The East Texas Geriatric Education Center-Consortium (ETGEC-C) hosts a monthly video series focusing on a wide range of aging topics. Some videos are light and fun, such as Quartet, Young at Heart and Age of Champions. Others are educational, like Exploring the Myths of Dementia. And then there are those that tear at the heart and make you wonder what it will be like when you are old, fragile and need help. Today we had one of those videos. Living Old is a PBS Frontline film from 2006 that looks at the challenges facing America’s growing elderly population. The film’s synopsis states “those over the age of 85 now comprise the fastest growing segment of the U.S. population, creating a much higher need for medical care and straining America’s health care system.”
There really was little good news reported in this film. Yet it could not be viewed as something you should ignore or avoid. It is important to look at the possibilities in one’s life for the realities of aging – the decline in physical and mental health, the inevitable loss of some level of function, the need to rely on others and to view yourself as a burden to those you love and who love you. The trick it seems is to either accept the inevitabilities of aging or fight it every step of the way. What it really comes down to is understanding what your quality of life may be when you are chronically ill, in need of Depends, sitting in a wheelchair with uncontrollable Parkinson-like symptoms… and you are in better shape than your spouse sitting across from you with advanced Alzheimer’s Disease, loss of vision and limbs due to diabetic wounds – who doesn’t eat because she can’t remember how to swallow.
What is considered ‘good news’ in this sad scenario? Some say if you are lucky you’ll be able to live and die in your own home, have a loving daughter to care for you or that your attitude will help relieve the pain and suffering. But if you’re really lucky, the good news is you’ll have a heart attack and go quickly!
The film focuses on the profound questions of what modern technology has done to prolong life to the point beyond when living seems worth it – yet being stuck without much alternative since assisted suicide and euthanasia (which are different from each other) is frowned upon or illegal. This is real life and death stuff with no easy answers. Even the best in the business, Geriatricians, with all the health knowledge at their disposal cannot fathom what to do when they get old and are unable to function. The film also focuses on the lack of health providers with adequate knowledge of geriatrics and how to care for older patients. Whereas the ETGEC-C and the other 45 GECs in America pride themselves on trying to fill this huge gap in knowledge and provide clinical training that health providers need to provide adequate care for their older patients, we are nowhere close to accomplishing this mission. The main reason I feel this way is that the need for quality health care for the very old is accelerating faster than the speed of the proposed solution, i.e. provide incentives for more health providers to enter geriatrics and fund programs such as the GECs to better train health providers. Throwing money at problems never seems to work well.
I am hoping that the simple act of increasing awareness of the issues of aging, such as with this video series, of understanding the dynamics of living longer with more years of disability and poor health, gets through to the general public and that it becomes more of a priority to have useful dialogue for better solutions – including one on the legalization of assisted suicide. And that opens up an entirely different discussion that will be examined in future posts.
Our Guest Blogger this week is Tony DiNuzzo, Ph.D., Director, East Texas Geriatric Education Center/Consortium, UTMB.
Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.
Based on: Living Old
- Trailer: http://www.youtube.com/watch?v=AcVKu6-PQCM
- Full Program – http://www.pbs.org/wgbh/pages/frontline/livingold/view
- Image Source: http://www.shoppbs.org/product/index.jsp?productId=2537118
November 12, 2013 at 3:47 pm
Transcript – Weekly Discussion on Aging – Held in Second Life, October 29, 2013
[10:13] Rodger Markova: Nice to meet you Roxie and Jimy
[10:14] Rodger Markova: Let’s go inside and I’ll bring up the blog if you have not already read it
[10:15] Roxie Marten: I watched the PBS story
[10:16] Tim (tskillian): Yes — I use segments of that video in my classes.
[10:16] Rodger Markova: Excellent. That’s quite a show
[10:17] Rodger Markova: I did get the Fargo reference there, Roxie
[10:17] Roxie Marten: They almost hit the point of living v.s. existing.
[10:17] Rodger Markova: yes
[10:17] Rodger Markova: I do wish we had a switch to turn off then it’s the right time
[10:18] Roxie Marten: I really thought the Russian woman in the show was being selfish, Let the old lady go.
