I know this is politically incorrect to say, but will say it anyways. The impact of people living longer or I should say "existing" longer is more than some people may realize. I'm 52 and the financial burden between taking care of elderly parents and kids still going to college is great. The emotional and mental stress that it causes continues to the point that it can break up families because there's not enough time or money to go around. Hiring help is an option, but not the end of story. I'm all for living long when a person is not suffering, but when every day life is such a struggle, I really have a hard time with it. anyone else agree?
And you can't have it both ways...first they say we are unhealthy from our poor diets and lack of exercise then we are healthier and living longer and longer, make up yer minds... Personally, I hope to God I don't see 80!
While in my supposely good mental health at this time, if the time comes, should I unfortunately get dementia, I say don't fix my heart if my head isn"t right!!
As a daughter from family of nonagenarians, this issue is of great interest to me.My post is going to be long but what it leads to, I think, is important….
What I think we are going to see – this is going to really, REALLY, affect us (age group of 40 – 70) – is the change of the medical classification of dementia to a terminal disease. This is going to be more important than your Medicare eligibility age raised or getting worked up about the Medicaid look back period or MERP.
Right now dementia’s tend to be treated for the “presenting symptom”. Example: dad isn’t eating = feeding tube & Megace; mom has pneumonia = hospitalization, respiratory tx & antibiotics. US Health System now does things based on curative therapy to treat dementia’s and illnesses that happen to a person with dementia no matter where they are on the level or stages of dementia. This costs $$ and resources the person still has the underlying terminal disease of dementia.
In 2000, the AMA’s Diagnosis, Management and Treatment of Dementia: A Practical Guide for Primary Care Physicians states: “Many physicians are used to thinking of cancer, congestive heart failure, and chronic obstructive pulmonary disease as conditions for which palliative care and hospice referral may be appropriate; most do not think about dementia in the same way….Alzheimer’s disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Thinking of dementia as a terminal illness from which people are dying over years instead of months allows one to focus explicitly and aggressively on a palliative care plan.” This is a BIG deal & HUGE change. After the AMA guide came out in 2000, we started to see more hospice created in anticipation of the increased #’s of terminal diagnosis for dementia. And more doc’s suggesting hospice which Medicare pays for.
Then in 2009, the Mitchell study came out. It’s a very detailed study on dementia, especially advanced dementia. Mitchell concludes dementia is a terminal illness best served via palliative care in advanced stages.
IMHO what the Mitchell study (and others too, but Mitchell is significant) is going to do is to enable change of what happens with dementia patients based on data. In turn, this will limit what is done TO and paid FOR with advanced dementia patients. Dementia, as a terminal disease, will all be about palliative care. Example: dad isn’t eating = comfort care, no feeding tubes; mom has pneumonia = comfort care, no hospitalization.
This change is already happening. On April 19, 2011 NIH released new clinical diagnostic criteria for Alz. The emphasis is now on biomarkers, scan/neuroimaging and cognitive testing to evaluate and diagnosis dementia into 3 stages. The last diagnostic guidelines on dementia was back in disco days of 1984.
The Mitchell study and NIH guidelines will guide what changes are made for advanced dementia care (stage 3). It will be radically different from what most of us expect from health care – which is all about “cure” and doing whatever might bring about a “cure”. It will be about palliative care only in a hospice based setting (either at their home, NH or free-standing hospice) for advanced dementia.
Once dementia is viewed as terminal and a person has reached a certain level of advanced dementia, the only thing the insurers, Medicare and Medicaid will pay for will be hospice and the limited comfort care within hospice guidelines. So if you wanted to “cure” your parent or your spouse of Alz, and they have advanced dementia, you will have to do it via private pay as the insurer & others will not.
I think the numbers are 4.5M + people with dementia in the US now and it is expected to triple in 40 years, then hospice based care (with its focused path of palliative care) is the only financially feasible way for families, Medicare, Medicaid and the insurers to deal with advanced dementia and have the resources for health care for the rest of the population. It’s not pretty but reality often isn’t.
People in my family have almost routinely lived into and past their nineties and never did they have these cognitive problems until they began eating highly processed, pre-packaged foods with all those unpronounceable names. It isn't the living longer but rather the decline of diet and lack of physicality that has brought us to this cognitive decline.
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More People Living to 90 and Beyond: How do we care for them all?
And you can't have it both ways...first they say we are unhealthy from our poor diets and lack of exercise then we are healthier and living longer and longer, make up yer minds...
Personally, I hope to God I don't see 80!
What I think we are going to see – this is going to really, REALLY, affect us (age group of 40 – 70) – is the change of the medical classification of dementia to a terminal disease. This is going to be more important than your Medicare eligibility age raised or getting worked up about the Medicaid look back period or MERP.
Right now dementia’s tend to be treated for the “presenting symptom”.
Example: dad isn’t eating = feeding tube & Megace;
mom has pneumonia = hospitalization, respiratory tx & antibiotics.
US Health System now does things based on curative therapy to treat dementia’s and illnesses that happen to a person with dementia no matter where they are on the level or stages of dementia. This costs $$ and resources the person still has the underlying terminal disease of dementia.
In 2000, the AMA’s Diagnosis, Management and Treatment of Dementia: A Practical Guide for Primary Care Physicians states: “Many physicians are used to thinking of cancer, congestive heart failure, and chronic obstructive pulmonary disease as conditions for which palliative care and hospice referral may be appropriate; most do not think about dementia in the same way….Alzheimer’s disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Thinking of dementia as a terminal illness from which people are dying over years instead of months allows one to focus explicitly and aggressively on a palliative care plan.” This is a BIG deal & HUGE change. After the AMA guide came out in 2000, we started to see more hospice created in anticipation of the increased #’s of terminal diagnosis for dementia. And more doc’s suggesting hospice which Medicare pays for.
Then in 2009, the Mitchell study came out. It’s a very detailed study on dementia, especially advanced dementia. Mitchell concludes dementia is a terminal illness best served via palliative care in advanced stages.
IMHO what the Mitchell study (and others too, but Mitchell is significant) is going to do is to enable change of what happens with dementia patients based on data. In turn, this will limit what is done TO and paid FOR with advanced dementia patients. Dementia, as a terminal disease, will all be about palliative care. Example: dad isn’t eating = comfort care, no feeding tubes;
mom has pneumonia = comfort care, no hospitalization.
This change is already happening. On April 19, 2011 NIH released new clinical diagnostic criteria for Alz. The emphasis is now on biomarkers, scan/neuroimaging and cognitive testing to evaluate and diagnosis dementia into 3 stages. The last diagnostic guidelines on dementia was back in disco days of 1984.
The Mitchell study and NIH guidelines will guide what changes are made for advanced dementia care (stage 3). It will be radically different from what most of us expect from health care – which is all about “cure” and doing whatever might bring about a “cure”. It will be about palliative care only in a hospice based setting (either at their home, NH or free-standing hospice) for advanced dementia.
Once dementia is viewed as terminal and a person has reached a certain level of advanced dementia, the only thing the insurers, Medicare and Medicaid will pay for will be hospice and the limited comfort care within hospice guidelines. So if you wanted to “cure” your parent or your spouse of Alz, and they have advanced dementia, you will have to do it via private pay as the insurer & others will not.
I think the numbers are 4.5M + people with dementia in the US now and it is expected to triple in 40 years, then hospice based care (with its focused path of palliative care) is the only financially feasible way for families, Medicare, Medicaid and the insurers to deal with advanced dementia and have the resources for health care for the rest of the population. It’s not pretty but reality often isn’t.