Not having medical procedures in old age

Not everyone gets dementia

Many people in their 70s are fit, active and full of life

Many older people who recieve treatment then go on and have a lot of fun in their lives

Do you want to deny yourself that?

I work with a lot of elderly people filling out disability benefit forms etc so do get quite a bit of insight into the health of older people. I agree with what you are saying but also sometimes feel older people aren't offered procedures that could help them like knee replacements/ hip replacements. Some seem to have just been forgotten or aren't even given the option.
My dad has some kind of advance directive that sets out the limits of what treatment he would want eg it specifies no artificial feeding in the event of a severe stroke etc. he's 87 and fit as a fiddle but adament he doesn't want anything to prolong his life !

It’s very difficult, and so much based on personal circumstances.

My dad died very unexpectedly of a heart attack this year- less than 2 weeks after his annual ‘just in case’ check up after he’d had a stent fitted 9 nine years ago. He was very healthy and active (and probably fitter than most 40 year olds) up until the day he dropped- teaching a fitness class that morning. He was 75 and in his case I absolutely would have advocated for anything that would have given him a second chance… but not at a lower quality of life- ie mental or physical impairment as he would have been miserable. He couldn’t sit still for 5 minutes.

However, my maternal grandmother got dementia. She went on at least 7 years too long, and died at 86. My aunt and uncle cared for her at home, with my aunt eventually quitting her job to care for her full time, before it became completely unmanageable. In that time she had various ‘patch ups’, but nothing that would have caused a quick death. It meant she was confused, angry and upset and in constant pain from various debilitating but not life threatening issues. It was awful. She didn’t recognise family and became abusive. She was not the same person at all. She had no quality of life. It was incredibly sad for everyone involved.

In contrast my grandfather, my dad’s dad, died at 98 and he had a brilliant quality of life up until the last 2 years, and only in the last 6m did he really go downhill. Up until his mid nineties he was regularly going hill walking (admittedly more slowly!) with his ‘wobbly walkers’ group. He had a large group of friends and a great social life. In his 80s he spent more time on holiday than at home. He died 3 years before his son. We had assumed my dad would follow the same pattern.

I think it makes it very hard to legislate for, but I absolutely think there should be more scope for doctors and family to say ‘enough’- we might be able to get this person to recover from this infection but their quality of life will be awful and it’s not in their interests.

You can put any instructions you like in an LPA. They encourage you to be very clear in your instructions so that there is no confusion or the chance that things can be left open to interpretation. So in your example you might word it

“In the event that I am diagnosed with dementia, or another similar condition that impairs my cognitive function, I wish to no longer receive vaccinations against influenza, Covid, or any other respiratory illnesses.”

The issue with modern medicine is that it has (largely) stopped people dying quick deaths (heart attacks, infections) so instead more people die slow deaths (dementia, cancer etc). I read of an elderly care doctor who said that he had decided that from the age of 80, he would refuse treatment - and that includes refusing the flu jab, covid jab etc as based on his observations he would rather go quickly than linger.

Of course, he may change his mind, and based on my elderly relatives, 85 seems a better cut-off point but there seems to be a lot to be said for going quickly with flu rather than the dementia decline. Can one have a LPA to say that if you develop dementia you don't want to have the flu or covid jab?

My mum filled in a form for her GP, stating that she didn't want life prolonging treatment only pain killers, she was very immobile and incontinent. She stipulated no CPR, and which hospital she was to be taken to if necessary. This was, apparently, to be put on her record and shared with other HCP.
It never got tested, as when she was taken to hospital after a fall, apart from bruises, there were no major health problems. She was discharged, and died 2 days later.

It’s a hard one but the example I have before me is that of my DAunt who died back in 2019 with dementia (not sure what type but her symptoms fitted vascular and Lewy Body… she hallucinated a lot but always recognised me to the end).
After about two years of decline and many hospital stays she was in hospital over Christmas 2018 with serious bronchitis. By this time she had lost a lot of weight (never big to begin with) and was probably about 6st and bed bound. She was incontinent and had developed a reflex of crying out for help, even when you were sat right next to her. It was pitiful. During her bronchitis they gave her antibiotics and oxygen and slowly it went away. She was discharged from hospital to a care home. There she spent three miserable months before dying in April 2019.
In the end her cause of death was a catastrophic bleed from a stomach ulcer, but I wish she had gone the Christmas before with the bronchitis.

The examples you give in your op are all people with dementia. And I totally agree, I would not want any medical intervention that would prolong my life with dementia.

