Blogging in Place

At Peace: Choosing a Good Death After a Long Life

Dec 20 2017

Aging in place is not the only goal for most senior citizens. The vast majority of elderly people also say they would like to die quietly at home.  But the result of inaccurate medical advice, coupled with an unrealistic sense of invincibility, is that most elderly patients still die in institutions. In fact, according to Center for Disease Control (CDC) statistics, more than 65,000 patients over the age of 85 die in American ICUs annually. These patients misguidedly thought that they could extend their lives meaningfully, when it is clear, in retrospect, that they underwent painful and futile treatments.

 Of course, if one wishes to die at home and not in a hospital, ER, or ICU it is fundamental to know the appropriate time to say, “No,” to aggressive medical treatment and when to say, “Yes,” to palliative care and, subsequently, to hospice care. 

A forthcoming book, At Peace: Choosing a Good Death After a Long Life, addresses that problem and empowers readers. It outlines specific active and passive steps that older patients and their health care proxies can take to help loved ones die more comfortably at home when further aggressive care is inappropriate. 

This book is not the typical book about end-of-life decision-making. What separates it from other books is that it focuses exclusively on elderly patients. It educates those patients and their families about their illnesses and their prognoses. This knowledge empowers them to make better decisions. Author Dr. Samuel Harrington leads the reader through this complicated process by interweaving the story of his parents’ decision-making with didactic elements of medical and technical information. 

Dr. Harrington describes the patterns of the common illnesses that afflict patients over the age of 65; he explains why doctors often fail to stop aggressive treatments when doing so would help the patient have a better life prior to their death; and, he shows how to recognize a terminal diagnosis even when the doctor is not being clear about it.

At Peace is divided into three parts. The first section deals with the limits of the American health care system as it deals with elderly patients. It explains that our system is exceptionally good at dealing with acute illnesses, but it is not good at dealing compassionately with the chronic illnesses and debility of old age. Most end-of-life decisions are being made by baby boomers either on behalf of their aging parents or about themselves. This generation has been inundated with optimistic messages that feed the sense of immortality in America. These include political messages that overpromise about “Winning the War on Dementia” or a “Moonshot to Cure Cancer;” direct to consumer advertising that exaggerates the effects of pharmaceuticals or supplements; and public relations messaging that magnifies the benefits of a hospital or health system.

Couple our system’s tendency to repetitively treat acute complications of chronic illnesses with the over expectation of patients and their families and you have a recipe for aging in place but dying in an institution.

The second section of At Peace teaches the reader about the six chronic illnesses (heart failure, cancer, COPD, stroke, dementia and diabetes) that, according to the CDC, cause 90 percent of the deaths in people over the age of 65. Understanding the clinical course of one’s illness and the comparatively comfortable deaths of dehydration, infection (sepsis from pneumonia or UTIs, for example) and various forms of coma, will help patients avoid the medicalized deaths associated with aggressive treatments.

The third section deals with the practical aspects of organizing a non-medicalized death at home. Chapters on pushing your doctor to discuss prognosis, pushing the hard conversations that patients and families must have, hospice care and how to know when it is appropriate, and strategies to hasten death when desired are supplemented by two appendices on advance directives and the special problems of dementia.

There is no easy way to die, but there many hard ways to die. At Peace helps the reader to avoid the latter.

Samuel Harrington, MD, an honors graduate of Harvard College and the University of Wisconsin Medical School, concentrated his clinical practice at Sibley Memorial Hospital, a community hospital in Washington, DC. His work on Sibley's Board of Trustees and his service on the board of a nonprofit hospice informed his passion for helping aging patients make appropriate end-of-life decisions.

You can learn more at samharrington.com  

At Peace: Choosing a Good Death After a Long Life, Grand Central Life & Style/Hachette Book Group will be published on February 6, 2018

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