A POLST order goes beyond what a DNR can cover: it allows you to set your preferences for treatments such as nutrition, pain medicine, and antibiotics at the end of life, and it applies both inside and outside the hospital. However, it’s not without its drawbacks. Ultimately, it’s safest to draw up not only a POLST, but other types of tried-and-true directives, to ensure you get the end-of-life care you want.
There’s almost always something we can do to improve our health and well-being — even at the end of our lives. Palliative care is designed to improve the quality of life for people with life-threatening illnesses and their families by keeping a person comfortable and making sure his or her values and preferences guide the medical team’s actions. For this reason, good communication with your care team — and your loved ones — is essential, even before you or a loved one has developed a serious illness.
The need to support injured soldiers dates back to our country’s earliest days. That mission remains essential today. Those who may be eligible for VA benefits and services — veterans and their family or survivors — make up a quarter of the United States’ population. Individuals seeking care through the Department of Veterans Affairs deserve a thoughtful and compassionate evaluation to not only compensate them for their service, but connect them with the care they need.
An estimated 43.5 million Americans provide in-home, long-term care for older adult family members with a chronic illness. In a new JAMA survey, caregivers are typically women who spend about 20 to 40 hours a week providing care. Most caregivers feel abandoned and unrecognized by the health care system. Spousal caregivers face greater challenges than caregivers helping a parent for a variety of reasons, one of which is that they tend to be older. Many caregivers don’t know about, or take advantage of, services and support systems such as respite care, help with non-medical services such as housekeeping and cooking, counseling, and more. The Caregiver’s Handbook, a Special Health Report from Harvard Medical School, includes detailed information that can help women and men provide better care for their loved ones and take care of themselves.
A longer lifespan can be a double-edged sword. You live for more years, but the later years may not necessarily be what you had in mind. We’ve known for some time that about 25% of older Americans can’t perform some activities of daily living without help. But we don’t know much about the other 75%. A new study suggests that two-thirds of Americans over age 65 need help doing everyday activities such as eating, bathing, and getting in and out of bed or a chair. Things you can do to help ward off becoming frail or disabled include staying active, managing weight and eating a healthy diet, preventing falls, making connections with others, and seeing your doctor(s) regularly.
Taking care of yourself and your nuclear family is not always easy. Add the need to take care of an aging and ailing parent or family member and the stress can become overwhelming. According to some estimates, more than 40 million adults in the United States care for older or sick adult relatives or friends on a regular basis. AARP has estimated that these family and friends provide up to $450 billion worth of care. The responsibility often falls on family members, because long-term care outside the home can be very expensive and most Americans can’t afford private long-term care insurance that might cover these costs. Regular health insurance, or Medicare, does not pay for the kind of regular daily care many adults need later in life. A new ad campaign sponsored by AARP (formerly the American Association of Retired Persons) and the nonprofit Ad Council wants caregivers to know that they are not alone and that help is available. The goal of the ads is to raise awareness of the effects that family caregiving can have and to help people find the resources they need to reduce the stress.
Although dying is a fact of life, few people want to think about it. One group that must think about dying are people with advanced cancer who are told they have just a few months to live. What helps them end their days as peacefully as possible? A new study from Harvard-affiliated Dana-Farber Cancer Center and Brigham and Women’s Hospital found that being at home instead of in the hospital, talking with a chaplain or other minister, and spending time in private religious activity helped achieve this. When it’s clear that there’s no stopping cancer, heart failure, or other conditions, palliative care can help create a situation that maintains quality of life and leads to a “good death.”
Many older people develop delirium when they are hospitalized. Delirium is a sudden change in mental status characterized by confusion, disorientation, altered states of consciousness (from hyperalert to unrousable), an inability to focus, and sometimes hallucinations. Hospital delirium is especially common among older people who’ve had surgeries such as hip replacement or heart surgery, or those who are in intensive care. Inflammation, infection, and medications can trigger hospital delirium as can potentially disorienting changes common to hospital stays, including sleep interruptions, unfamiliar surroundings, disruption of usual routines, separation from family and pets, and being without eyeglasses or dentures. Although delirium often recedes, it may have long-lasting aftereffects, including premature death and poorer outcomes, such as dementia and institutionalization.
Alzheimer’s disease is a “disease of behaviors” that can wear down family and loved ones. In a talk called “Dementia and Cognitive Decline (Aging Gracefully)” Barbara Moscowitz, coordinator of geriatric social work for the Geriatric Medicine Unit at Harvard-affiliated Massachusetts General Hospital, offered helpful insights and tips into caring for people with Alzheimer’s disease. Moscowitz drew not only her 30 years of professional experience, but also on the personal experience of helping take care of her mother, who suffered from dementia the last several years of her life.
By Barbara Okun and Joseph Nowinski. Saying goodbye as the end of life approaches can be difficult, even for someone like writer Joyce Carol Oates. Her recent essay in The New Yorker about the impending death of her husband highlights the need for each of us to think about death and dying—and discuss them with loved ones—long before they become a likelihood.