Not having medical procedures in old age

[Orangesandlemons77]

I should possibly post this in AIBU, but thought those here might understand what I'm on about.

I'm in the age of having parents and neighbours getting old and seeing a pattern emerge.

They seem to get treatments / surgery to prolong their life but this seems to not bring a good quality of life.

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.

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

My elderly dad has mixed dementia and recently suffered with pneumonia which used to be called the 'old mans friend' he was treated with antibiotics and now recovered but struggling with UTIs and confusion.

I had genetic testing and have a copy of the APOE4 gene meaning I have a slightly higher risk of alzheimers and maybe this is focusing me on this as well.

I am considering doing an advance statement stating no life saving treatments / surgery after say 75. I'm also doing a PoA as well. I already have a problem with the bowel which can result in obstruction (adhesions) so that might see me off before the dementia kicks in.

Sorry if this sounds morbid but I wondered if this resonates with anyone else.

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.

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

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.

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.

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.

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?

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.”

I think you can state this kind of thing in it yes.

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.

Yes- probably because I have the genetic risk which is about 3X higher than normal, making me focus on this.

This is such a good point, my perspective will be slanted due to this and also having several relatives with it.

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 !

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.

Perhaps this is easier than most people know about with the advance directives etc and it is just that people aren't aware?

Another good point, maybe they are not offered things as well, could this also be written about in a directive e.g. "I would like surgery if needed for e.g. hips?"

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?

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).

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.

I think I agree OP.

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 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!

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

It's on that link I provided, it is the most recent document. I was wondering about this too.

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!

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

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.

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