shelley had no idea how long the situation would last. Her time spent taking care of Lou took away from her family and took away time from herself. She struggled with how best to take care of Lou versus just shoving him into a nursing home. We are not educated nor do we as a society have the supporting structure to deal with elders that need assistance from now to infinity. Most families in the US now all work full time jobs and then have deal with assisting those we love in later years of life. Helping is different than supporting and globally the “traditional family systems became less a source of security than a struggle for control- over property, finances, and even the most basic decisions about how they could live (Gawande, 19)”. I do not think that most families can successfully care for an elderly relative long term. I and other could accomplish the task at hand with education and strong support systems that enable families to deal with the independent needs of the elderly. Preparation is the key to success especially with regards to the financial freedom to have assistance either at home or an external home that enable the elderly to be as independent as possible. We must find a way to make the cultural changes towards people having the best life possible given their situational needs and desires. Then we have a “Winner, Winner Chicken Dinner!”.
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