The 'New' Old Age and the Value of Hospice Care

"We are a culture that denies death … therefore, we are all walking towards death backwards! It is better to turn around." — Michael Meade

"I'm sorry, but there's nothing more we can do … "

So begins that stage we call the "end of life." This life stage is also precipitated by the elderly or terminally ill person's decision to stop actively fighting for life.

In the old days, people died fairly rapidly of "old age" — succumbing to hardening of the arteries, heart attacks, strokes and a myriad of opportunistic diseases. But with advances in medicine — in particular the development of antibiotics, cardiopulmonary resuscitation, artificial nutrition, and hydration and dialysis — the period that once led to an "old age" death has lengthened.

This life phase is now characterized by a series of crises, remissions and recoveries that can last up to 20 years.

So what does that portend for Baby Boomers and subsequent generations? It means the life endings you and I fantasize about — sudden passing doing something we love, or simply drifting away in our sleep — are statistically unlikely. Modern medicine has done its job well; more than 90 percent of us will, in fact, die by degrees due to chronic illness.

Today, more people than ever spend the final few years of life unable to care for themselves. As we enter our 70s and 80s, most of us can expect serial years marked by frequent trips to doctors and emergency rooms. There will be years spent in assisted living and long-term care facilities. Ultimately, the consequences of aging will be physically represented by catheters, appliances and feeding tubes.

Coping With Reality

None of us wants to countenance what on the surface seems a bleak and dreaded prognosis. We midlifers are supremely adept at the art of denial when it comes to our own mortality — and the inevitable decline of our physical bodies in the years preceding death.

But denial is not the answer; only in facing our fears can we defuse them. By replacing fear with faith — and information — our fears cease to hold power over us.

Institutional Attitudes

According to Dr. Christina Puchalski, an expert on end-of-life issues, one obstacle to enlightened attitudes about death and dying is the mindset among many physicians that old age is a disease to be "cured." Even though death is inevitable, there remains an emphasis on remedial care rather than a gradual shift to palliative (hospice) care.

"All too often," Puchalski says, "people die in hospitals or nursing homes, alone and burdened with unnecessary treatment; treatment they would have refused if they had the chance to talk about their choices with their physicians long before the deathbed scene."

According to Dr. Jonathon P. Weston, Medical Director of Pikes Peak Hospice & Palliative Care in Colorado Springs, Colo., it's important to take several steps when beginning the final journey to death:

• Discuss what is inevitable for all of us
• Continue to long for life, but learn how to die
• Obtain what is easy to attain — relief from physical suffering — so that one's emotional and spiritual needs can be addressed
• Hope for the best, but prepare for the worst

In order for terminal patients to choose their plan of care, Weston says, they must first:

• Know their medical options
• Have physicians who feel comfortable in explaining those options, even that of refusing some or all interventions
• Feel confident their physicians will not abandon them
• Know the benefits of palliative care and how to obtain it

A Sampling of Options

Weston outlines a few options terminal patients will want to discuss with their physicians and families:

• Receiving all or most of their care at home
• Prioritizing goals for their care, with relief of suffering often being primary
• Minimizing or eliminating blood tests and X-rays
• Attending to emotional, psychological and spiritual needs, as well as physical ones

The Value of Palliative Medicine

Although only 19 percent of dying patients avail themselves of hospice care, the comfort and benefits it offers are significant:

• A greater emphasis on pain and symptom relief
• Improved communication between patient and family
• An increased sense of control for the patient
• A treatment plan that's better aligned with the patient's perceived quality of life

"In the United States," Dr. Weston says, "the majority of terminally ill patients either are not referred for hospice care — or are referred so late in the course of their illness, they cannot take full advantage of the services hospice programs offer for patients and their family members."

Making Peace with Death

The late Albert Schweitzer once wrote: "We must all die. But if I can save him from days of torture, that is what I feel is my great and ever new privilege. Pain is a more terrible lord of mankind than death himself."

All of us — doctors, family members, patients and potential patients — would do well to pull back the curtain of fear and denial that until now have marked our culture's attitudes about death and dying. For, as people of faith, we have nothing to fear. God's Word is clear:

Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or nakedness or danger or sword? As it is written: "For your sake we face death all day long; we are considered as sheep to be slaughtered." No, in all these things we are more than conquerors through him who loved us. For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither the present nor the future, nor any powers, neither height nor depth, nor anything in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord." (Romans 8: 35-39, NIV)

For more information on hospice and palliative care, you can visit The National Hospice & Palliative Care Organization.

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