[10:18] Rodger Markova: Yes, caregivers can find it hard to let go
[10:19] Roxie Marten: I live in the state that Dr. Kevorkian was from. I honestly supported his work. I think it is living that is being selfish and not letting their loved ones go
[10:20] Rodger Markova: I agree.
[10:20] Tim (tskillian): I think a few of the doctors interviewed in the piece made the point also.
[10:20] Rodger Markova: There are however realistic fears about masking murder as assisted death
[10:21] Roxie Marten: It’s our hang up as a society about death. I have met people who would rather tell you about their sex life than talk about death or their mortality
[10:22] Rodger Markova: oh yes, very true
[10:22] Tim (tskillian): It is a very uncomfortable subject for many
[10:22] Tim (tskillian): or most
[10:22] Rodger Markova: I’d echo most
[10:23] Roxie Marten: In our house we handles death and sex with the same openness in discussing with our children.
[10:23] Tim (tskillian): how old are they?
[10:23] jimyd6sh: I agree unless a person has experienced a near death situation I don’t think most people like to talk about it
[10:23] Roxie Marten: Death happens, no one gets out of this alive
[10:23] Rodger Markova: My two sone are in there 40’s but I think we did better with death than sex when they were growing up
[10:24] Rodger Markova: sons*
[10:24] Roxie Marten: my children are now grown but when they were young and hitting puberty my mother was dying. so we had to deal with both topics at the same time
[10:24] Rodger Markova: That was no doubt stressful
[10:25] Roxie Marten: I have told my children I don’t want to live past 70. in my family that seems to be the magic number when it all goes to hell body and mind
[10:25] Rodger Markova: All our genetic pieces are different
[10:25] Tim (tskillian): i think it is difficult to know when
[10:25] Tim (tskillian): when do you cross the line into knowing it is time to go?
[10:25] Rodger Markova: My family generally seem to get into their 90s
[10:26] Rodger Markova: Yes, when is a difficult thing
[10:26] Roxie Marten: The key of being a good guess is knowing when to leave the party 🙂
[10:26] Roxie Marten: er guest
[10:26] Rodger Markova: true
[10:26] Tim (tskillian): 🙂
[10:26] Rodger Markova: the scary thing is getting dementia before you feel ready to go and then the decision is out of your hands
[10:26] Tim (tskillian): a good way to put it Roxie
[10:27] Tim (tskillian): as well as being put into the position of making that decision for a loved one with dementia
[10:28] jimyd6sh: thats why learning about advance directives is important
[10:28] Rodger Markova: yes, having the family decide is quite hard
[10:28] Roxie Marten: One of the doctors seem to make light of making those choices before it becomes critcial, I think it’s important to do that
[10:28] Rodger Markova: Advanced directives can be and are ignored all the time
[10:29] Tim (tskillian): not being in healthcare — i have little personal experience, but my mom (nurse) has told me that they are very open to interpretation at times.
[10:29] jimyd6sh: that does scare me the amount of family that wishes to ignore advance directives out of personal issues
[10:29] Roxie Marten: I think you have to be your advocate in these things and be forceful if need be
[10:30] jimyd6sh: this might be my military background speaking but i don’t like interpretation
[10:30] Roxie Marten: I agree iwth you Jim
[10:30] Rodger Markova: yes, and just mindlessness it seems. When my father was dying we was resuscitated when his advanced directive specifically said no
[10:31] jimyd6sh: was that a family choice or a doctors chioce?
[10:31] Rodger Markova: It was done at night when no family member was there and the night shift physician did not know about it
[10:31] jimyd6sh: wow
[10:31] jimyd6sh: information pass on between profession you think would be important
[10:32] Roxie Marten: My dad had a brain aneurysm and we pulled the plug on him. that was not my father laying in that hospital bed and I knew the life style he led up to that, farmer, outdoors man, mayor of our town, he would not want to live like that
[10:32] Rodger Markova: did not know, apparently, about the advanced directive
[10:33] Rodger Markova: Yes, I did the ame with my mother. She had had a servies of strokes and was past any hope and not eating on her own. We waited until she passed on
[10:33] Rodger Markova: took a long time
[10:33] Tim (tskillian): it is very difficult having discussions with family members about advanced directives.
