Not having medical procedures in old age

My late DF was similar, in and out of hospital and didn't have a great quality of life. A new valve later and he was firing on all cylinders again. If he hadn't had the procedure done he possibly could have carried on the way he was for several years, which wouldn't have been enjoyable for him, and caused great worry to me.

Hip replacements are quite a big operation needing physio soon after and for a while after.

There is risk of DVT with anyone, but someone with a sedentary lifestyle increases the risk.

Things like pacemakers and subcutaneous procedures can be done quickly with only a small incision that only need a couple of stiches, if that.

It's a balancing act of what benefit there is to the person taking in to account medical history and lifestyle.

@Haroldwilson no I would not have seen 50 as a terribly old age as a teenager nor did i think my life would be over before then. However, I have now in my 50s seen a lot more death than I had at that time. My husband, suddenly and tragically, friends of course, my grandparents, multiple aunts and uncles, my dad, my godmother, my mother in law, some cousins. I have worked in palliative care, in oncology, and in 'front door' care at a major hospital. I currently work in post-stroke community care. As a result, I've seen a lot of people in a lot of different states, though I must say that the nature of my job means I'm not often at the actual deathbed.

My perspective is that I want to die with regrets. It seems to me that doctors working in care of the elderly too often have an appallingly skewed view of what constitutes an acceptable quality of life. It's quite possible that the majority of people in this country agree with them. That's fine but I want to go long before I reach the point where showing a faint sign of recognising a piece of music, or showing a preference in yogurt flavours, is the top experience of my day. The single best thing my mum did was tell me her own view of what quality of life represented to her - the ability to get around independently and make her own decisions. I wish with all my heart she had taken the available legal routes to make that official, but when I am fighting for her against the invasive treatments offered, at least I know what she wanted. And her appalling experience has taught me what I can do to prevent it for myself. In the end I can't really choose- I dont think I have the courage to end my own life. But I have done what I can to protect myself from other people's 'horror' at my own choices.

Having cared for people with dementia both personally and professionally, I do not want to spend one minute longer than necessary with dementia. It’s such a cruel disease and it’s inevitable that it gets worse. The extreme distress and other upsetting side effects like regular falls, forgetting the most basic of functions etc can happen long before it gets to end stage.

It can go incredibly fast too. It’s often at the moderate stage before you realise that a loved one has it. It’s often very deceptive. I have known a few with “contented dementia” that is they weren’t actively distressed but they still weren’t the person that they used to be and their quality of life had diminished.

Each to their own but having seen the extreme distress that it can cause, I think that actively prolonging a life with dementia with surgery causes far more harm than good.

If your teen self had been asked whether life was worthwhile at your current age op (50 ish?) I'm guessing you'd have said no, you'd rather die than be your current age.

I think you can give older people the dignity of saying if they want to die or not. If the choice is uncomfortable intervention or certain death, they might choose the intervention. It's between them and the doctor, really. So long as the reality of the treatment and prognosis is explained.

Dementia in itself isn’t a reason not to have life saving treatments or surgery. There’s a huge difference between end stage dementia and the earlier stages, where many people still have a decent quality of life. I find it strange that someone would refuse minor surgery, such as a pacemaker just because they have a dementia diagnosis.
I personally wouldn’t be saying no to life saving surgery if I had mild dementia, still lived independently at home, was still able to enjoy hobbies etc just because in 10 years time I may be in a care home, Incontinent, unable to feed myself or recognise family . Yes, id have an advanced care plan in place for that ‘end stage’ but I wouldn’t let it dictate my life in the years prior to that situation arising.

I think the point is, as long as you have capacity, you can still get the intervention. If you find yourself in better shape than you thought at 80, you may decide to go ahead and have treatment for cancer, but you may feel that if you had dementia at 80, you wouldn't want intervention; or you might not have dementia but have other health problems and mobility issues that are only going to get worse and be adamant you don't want your life prolonged.

FIL at 84 was diagnosed with three lots of cancer last year. One stage 4. He was offered and started chemo, giving IMO, complete false hope to him, his elderly wife and adult children. I'm a nurse and suspected it was futile and indeed he passed away several months later after to-ing and fro-ing for numerous scans, appointments, admissions etc.
I'm of the firm belief that many people are living too long with pretty poor quality of life. I once spoke to an oncologist who said he would never put his older family members through the treatments that some family members expect. The patient themself IME, is often far more philosophical but get swept along and 'don't want to let people down'.

My mum was the opposite. A year ago she was diagnosed with cancer and chorea. She refused all tests and treatments, wrote an advance statement to this effect, and died this January aged 81.

I'm very much in agreement with you @Orangesandlemons77 - but appreciate it is very different between individuals. I think this view will get more common as more people see loved parents struggling through years of dementia or frailty and decide they'd rather have a slightly shorter life in better health

I definitely want to have an advanced directive in place as things are. It might be different if I were one of those perky people in super good health, but existing skeletal issues that will get worse as I get older mean I will not be one of those people running marathons and 80s or whatever; nor am I likely to enjoy a super comfortable retirement with lots of holidays. Honestly, from all I've observed I don't feel like it's worth trying to live past mid 80s for me. Would never demand the same of anyone else, but for me I can't see an awful lot that would make life fabulously worthwhile past that point unless you are very fortunate with wealth and health.

