living your best to the end

Myths about aging, proud octogenerians

Jack Pinkus in action at Baycrest Jack Pinkus, retired pharmacist with 17 years on the Board on the Ontario Pharmacists Association opened his educational session at Baycrest by exploding the following myths: • Age will inevitably bring illness • Damage is already done, so why bother taking care of my health • Getting old means losing mental sharpness • Getting old means being sad, lonely and inactive. This was good news to the group aged 70+. He then explained succinctly the difference between normal forgetfulness and signs of dementia: “Everybody forgets their keys. That’s not a problem. That’s normal. It’s when you forget what the keys are for – that’s when you’ve got a problem.” Medication messages specific to getting older: • Aging makes the body more sensitive the effects of medication. • Having trouble with the small type on your prescriptions? Ask your pharmacist for a larger easier to read label. Messages relevant to everyone: • Natural does not mean safe. The worst places to store medication are: • Bathroom: humidity affects chemistry. • Fridge (unless specifically indicated): cold and humidity affects chemistry • Window Sill: sunlight affects chemistry. We’re always instructed by have a list of what we’re taking. I puzzled about what to use when making and keeping up a list of meds: Brand or generic (not to be confused with what happens when brand names become generic) I mean, how much easier to say Prozac (nothing to disclose) than Fluoxetine Hcl. The answer: Wise to have both, especially traveling outside Canada when brand names may be different. During the session, another example of how much...

Pew Research Center:Views on End-of-Life Medical Treatments

 Staying Alive: what more of us want to do  “The share of the public that says doctors and nurses should do everything possible to save a patient’s life has gone up 9 percentage points since 2005 and 16 points since 1990. From Pew Research Center forum “Views on End of Life Medical Treatment.” That more adults want everything done to keep them alive at life’s end does not surprise me. Doing everything vs dying peacefully But, this may come as a surprise in light of reports saying we want to die peacefully, at home, which assumes fewer interventions. It also seems to fly in the face of numerous initiatives encouraging discussion – with the underlying hope that talking and normalizing the topic will have the effect of reducing the ‘give me everything’ approach. Where’s the disconnect? As I continue to talk about life’s end whenever I get the chance, I am constantly confronted with the reality that explains the disconnect: the assumption, presumption and possibly the expectation that we who are not immersed in the world of health specific to end of life will understand the context and repercussions of ‘give me everything’. Even healthcare professionals in areas other then end of life often don’t have a sense of or focus on effects of interventions, beyond the intervention. On the surface it makes sense: the promise of medical advancements combines with the medical professional’s mandate to heal and cure – often resulting in unrealistic hopes, expectations and goals. Dr Ken Murray‘s How Doctors Die lets us in on the fact that his colleagues adamantly forgo ‘futile treatments’. Then too,...

Organ and Tissue Donation: a learning experience

Donna Renzetti (left, standing) Vice President, Corporate Services and Chief Financial Officer at West Park Healthcare Centre came in on a Saturday to make sure there were plenty of chairs at the ready for the Trillium Gift of Life Network (TGLN) presentation on organ and tissue donation and transplant. She needn’t have worried: the gathering group were all wheelchair bound – or rather, wheelchair liberated (depending on your point of view) with the range of wheelchairs equivalent to a high-end car collection, complete with customization. I’m a public member on West Park Healthcare Center’s Palliative and Supportive Steering Committee, and am always up for attending education sessions that can increase my knowledge and understanding of end of life concerns and issues for their residents. Donation is not just for the able-bodied These good folks, for whom day to day living is their first priority, were interested in learning about organ and tissue donation. Their home is the complex continuing care section of West Park Health Center and many live with terminal degenerative conditions like Lou Gehrig disease (ALS) , Lung Disease (COPD), stroke, traumatic brain injury. Restricted and diminished though these West Park residents may appear to me – it’s clear they know exactly with whom they want to sit and are affectionate and caring with one another – communicating by various means. This is a substantially different crowd than the week prior, when I’d attended an Ontario Hospital Association conference on Ethics and Legalities in End of Life, where TGLN also made a presentation, encouraging discussion, decisions and making wishes known. That group, from various healthcare organizations, heard:...