[10:33] Rodger Markova: yes
[10:34] Roxie Marten: When I became disabled I felt it was time to have some honest and frank talks with the children, I am divorced they are the ones who will do it, at least on the surface they seem to grasp and understand what I want and why
[10:34] Rodger Markova: That is good
[10:35] Tim (tskillian): Good Roxie
[10:36] Roxie Marten: but i hope i am talking about events that still a few years down the road and if I keep saying it, it will sink in that now I don’t want to live like that old lady in the show who in bed and had no idea where she was. btw she looked like a small pile of bones to me in her bed
[10:36] Tim (tskillian): yes — it was very sad
[10:37] Rodger Markova: What about the ethical side of medical interventions, short of the last days, but ones that prolong people’s lives who have a poor quality of life already
[10:38] Rodger Markova: Say someone with very advanced cancer having a heart bypass?
[10:38] Tim (tskillian): those are difficult questions. it reminds me of the debate between active and passive assisted suicide.
[10:39] Roxie Marten: It may come down to a question of available resources and economics. We are facing a growing shortage of health care resources.
[10:39] Rodger Markova: Yes
[10:40] Roxie Marten: My question with care also comes to this. Just because you can, should you? Great we can do heart transplants, your 80 years old with other health issues, Should we do this?
[10:41] Rodger Markova: I’d be inclined to say no as a general policy but I do know 80 year olds in very good health
[10:41] Rodger Markova: and my mother-in-law turns 100 on Friday
[10:41] Roxie Marten: wow
[10:41] Tim (tskillian): yes — and it is very difficult to write guidelines with very bright lines between yes and no
[10:42] Rodger Markova: I agree
[10:42] Tim (tskillian): James is working on defining Quality of Life.
[10:42] Tim (tskillian): There is a great deal of literature on it, but a hard concept to quantify.
[10:42] Rodger Markova: and we really must deal with the ethical issues before the “can we afford it” question
[10:43] Roxie Marten: don’t they go together?
[10:43] Rodger Markova: Yes, quality of life is the kingpin here isn’t it?
[10:43] Roxie Marten: Yes
[10:44] Rodger Markova: I don’t think they do. Ethics first. Whatever is right we can afford
[10:44] Roxie Marten: For some reason I am thinking of a quote from the book Tuesdays With Morrie, Morrie Schwartz said “If you don’t know how to live, you don’t how to die ”
[10:45] Tim (tskillian): what a great quote
[10:45] Rodger Markova: Yes, love the film (never read the book)
[10:46] Tim (tskillian): Quality of Life is the kingpin, but it is to a great extent individually defined. Leading to the second Kingpin of dementia or depression or some other cognitive disability making it difficult for people to express QoL
[10:46] Roxie Marten: If you are laying in a bed, can’t move, can’t control your bowels and don’t know where you are, the sole reason you are still living is your son/daughter/husband/wife refuses to let you do. that sure ain’t living in my book
[10:46] Rodger Markova: We are officially out of time for our discussion. May I have your permission to post our discussion as a comment to the blog?
[10:46] Tim (tskillian): ok with me
[10:46] jimyd6sh: sure
[10:47] Roxie Marten: Sure, thanks for having me, I have been trying to get over for this for a long time, Life keeps conspiring against me LOL
[10:47] Rodger Markova: I am happy you got here today.
[10:47] Tim (tskillian): Thanks for coming Roxie.
[10:47] Tim (tskillian): I have many questions about VAI
[10:47] Rodger Markova: Please come again when the stars align
[10:47] Tim (tskillian): would like to talk about it more sometime
[10:47] Roxie Marten: I am happy to answer what I can
[10:47] Roxie Marten: sure anytime you like
[10:48] Roxie Marten: I am a big supporter of VAI, great people. resources
[10:49] Tim (tskillian): see you soon
[10:49] Rodger Markova: See you all later.
[10:54] Tim (tskillian): OK Roxie
[10:54] Roxie Marten: See ya
[10:54] Tim (tskillian): Take care
[10:54] Rodger Markova: Bye