Quality of life vs quantity of life: How old is too old?

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As many of you know I cared for my wonderful father in my home for 5 years. I found this website during that time and I thank God that I did for it got me through those years and months until my dad died in a nursing home. He was out of his mind due to hepatic encephalopathy (brain swelling related to liver failure). The last few months of my dad's life I lost 30 lbs. I couldn't sleep. My brother and I spoke by phone at least 3 times a day. I was living a level of stress I never knew existed and at the center of all of this was my brilliant, loving, funny dad who had reverted back to being a child. And I was the mom. So many times during this period I prayed for my dad to pass away. I wanted him to be out of his misery and yes, I wanted to be out of my own misery as well. I have come to believe that feeling like that is normal. How many times have we seen a post here from an adult child caregiver who wishes their parent would just pass away?

But what got me to talk about it here was a patient I had yesterday, Mr. Smith. Mr. Smith is 89 years old, he lives alone in a large house although he only occupies 2 rooms of the house now since he can barely get around. In going over his medications I noticed he had recently been prescribed a fungicide and the first thought that popped into my head was that this guy is so old he's growing mold on his body! He doesn't have dementia but is incontinent however he refuses to wear Depends. So every couple of hours he pees in his pants and his aide has to clean him up and deal with the soiled clothing. And at 89 he pees a lot. While he can eat he can't prepare food for himself because he has no balance. He has a walker and is very unsteady on his feet. He has 24/7 care and ulcers on his bottom because he sits all day. He's educated, charming, personable, a widower with 2 grown daughters. His daughters take care of his bills and his Dr.'s appointments. He shared with me that his one daughter does more than the other daughter. His house smells like urine and 'dirty body' and is shabby and in disrepair. Is this quality of life?

How about Ms. Jones: Ms. Jones lives in a broken down trailer which is situated in an adequate neighborhood. She's been there for decades. She had maggots in her food and rats in her pipes. She's caught in the middle of a family feud between her son and son-in-law. She falls frequently but has yet to sustain a serious injury. After each fall her family insists she be taken to the hospital to get checked out. Ms. Jones complains bitterly about this each time. Ms. Jones feels that she grows weaker in the hospital and can't wait to get home to continue her exercise routine which she does faithfully everyday. Ms. Jones cries. She worries that she's going to outlive her money. Her heart is broken over this feud in her family. She's lonely but she refuses to move into Assisted Living. She insists on staying at home. Part of her family pays her bills, part of her family takes care of her other business. She doesn't drive anymore and depends upon others for her groceries and transportation to Dr.'s appointments. I can almost predict that Ms. Jones will fall any day, break a hip, and spend the rest of her life in a hospital bed until she slowly drowns in fluid from her congestive heart failure or from suffocation from pneumonia which is sure to follow such a fall.

Last we have Mr. Green: A former physician, Mr. Green has lost the use of his legs due to peripheral neuropathy. He lives with his wife in a large home. Over the years they have installed 2 stair lifts, a Hoyer lift, and mechanized pulleys that carry Mr. Green all over the house including the 2nd floor. Mr. Green sleeps downstairs in a hospital bed and his wife usually sleeps in a chair beside him. She has for years. Every once in a while she'll go upstairs and sleep a while in bed. Both Mr. and Mrs. Green are in denial about their living situation. Neither one sees a Dr. Ever. Mr. Green has a catheter and very poor eyesight. He has 24/7 care that the Green's ask to sit in another part of the house, out of the way, until needed and beckoned by intercom. Mr. Green thinks that some day, when he's gone and his house goes up for sale, his house would be a wonderful find for someone who is disabled. I didn't have the heart to tell him that any real estate agent will insist that the stair lifts and pulleys be torn down. And I knew that someday it would be his adult daughter's job to put this house on the market. Having gone through that myself I knew what she was going to be in for and wondered if it had occurred to her. By the way, the daughter visits for about 30 min. a week.

