“They are big on the smile, nod and move on approach.”
My son has been using that on us since he was 13.
A big YES to frequent visits and interaction between seniors and children. A nursery or elementary school within walking distance or even on site would be a wonderful thing. Until you are the elderly person stuck in a home with a bunch of other elderly people, you have no idea how much the sight of a youthful face is appreciated!
Visiting doggies are also much appreciated.
The Right Paperwork for Your End-of-Life Wishes
Once the patient has been lifted onto the conveyor belt of life support, it can be very hard to take him off. A Polst form can help.
http://opinionator.blogs.nytimes.com/2015/04/29/the-right-paperwork-for-your-end-of-life-wishes/
^ interesting info thanks oldmom4896
Related to that is this older article about advanced dementia and withholding antibiotics for pneumonia, often a cause of death,for those suffering advanced disease.
http://newoldage.blogs.nytimes.com/2010/07/23/when-pneumonia-follows-severe-dementia/
Thanks to both oldmom and southjerseychessmom for those articles.
My mother recently entered a ‘health system,’ formerly known as a nursing home, though she is in the ambulatory dementia unit for now. Upon her admission I went over a MOLST form with one of the social workers. Sounds just like the POLST, with “M” for Medical vs. “P” for Physicians. I appreciated how detailed it was: intravenous, yes or no, feeding tubes, yes or no.
I am now reconsidering the yes to antibiotics, based on the pneumonia article. I had said yes, since she is prone to UTIs and ear infections, and I wanted her to have treatment for those. Hopefully when we are discussing her final treatments (she’s relatively healthy for 88) we can review those answers.
Oldmom, I had the YES antibiotics, because of UTI’s too. I am glad she has the POSLT on file since I doubt my brother would follow her wishes for the rest. I am also using it next week when I take her to a new cardiologist; hoping to get her off the statins. I don’t think “long term” cholesterol reduction has any benefit in the long term she has left. A heart attack isn’t a bad way to go either, IMHO.
Did I also mention that they put her on Ensure? she has lost so much weight. Expected, yes, but another step down the ladder. Weighing options is really hard at this and really at every stage.
I was just reading another NY Times article that says not to use Ensure or other supplements because they’re basically liquid candy bars that have not been shown to improve outcomes.
http://newoldage.blogs.nytimes.com/2014/05/22/geriatricians-beware-liquid-candy/?_r=0
http://newoldage.blogs.nytimes.com/2014/03/07/geriatricians-question-five-common-treatments/
Remeron was pure evil for my father. Early in his diagnosis of dementia/Parkinson’s, he took that drug for depression. I think he must have gained 100 pounds overnight because of that drug. As soon as he stopped taking it, all the weight disappeared. My mother was so upset with him for eating all the time, but, really, according to another doctor I consulted, he couldn’t help it because he would have been hungry ALL of the time. By the time he died, I don’t think he weighed much more than 100 lb.
Thanks for sharing. I find the nuances of what type of care to provide at what point in time so interesting. For me, the backdrop of my father’s dementia provides some clarity on MOLST type of issues, but so do other, completely unrelated things. 1- he is 90. 2. He has one hip joint that is somehow not painful, but is bone against bone, rubbing for apparently for over a decade 3- he has a complex consequence of a prior surgery that could eventually necessitate cumbersome (from his point of view) management, as he is not a candidate for a 6 hour surgery to repair it. Enough is enough.
I saw the pneumonia article years ago and spoke with a nurse who described pneumonia as a gift for frail elders. No longer would treat that. My father is still happy with his life, enjoys conversations within his capabilities and remains engaged with his care givers and peers, just has zero short term memory and fewer long term ones every year. Still, I think that the thing I would regret the most as his proxy would be to miss a graceful exit and wind up with a painful period of complete debilitation, that I know he would never have chosen.
All of us here I have to figure this out without a crystal ball, and in some cases, solo. I find it very helpful to hear how others are thinking. Thank you.
My dad’s living will was very detailed and specific and a great help during his final hospitalization. I’d be happy to forward it to anyone here who PMs me.
When my dad passed away 2 years ago, pneumonia was a blessing. He had fallen off the cliff into full-blown Alzheimers, terrible agitation, and was violent. He had a DNR. His living will was also specific and I knew that while we would treat UTIs, we would not treat pneumonia.
It created a rift in our family, but I knew what my dad wanted, my mother was in agreement, and she got the final say.
On the other hand there’s this:
When a Medical Proxy Saves a Life
My grandmother thought she was ready to die. She was wrong.
http://opinionator.blogs.nytimes.com/2015/04/29/when-a-medical-proxy-saves-a-life/
IMO, that’s a “I lived because I didn’t wear my seatbelt,” story, oldmom. Nice for her, but I’d guess that a tiny, tiny percentage of elderly patients under those conditions come out of that the way her grandmother did. I am not impressed with the way her mom went against grandma’s wishes.
My mother called me… from dementia land in an assisted living… I was so excited she called me, instead of me calling her… she wanted to talk to her daughter (it was me and she did not get it)…she wanted to tell me to ask my brother to call her… grrr.
{{rockymtnhigh}} hugs. If it happens again, just hang up and call her right back? At least she was thinking of you. That is where meeting them in their reality can be easier and you can still have the connection.
I am going up to see my Mom next week. Right after a sigmoidoscopy. Don’t know which is harder to face sometimes. It is sad to see her all shrunken both in body and mind. She was a “bigger than life” kind of person… back in the day.
Thanks, travelnut, that’s really helpful, confirmed by dentmom.
Hugs, eso. You’re going through a hard time right now.
I can’t be impressed with the “saved a life” story either. She went on to live a life that many of us would think of as a quality of life, but I’m not convinced the grandmother thought so.
RMH, you are the person she called when she needed something. She must know on some level you care and are important to her.
Have a good visit eso. I haven’t faced much physical frailness with my parents, but seeing my dad so frustrated with thoughts being so fleeting breaks my heart.
Thank you. During my dad’s final hospitalization, I made decisions based on my dad’s living will that resulted in his death probably sooner than it would have happened without these decisions. I am 99.9 percent sure that it would have been the decision he would have made for himself if he had been capable of doing so, and that it was the right thing to do. But of course it’s scary to have had that power and every once in a while I have second thoughts.
No second thoughts, oldmom. There are few certainties in medicine. We make the best decisions we can, given what the doctors tell us and what we believe is best for our parent. You acted in good faith, and with love, and that’s all any of us can ask when our time comes.
Any thoughts on sandals for elderly men with swollen feet? (Exciting topic, I know ). I bought my 84 year old father velcro sandals - Dr. Scholls brand - thinking that having sandals might make it easier for him to go to the pool and walk in the heated pool. But the straps’ velcro did not line up properly for him - since his feet are so swollen. I offered to take the sandals to a shoe repair store and see if they could add more velcro - but of course he was just disgusted at that point and told me not to bother and to just return them. Kind of puzzling as I bought the same size as his velcro shoes from the same company and those fit ok.
Of course, he prefers to sit and complain rather than try to find a solution to anything.
Any recommended brands?