living your best to the end
Infections in the elderly how to best treat: Are antibiotics always the answer

Infections in the elderly how to best treat: Are antibiotics always the answer

‘If you don’t give her antibiotics, she’ll go toxic and die.” Although my 96 year old aunt (pictured at left, between me and my cousin – her daughter) had no symptoms of a bladder infection, a urine test resulting from cloudy pee revealed she indeed had a Urinary Tract Infection (UTI. My aunt hadn’t complained about pain or discomfort, my cousin – her ‘power of attorney’ – authorized treatment with antibiotics. Many would agree. However, when I shared this with Dr. Jocelyn Charles, Chief of the Department of Family & Community. Medicine and Medical Director of the Veterans Centre at Sunnybrook Health Center, she shook her head. “Treating the test results and not the patient.” The (assuredly well-meaning) healthcare professional who made that pronouncement was talking about ‘sepsis’: when the bloodstream – and therefore the whole body – has become one big infection it becomes ‘toxic.’ In a younger person, antibiotics – standard protocol – would be a no-brainer. Rarely it seems, is taken into account the repercussions of ‘standard protocal’ in the elderly. Functionality and age should have an impact on treatment decisions From the blog, Geripal – devoted to optimal treatment of the elderly: Survival from severe sepsis: yes the infection is cured but not all is well – the point is made that, in the elderly – unlike those younger, whose bodies have more resources – treatment does not equal ‘back to how she was before’. Instead, treatment that sounds so necessary and logical can lead to increased confusion, worsening dementia, and a more vulnerable immune system. In my aunt’s case, several courses of antibiotics failed....
Palliative Care: Doing ‘nothing’ is not an option

Palliative Care: Doing ‘nothing’ is not an option

 Dr Daphna Grossman wants to set the record straight “In healthcare it seems we talk about ‘doing everything’ or ‘doing nothing’. With Palliative care ‘nothing’ is not an option. Certainly there are standards and recommendations and then there’s the Art of Treatment: our goal is to treat the whole person – physical, psychological spiritual and social. We look at a person’s goal of care. Can this goal be achieved? Not all illnesses can be cured however, symptoms can be alleviated.” Dr. Grossman is a Palliative Care Doctor at North York General Hospital, co-lead for the supportive care program, and involved in research and teaching. She paints this picture: deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpuf deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpuf deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpuf deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpufHer passion for palliative care radiates off her, paints this picture: “If we only treat patients in terms of their physical issues such as addressing their test results it’s like looking at a picture in black and white. We need to also address the context, the person, who they are, and what is important to them to paint a picture that is in colour.” The thing is, people,often perceive Palliative Care as a euphemism for on the doorstep of death, where nothing more will be done....
End of life decisions and next Tuesday’s food.

End of life decisions and next Tuesday’s food.

Dr Rebecca Sudore: changing focus from planning end of life to preparing for end of life decisions An Associate Professor In-Residence in the Division of Geriatrics at University of San Francisco, the impossibly young Dr Sudore is dedicated to helping vulnerable older adults and their families make informed medical decisions, especially for advance care planning and at the end-of-life Dr Sudore, at a University of Toronto Bioethics Speakers series, used this question to illustrate the impossibility of meaningful planning for life’s end: ‘Do you know what you’re going to eat next Tuesday? The answer: ‘it depends’. And so it is in planning for what’s essentially the unknowable in the end of life journey. Dr Sudore’s research recognizes the possibility of not everyone agreeing and focuses on preparing for decision-making. Seemingly simple questions, says she, open the floodgates. Is there anyone you’d trust to make medical decisions? Do they know? What have you talked about with them? 50%-76% will be unable to make our own end of life medical decisions The importance of conversations with the surrogate can’t be emphasized enough. Even so,having spoken to dozens of surrogates as part of her research, the findings are distressing and revealing: Many surrogates don’t want the role. Sudore thinks it of paramount importance to ask the question of patients: Are you ok with your surrogate making ‘in the minute’ decisions? Giving your surrogate permission to override or change your wishes – putting flexibility or leeway right into your Advance Directives – can make the difference between a surrogate adjusting to loss or suffering from Post Traumatic Stress Disorder. Dr Sudore gives, as an...

Modern Medicine can keep you alive

Modern Medicine can keep you alive Machines, medications and man-made parts: modern medicine continues to find and develop life-saving and life-prolonging interventions. Advancements in heart research include: Bypass surgery Man-made implantable cardiac devices like pacemakers When organs fail, there’s dialysis for kidney failure, and transplants for kidney, lung, liver and heart. Cancer continues to be researched, and survival rates and life expectancy has greatly increased. For neurological (brain) illness and injury, medications and interventions are emerging, and rehab helps with increased function. Even infections – which were regularly the cause of death in past generations – are now treated with antibiotics. However,  as the body winds down, so-called ‘Heroic Measures’ may do more harm than intended.  CPR (Cardio-Pulmonary Resuscitation) Breathing Machines (ventilators), Feeding tubes and specific medications can be considered  Heroic Measures or seem more like Futile Treatment. When making decisions about any of these, it can help to understand the longer-term results and possible complications. A End of Life Machinery A Staying Alive My big brother, John, had the best possible end by KathyKastner | Dec 30, 2019 | Blog, Personal StoriesMy bro died at home, on Palliative/Hospice Care Although we did not know it at the time, my brother’s ‘end’ started November 2018, with a brain tumour diagnosis. Surgery before Christmas that year was deemed ‘successful’ and John was in such good physical shape that he was released early. He sailed through weeks of radiation and chemotherapy with few of the expected side effects. His only physical change was that he started wearing hats. Humour was his go-to modus to get through, the sillier the better. We...

Important to consider

You can change your mind. And change it again. End of life choices and end of life decisions are often complex and ‘subject to change without notice’ Options and choices can change as life changes. Often decisions need thinking, learning more and then re-thinking. New York Times columnist Jane Brody writes of a retired Judge whose ‘directives became very specific: “Judge Laws said in an interview, he’d want to be ventilated temporarily if he had pneumonia and the procedure kept him alive until antibiotics kicked in and he could breathe well enough on his own. What he would not want is to be on a ventilator indefinitely, or to have his heart restarted if he had a terminal illness or would end up mentally impaired.” Mapping End of Life Choices Questions to ask of any proceedure, intervention, medication: Q1 How long will it take me to recover, and what can I expect while recovering? Q2 When I recover, will I be back to where I was before?  Q3 What are the possible complications and treatments (repeat Q1) Q4 What’s likely to happen if I don’t? What to consider as the body winds down: We need less and less to eat and drink, as the body functions less and less. Forcing eating or drinking – for fear of ‘starving to death’ – can cause unnecessary complications: “The body can no longer use food or fluids, and providing them may cause fluid retention which makes breathing harder” Dr Michael Gordon, Geriatrician  Implanted Medical Devices: their purpose changes at life’s end At life’s end, the very things that keep you alive, may...