That's awful - about the feeding tube I mean. I hate that that can happen even with an advanced directive, that feels really violating. When my grandmother had lost all interest in food and drink (I'm not sure she actually recognised what food was) and was absolutely skeletal, care staff would consider it was a "good" thing when they got a certain amount of fortified drinks/supplements down her. Even then I remember thinking: "is it? really? to what end?" I suppose you can't just let people starve, but I've since learned from my doctor friend that when people are approaching end of life, they don't really feel hunger and thirst in the same way. We might imagine they're very hungry or thirsty because we would be, but her patients have capacity and they can tell staff they're comfortable.

I used compassion in dying to do an advanced directive when I was 38
The doctor did give me a bit of side eye but I said look if I get hit by a bus tomorrow it's no good not having something in place

Mine is no life saving or extending treatment if I have dementia or a massive brain injury basically. No antibiotics etc

It's a difficult question really.

When my dad was in his late 80s he had several chest infections and was hospitalised. I was really grateful that his GP took him seriously, called an ambulance etc and that the hospital treated him. He then went on to develop vascular dementia with hallucinations and was bed bound. That followed with 6 months of him lying in a care home and I think he would have rather have gone to pneumonia the previous winter. I was devastated at what happened to him but would have been equally devastated at the time if they hadn't given him the antibiotics for his chest infection and we had lost him to pneumonia as at that time I wouldn't have known what the future held.

Exactly. The Who famously sang 'Hope I die before I get old'. They're entering their 80s now.

My Mum has Alzheimer's and the nurse wanted to stop her Alzheimer's medication in case it was causing heart issues. I pushed back on this (not very much, but they agreed).

They wanted to stop drugs that are helping with her dementia in case it caused her a heart attack. It's crazy. It would be good for her to die of a heart attack.

My Dad died suddenly and unexpectedly of a heart attack which seemed like the end of the world at the time, but in hindsight, I would want everyone I love to die of a sudden heart attack in their 70s whilst well, active and happy.

You don't know that you'll "always" do that.
My mum said that before she had her disabling stroke. But despite her quality of life being very poor for the next ten years, even towards the end she refused a DNAR. Her instinct to live was stronger than she'd thought it would be

It's hard to find a balance. My mother had a horrendous last few years. She had a hip replacement which went wrong, and it took her several months to get back to walking her dog and driving, but the botch meant she had a pronounced limp as they'd not got the dimensions of the replacement correct, so she could never walk for the same kind of distances.

After a couple of years of her being relatively "normal" in terms of activities, she got diagnosed with cancer, meaning a couple of operations, chemotherapy and radiotherapy. From the moment of diagnosis, her life was dominated by hospital/gp appointments, feeling crap due to the treatments/operations, etc., and after two years of that, they discovered they hadn't cleared it all anyway and it was coming back.

She only got "peace" when the oncologist told her there was no more they could do. She said she finally felt "free" and could just concentrate on living the rest of her "shortened" life as she wanted to, and more than delighted not to have to constantly be going for medical appointments when she could have been doing more fun things.

Her last few months were some of her happiest as she just went out and did things, even simple things, like walking her dog, looking after her garden, etc., which she couldn't do when it was just one long round of hospital appointments and feeling crap!

This is an excellent point.
When my mother was dying of heart failure a palliative care consultant said to me that doctors aren't often skilled at death. They strive to prolong life long after the patient's prospect of recovery is nil.

I'm in the process of completing LPA health ( did the financial years ago ). I want no treatment if I have lost capacity. If I get an infection I want it to finish me off.

I have a question.
I read somewhere that if you have an advanced directive and LPA supercedes it. Or vice versa. Does anyone know?

I am considering doing an advance statement stating no life saving treatments / surgery after say 75
I suspect you will think differently when you are 74!

I can't help think that if the Pope was anyone else, he'd probably have been put on palliative care now. As he's had over a week of intensive treatment and is still deteriorating. I only hope that he wants to be actively treated.

I think I agree OP.

I agree that if someone has a diagnosis of dementia, it is much kinder to allow some physical ailment (heart attack, stroke) to take them quickly.

I watched my father waste away with dementia for years, although he was physically in good health, and it was awful. I used to hope for his sake that he would pass away peacefully in his sleep.

I suppose the big difference is quality of life, if an elderly person has the potential to live on with a decent quality of life, without dementia, then of course they would want intervention.

Thanks to H Shipman (as explained to me by the community palliative team) doctors are very very loathe to not attempt treatment even if you have a DNR , have done a living will, and given POA to your closest family who say ‘enough’.

I had two big stand offs over one of my parents (90s, dementia, multiple conditions).