These are just 3 real example of many of the patients I see. They're holding on for dear life to what little they have left. Each one has various ailments and illnesses and each one has at least a dozen of medications they take everyday. For heart failure, diabetes, high blood pressure, etc. Do we really need to live this long?

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It's funny what you can get to be comfortable with, isn't it? My parents bickered incessantly. I found it unbearable, they didn't even seem to notice it was happening. And oh God, once they got deaf…! I can remember losing it completely once and yelling "aaaarrrrgggh!! What is the POINT of your even having a conversation? Just Stop Talking!!!" (I was that sort of teenager, I'm afraid.) I suppose now I can see the funny side of two people trying to have an argument when neither can hear what the other is saying (which added a second thread to the argument, of course - "Well DO speak up!" "I am, it's not my fault you're deaf!" "What?").Maybe that's what she misses, in some way. It would explain why she's so d*mn provoking… Sorry, it's been a rough day.

It is frustrating when people dodge medical attention, but on the other hand… My ex-partner is facing treatment for prostate cancer and I don't envy him the array of unattractive options he's been asked to consider (tests coming up this week, fingers crossed it's nothing too aggressive or advanced so he won't have to pick anything awful). The ironic stomach ulcer is familiar, too; although it makes me blackly remember my mother's total and absolute denial that there was anything wrong when I questioned her - two days before a passing GP found her collapsed in the hall of her home. Not fancying treatment I can understand. Bare-faced lying about symptoms, though… grrrrrrrr. Sorry, as I said, it's been a bad day.
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Countrymouse, he was kind of a fatalistic person; he put off getting care for a bad prostate for so long that he got uremic and complained he couldn't swallow (??) we never did figure that out, but he finally went in, got his plumbing fixed, and his kidneys even recovered fully. He gave himself an ulcer from taking aspirin constantly for stomach pain, we got through that one too. He MAY have been worried that MIL was failing and if he was in hospital no one else could care for her, but then even after she finally got into care he didn't get anything done. Theirs was not a happy marriage - there had been physical abuse on at least one, perhaps only one occasion, and they yelled at each other and undid each other's projects at home, and yet there was some kind of loyalty and love going on too. When she could not cook any more, he would go buy hoagies and bring them home for them to eat. They, especially she, fiercely resisted any outside help, and even their kids and kids-in-law were mostly outside.
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Well, now there is one good thing about dementia. You don't know you have it.
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freqflyer, I know just what you mean. My parents stayed in the neighborhood for over 65 years. My mother and I are still here. All around us are young couples having lots of babies. When I go out for a walk I see no one but people almost young enough to be my grandkids. We exchange hellos when they talk to me at all, but there is nothing to base any relationship on. We are miles apart. I wondered why my parents didn't move to a place where they could actually be part of the community. But my parents were hermits, so the people around them didn't matter. Personally I find it miserable here, not being able to hobnob with the neighbors. My mother thinks I should stay here after she dies. I just say "why?" There is nothing here for a person my age. I plan to do just what you said and look for a good retirement community.
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After reading all the comments on many different discussions it came apparent that my S/O and I plan to do things differently. Within the next 5 years, if not sooner, we plan to move to a retirement village.... at least there we can make friends with people of our generation, and I believe having friends is a gateway for a better quality of life. Plus there are community dining rooms so one can see other faces while eating. Walking trails, transportation to stores, etc.

My parents are still in their single family home and Dad said he is so bored.... they no longer drive at 92 and 96.... and I still work so I can't be around to entertain them, but I do get their groceries and take them to their doctor appointments and other errands. My parents could easily afford the best retirement village in the area but refuse to do so. That's one mistake I don't plan to make. I don't want my S/O's children to be doing what I am doing at 10:30 at night, be on senior care websites.
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VS, I'm sorry about your FIL but I also wonder if he was right. Well, clearly he felt he was right, and you were right not to argue. But what I mean is, I wonder if the risk of surgery going wrong was the whole story for his decision against it. it's as though he was given a choice of mode and decided that he'd been offered a good one - you can't get much quicker or more certain than a rupturing aortic aneurysm.

