You know the song – “The Gambler” (written by Don Schlitz and made famous by Kenny Rodgers).aces and eights

You got to know when to hold ‘em Know when to fold ‘em Know when to walk away Know when to run Your never count your money When you’re sitting at the table There’ll be time enough for counting When the dealin’s done

But my favorite line is: “Every Gambler knows that the secret to survivin’ is knowing what to throw away, and knowing what to keep” and that “the best you can hope for is to die in your sleep.”

For those in old age, gambling could be a way of life whether sitting at the poker table or sitting in a wheelchair at the neighborhood nursing home.  Some say the gambler depicted in the song was lucky.  It is implies that he dies in his sleep.  And that for many old folks with a terminal illness who unexpectedly pass in the night that could be a blessing.

Has the gambler broken even?  Has he finished his last hand and feels it is time to walk away from the table?  In aging this bring up profound questions of death and dying.  Ethical concerns, like the decision for aggressive treatment or to sign a DNR (Do Not Resuscitate order).  Or when to seek care or when to give up.  I bring this up because some in the field of Gerontology and Geriatrics spend a lot of time examining the choices older folks need to make, or are faced with, as they age.  In old age, do you get that hip replacement and say “he died with two good hips.”  It may be a good idea if it improves function, relieves pain and helps you get around.  But is it a good idea for such a surgery at age 95?  Do you resist any medical intervention when you clearly need the EMS to come and take you to the hospital?  Do you keep playing a losing hand or fold ‘em in hopes of a better day?

What often happens is the need to prioritize.  In the study of Geriatric Medicine, those who know, such as Geriatricians, will weigh the options of care between what can actually do the most good for the older patient and what will adversely affect their quality of life.  That is not an easy thing to figure out.  And there are some of the best Geriatricians in the country who will tell you, “when faced with a difficult medical decision for my patients, I am often still rather confused and unsure of what exactly is the best course of action.”

Now I am not a Geriatrician, but I know several who are and they will probably tell you that unless you know what you are doing, you may very well do more harm than good when trying to provide care for an older person.  This is because it is so damn difficult.  There are so many variables to consider besides age.  What are the patient’s wishes?  What are other medical conditions that may or may not also need some intervention?  What medications should they be on or off to make any hope of recovery effective?  What kind of support do they have to sustain independent living after a major intervention? What does the family say and want? On and on and on.  Many may try to be too aggressive in their treatment and really mess up a patient’s quality of life.  The key is education – learning what needs to be done to come up with the best results – and like being dealt a good hand, a little bit of luck.

And remember – no matter how much you trust your opposition – always cut the cards.


The Guest Blogger this week is Tony DiNuzzo, Ph.D. He is the Director of the East Texas Geriatric Education Center/Consortium

Join us for a real-time discussion about ideas raised by this essay on
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