Dialysis and End Stage Kidney (Renal) Disease – ESRD

End of life planning for those with specific chronic conditions:  Topic – Kidney Failure “End-of-Life Care planning (aka: Palliative Care or Advanced Illness Management) is essential for kidney failure patients.” Dr Robert Bear, Nephrologist, Blogger, Tweeter and Author Dr Robert Bear, whom I met via twitter (@RobertAllenBear) educates me on end of life decisions faced by those with end stage kidney disease – also called kidney failure. “While many frail and elderly patients with kidney failure will not choose dialysis treatment, for those that do the annual death rate on dialysis is 15-20%; and, overall, about 20% of long-term dialysis patients will ultimately decide to withdraw from it. “ As Dr Bear reminds me: “60 years ago, doctors would give mostly comfort care to those with end stage renal disease (ESRD) These days, specialists who provide that kind of care are in short supply” Today, for those with ESRD, comfort seems less emphasized than dialysis, now an option, thanks to medical advancements. It wasn’t until I saw ‘Gayla’s Goodbye’ and heard first-hand why she decided not start dialysis, that I began to understand its impact on life: ”My mother had kidney failure (ESRD) and went on Dialysis. She got more and more exhausted from those trips to the clinic. They took up so much of her life. It’s not for me.” Gayla subsequently died peacefully at home. Dr. Bear describes dying of ESRD as ‘typically a painless death’: “As the poison levels rise she would’ve spent more time sleeping. Essentially, she would have ‘slept away’. [blogger’s note: isn’t that how we all want to go?] “If patients are in...

Dr Paula Rochon: Medications and the Elderly

Dr Paula Rochon, Geriatrician,Vice-President Research–Women’s College Research Institute; Adjunct Scientist Kunin-Lunenfeld Applied Research Unit I heard Dr Paula Rochon speak to a small but extremely attentive group of senior seniors. The topic: Medications and the elderly. Rochon is a Geriatrician by training, and her research focus and passion is medication. My take-away: don’t underestimate the impact of medications – the time and effort and challenges required to take ‘em, and the potential effect on other functions. I spoke with Dr. Rochon afterwards, and she clued me in to specific issues related to medications and aging, and a message to pass along to fellow females: Women have to be particularly diligent because so much medication research is done with men. Here’s what I learned: Even if your parent’s been taking the same medication(s) forever, it’s still a good idea to get them reviewed every 4 -6 months. Why? Because aging bodies may not need as much of any one medication. Ask if all medications are necessary, or if any medications can be eliminated If new medication is prescribed, find out what it’s for, if it’s replacing something else, and how it’ll interact with other medications food and drink. Much as weight plays a huge role in how much medication infants are given, as an aging body shrinks, they may not need as much medication. Know your parents weight and height Many medications, or combination of medications can cause confusion, which can lead to a mess o problems: confusion, losing balance and falling, misplacing glasses, dentures, and often –are you ready for this: misdiagnosis of dementia or early Alzheimers. Many pills...

Communicating Prognosis at the End of Life

How to tell patients they’re likely to die Health care professionals often have difficulty facilitating hope and coping strategies when managing end-of-life issues.  Advising a limited life expectancy has an obvious impact on the patients, caregivers and their networks ability to remain optimistic. To overcome this health care professionals can offer to answer questions, discuss promising new treatments, treat the patient as a “whole person”, discuss the limitations of end-of-life estimates, present information about palliative care and advice on other alternative treatments. Often this information will need to be staggered to avoid overwhelming the patient. If a patient’s health is deteriorating a time will come in which discussing death and dying becomes important. In the terminal phase the patient and their caregivers may hold unnecessary or misplaced misconceptions about the process of dying. This discussion can do much to alleviate anxiety. Patients’ information needs differ with context, prognostic stage and distribution rates. Though most patients will prefer being kept highly informed and appraised of treatment options this need will differ in relation to the context of their own health and their stage in the prognostic cycle. Further, whilst some patients may prefer an “all-at-once” approach to information, others will prefer it to be dispersed across a series of touch points in a more “piecemeal” approach. Discussing prognosis and end-of-life issues has been identified as an important component of care by patients with progressive life-limiting illnesses, and their families.1,2 Being adequately informed is essential for such patients and their caregivers to participate in decisions about their treatment and care, to set goals and priorities, and to prepare for death. Clinicians...