When quality of life supersedes length of life

Well in advance, the elderly need to make clear to family which is more important to them – quality of life or length of life. It’s a subject most of us avoid to spare our children unpleasant conversations, yet knowing ahead of time what Mom’s or Dad’s wishes are can be comforting. That way when a daughter or son is weighing a treatment plan recommended by a doctor they have some guidelines.

A recent article published by National Public Radio concluded far too many elderly are subjected to aggressive surgical or other treatments mainly because today’s health care strives to prolong life even when the patient would be better served making the most of their final days.

The article told of 90-year olds having surgery to remove skin cancers that had little likelihood of ever posing a problem. Surgery left one patient facing further excisions to encourage healing. What old person wants to spend their last weeks in hospital, with daily treatment of some surgical site that refuses to heal when they could instead be at home walking their dog or sitting stroking their purring cat in their lap watching a TV talk show?

The study reports operating on frail elderly doesn’t guarantee they will live longer or return to the quality of life they once enjoyed. You could argue surgical outcomes are not guaranteed for young people either. But at least the youngsters deserve a fighting chance. Fixing one complaint when a 90-year-old suffers from many may be of little help overall.

Older patients are less tolerant of anesthesia, their skin takes longer to heal. On average they spend twice as long in hospital following surgery, and twice as long in intensive care.

The study reports 18 per cent of elderly undergo surgery in their final year, eight percent in the last week of their life. Following abdominal surgery, 20 percent die within 30 days. Where’s the gain in such short outcomes? If the patient so chooses, skip the surgery, manage pain and let them live out their days as comfortably as possible, if that is their wish.

One problem that leads to so much expensive hospitalization and treatment, the report notes, is our reluctance to question or disagree with a doctor’s recommended approach to treatment.

I have no hesitation on that front.

Somewhere in my medical file is a follow-up order for a chest x-ray I was to have had in July 2017. My doctor wrote the order in January following a short cold. I felt fine, saw no need for a follow-up x-ray, so never had it done. My doctor never followed up to ask when I would do it. So far I’ve not regretted skipping that order.

In a more recent incident, I fractured my middle finger in a manoeuvre so innocuous I refused to believe it. Family insisted I have it checked. By then the comminuted bones had set in their own peculiar shape. My doctor gave me two options – surgically re-set the joint with pins, or live with it as it was.

Against leaving the finger as it was I weighed surgery with anesthesia; hospitalization with the chance of catching a superbug; showering with my hand in a plastic bag; and repeated visits for followup care.

Granted, my handwriting aged 20 years; I can’t grasp one blueberry or sheet of paper as before; I have to reduce speed playing one section of Rippling Water Jig because that joint is less dexterous; and that finger freezes in my mittens.

My family knows for me quality of life supersedes length of life.

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