75 is very young to say no life-saving treatments. I have relatives in their mid/late 70s who live very full and active lives. I'd be horrified if they declined a life saving op on the basis of age.

Op recently had this conversation with my dad (80) . He was in hospital over Christmas with a bad reaction to hernia surgery then a stroke. He's talked about his final plans and has spoken to his doctor about a do not resuscitate order. I don't agree with it but its his choice

Everyone should be made to do an LPA! They’re not just for the elderly - what happens if you get hit by a bus and are in a coma aged 35? They’re should be easier to update so that you can add/remove attorneys as life progresses but we should all have something that identifies our wishes for medical treatment.

For example, one has vascular dementia, but recently had a heart problem and got a pacemaker fitted. If this had not happened I think they would have died of heart failure, but now they might go on for years getting slowly worse mentally. How they decide to turn it off I don't know.

Pacemakers are not implanted for heart failure, they control the rhythm of the heart and this can improve blood flow so lessen the dementia.

They don't get turned off, the battery runs down and they can be programmed to extend the battery.

Another similarly has the same dementia but had a heart valve replacement surgery and that os now keeping them going.

I would guess this was a transcatheter aortic valve replacement, it is not an operation it is a medical procedure. A cardiologist makes a small incision, usually in the thigh and uses a catheter to insert an artificial valve.

It can considerably improve quality of life.

Same. I have an advanced directive. She didn't, and lost capacity pretty rapidly, and so began a horrible charade of rounds of IV antibiotics every time a woman of 80 with advanced dementia and two unhealing broken hips from osteoperosis got an infection which was, naturally, a lot. She must have weighed 5st by the end. Surely that's not what people go to medical school for. Surely that's not the aim of medicine. I have a lot of reservations about assisted dying, but I'm very much in favour of re-normalizing natural death. My friend who is a doctor feels the same - she's very on the fence about assisted dying and thinks it could go very wrong very quickly, but also thinks it would be much less of an urgent question if we just....pulled back a bit as a matter of policy. Stop doing so much to people who are at the end of human life expectancy. There might be certain circumstances where a major intervention is warranted, but not as a matter of course. Allowing natural death is also a lot less ethically fraught from the doctors perspective than assisting someone to die.

If someone has the capacity to refuse, then there isn't any issue because they can make an informed choice about having medical intervention to prolong life.

It's when a person doesn't have the capacity to decide that's worrying because it's harder to tell if it's something that they would want. Some procedures might improve quality of life and others might just make things feel worse.

Exactly, the pacemaker has massively improved her quality of life and that’s why I think we shouldn’t be judging or rationing medical procedures based on perceptions of being too old to be worth it or current levels of ill health that can be or have a good chance of being improved by medical intervention.

I think the default should be to get the person the best medical care unless they refuse it.

@user1471453601

But being older can be positive. Older people have experienced an awful lot and can give advice based on that. Keep on posting!

The “fear of going through it” I meant as a reference to going through old age and the gradual loss of health, mobility and mental acuity. The decades long slow degradation. Not death itself. I realise I wasn’t 100% clear the fear isn’t of death but of the side effects of aging.

I'm making an advanced decision to take effect if I ever become unable to make or communicate decisions about my health and wellbeing. I've met enough people who were resuscitated and unhappy to have been "brought back."

(Don't get me wrong, I also know people who were thrilled to have a second chance at life.)

I'm only in my 40s, but I don't want money spent to keep me alive in discomfort.

Until my step mum - 92 - had her pacemaker fitted last year, she cost the nhs a fortune for 2 years, in and out of hospital, bed blocking for weeks each time. Now she pootles along, yes she has some cognitive decline, but sometimes doing something is better than doing nothing. She wasn't actively dying, just too ill and uncomfortable to not be in hospital... for a bit... regularly...

Thank you. Whenever I see posts in the future asking why people like me (old, no young children ect) post on her, I'll think of you 😍.

@user1471453601

You put that very succinctly.

I’m glad you can “visit” on MN. All human life is here!

It's not at all simple. On the face of it, I have my every need catered for. I have financial security too, thanks to a good pension.

What I don't have is autonomy. I haven't been outside my house since before xmas. I haven't had a visitor (outside my adult child and their partner who live with me) since November.

My adult child is well aware of my desire to just go. Whatever way is mine. But medics want to keep me alive with drugs. And the really odd thing is, I comply.

Why I comply, I cannot figure. Maybe it's because I don't want to be the reason my child (adult though they are) will be sad, and I don't want to be the cause of their sadness. Though, inevitably, I will be.