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....
10 ways to think creatively

10 ways to think creatively

What if what you want until you die can’t be done exactly as you imagined? Consider it an opportunity for creative thinking.  No ocean in sight? Make an ocean sounds playlist Ocean pictures: on the wall or on a digital photo album Video the beach and ocean, make a loop Virtual reality Ocean simulator game Create a mini beach scene: sand, a cocktail umbrella Make a Japanese sand garden Books about the ocean Make the most of an opportunity: the ambulance driver made a pit stop at the beach, for a last visit Find a sympathetic accomplice: a nurse broke the rules: she wheeled her patient to a balcony where he could see the ocean, have a smoke and a glass of wine...
Medically Assisted Dying: the benefits of the process

Medically Assisted Dying: the benefits of the process

Medically Assisted Dying When medical assistance in dying – MAID  (also referred to as Medically Assisted Dying – MAD and Physician Assisted Dying – PAD ) was just a twinkle in eye in most of North America, I began my layman’s journey into learning all things end of life – encompassing much more than ‘help me die’. Now, with medical assistance in dying taking center stage, I’ve made it my business to attend every Town Hall, Presentation and Info session. While the ‘license to kill’ crowd takes every opportunity to insist it’s suicide and murder, little time and attention is paid to two important outcomes: When MAID is refused Benefits of the process requesting MAID Taking a leaf from the ‘suicide and murder’ crowd, consider what happens when the MAID request is refused: You are condemning someone to a prison of suffering. A lifetime sentence with no parole. For some, it’s akin to sanctioning their torture. Of those who say, with a sneer in their voice:  “oh you can off yourself anytime you want, it’s the ‘medically assisted’ we object to”  Consider the aforementioned – imprisoned by their own disease whose very condition prevents them from taking matters into their own hands. Suicide: an act of desperation. MAID: an act of contemplation …with benefits. And therein lies an unexpected benefit of applying for MAID. In the poignant podcast series, ‘Better off Dead’ Andrew Denton takes personal umbrage when he hears a 24 year old applied for MAID. “I think of the years ahead of her – a mother, a wife, a career woman.” To this well-meaning sentiment, my rejoinder...
Elderly and Sleep

Elderly and Sleep

Best Mattress and Sleep Positions for Elders Guest post: Sarah Cummings, The Sleep Advisor We need less sleep as we get older. Everyone knows that right? Wrong! Completely and utterly wrong. The myth that the need to sleep drops as we advance in years is one of those random misconceptions that somehow takes hold and persists – kind of like how if you eat something within five seconds of it falling on the floor it will be fine. No, it won’t. The truth is that after we have passed through adolescence, the need for sleep remains largely constant throughout our adult life. What changes is our ability to get good quality sleep. More than half of older people have a least one complaint about how well they sleep. So what do we do? Well some of us will compensate and make up the shortfall with daytime naps, others will basically just get used to being tired and achy thinking it to be a part of the natural ageing process. Which to extent it is, but you don’t have to give Father Time such a helping hand! I’m here to tell you that you can take back some control over your sleep and try and maximise how much you get and how good you feel when you wake up. All you need to do is pay a little attention to what you sleep on and what position you adopt. What type of mattress do you need? Every body is unique. What works for Mrs Stevens nextdoor might not work for you. It shouldn’t surprise you then that there is no simple...
Ricky’s mother had a ‘good death’

Ricky’s mother had a ‘good death’

Of the three siblings, Ricky – the sole daughter – was closest to her mother, Anna. “When my marriage ended, my kids and I lived with my mother. We all adored her.” In the last three years of her life Anna- who died at age 91 – was beset by Dementia. “It was more than memory loss – it was her wonderful personality that vanished.” In spite of the pain of her beloved mother disappearing, Ricky took care of her until the end. It was an end ‘strategy’ that the sibs agreed on: no heroic measures. No CPR should her heart stop, no medications to jump-start her system, no breathing machines and no feeding tubes. “The day she passed the entire family had a get together in her room. We brought take out food and ate our picnic sitting by her saying our farewells .I returned later that evening to have time with her alone. I curled up around her, and whispered, it’s ok to go. She died later.” As spokesperson, Ricky stood firm in the face of health care professionals who repeatedly tried to sway the agreed-upon ‘natural death’ route. Afterwards, she was asked to give an interview about why she and her sibs could stand their ground.“The sibs and I did not see the point of meds that would prolong a life that was obviously ending… comfort was our priority and we felt that would be what she would have chosen had she been able.”...
A beautiful death

A beautiful death

“My mother was ‘dying’ for about 10 years – with her sickness, she seemed often on the brink of death, and then she’d rally. We’d all said our goodbyes a number of times. But on the day she actually died, my father was in her bed, his arm around her, holding on to her. He’d been in this position for a long time when my former brother-in-law came to visit. “My mother and her former son-in-law had kept up a really special relationship even after my sister had divorced him. They were very close and spent a fair bit of time together. My father would call him ‘her spiritual companion’. When he came into my mother’s room, she was looking grey and frail. My father’s arm was falling asleep holding her. ‘Can you take over here?’ he asked when former brother-in-law appeared. Take over he did, cradling my mother against him. My mother looked at him and her face lit up. Her cheeks became rosy and her eyes twinkled. She looked like a teenager again. She smiled, and took her last breath. It was a beautiful death. I was glad to have been there. Interestingly, when I was about 5 years old, I had a dream that my mother died in the arms of a younger man. It was the only such dream I’d ever had.”  ...