My mother went back the other evening to her "I don't know why Daddy had to go and die" theme - God I sound like a bitch, but I have sound reasons - which also brought this thread back to mind. At 71 he was much too young, and we all miss him. But at 86, as he'd be now, not allowed to smoke or drink beer or ride his motorbike - if he were still with us he'd be as miserable as sin and in a permanently terrible temper. His heart attack was very preventable and I kick myself all round the room frequently for not having seen what was almost under my nose, but then the comfort is that he is not getting too old for him to bear.

I agree with you, people must be given good information and allowed to choose for themselves. The corollary is that we must learn to be better at looking reality in the face, ready for when it's our turn to decide.
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My only caveat is that quality of life should be judged mainly by the person living it.
Doctors and nurses are notorious for underestimating/underimagining quality of life, and sometimes assuming that it is non-existent just because of age or because of the condition they see someone is in when they are sick. It can be wrong to just assume, and withhold treatment that will give people more years to their life AND more life to their years.

Fungal infections happen to all kinds of people at all ages otherwise in good health. Pneumonia and CHF don't inevitably ensue after a fall. Adults wo have pretty clearly not fractured anything and don't have concussions don't need an ER visit with every fall, necessarily. Pressure sores are preventable with cushions and weightshifting even if you sit A LOT, if you stay nourished. A well adapted house is worth it to give the person living there ease of mobility. My mom's "van" (an adapted Scion xB) would have been easier to sell without the adaptations, true, but I would not trade those dollars for the ability to get her out, SAFELY, for pizza or dinner at Applebee's after her medical appointments that we enjoyed the last year and a half of her life...

If these folks did not feel they had quality of life, they would not fight for it. I'm not saying prolong life at all costs, that would be silly. Mom wanted DNR and by the end I was grateful that she passed before things got even worse than they were - she had angina, poor vision and hearing, and was starting to lose swallowing ability, besides not being mobile. But we would have missed an awful lot of living if she had just died when she fell at home instead of 3+ years later. The lady in the HuffPost article - brave but..well, you could argue that an 87% chance of surviving surgery might beat the sure thing of the heart condition as it was, but her values included ANY real risk living as an invalid without all her faculties being a huge negative. I can respect that decision but also, like her daughter, would have missed her and could have wished she'd given it a shot. My mom possibly should have had bypass surgery when she could - she did not decide rationally, just said "not now maybe later" and later was too late; my FIL decided against repair of an abdominal aortic aneurysm, and I was oddly enough the one to point out that he was competent and could not be forced into it when BIL asked if that was possible - he took a better than 80% chance of successful surgery versus at least an 8-18% chance of a fatal rupture per year, maybe more - we never did learn how large it was - and he had the rupture. People often weigh only the risks of surgery, not the risks of no surgery. He was just 80. Too young in my opinion, because age is just a number...I think there should be no cut-off age for interventions per se, but people should have guidance and information to make the best choices that are right for them and their families.
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ive read that docs have the tools to let a person go regardless of the wishes of the family when treatment becomes futile. i cant remember the particular terminology but an example is witholding antibiotics that just arent expected to work ..
i completely understand dnr reasoning . i compare it to firing up a busted car engine one last time. a last gasp of noise and smoke , then a violent ending anyway..
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There's a powerful Huffington Post article on what modern medicine has done to interfere with dying, and what we can learn from an 84-year old woman who chose to let go gracefully.

Some are so abdamant about prolonging life, they forget all about quality of life.

Some frightening costs for prolonging life:
..."About a quarter of Medicare's $550 billion annual budget pays for medical treatment in the last year of life, and during that time, one third to one half of Medicare patients spend time in an intensive care unit, where 10 days of futile flailing can cost as much as $323,000. Overtreatment costs the U.S. health care system an estimated $158 billion to $226 billion a year."
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It worked out great - in a way - for my mom. The system spent money to keep her healthy and active, and at the end, at age 80, she walked a mile on Thursday and was dead on Friday. I'd be glad to have her, even vegetating in a NH, but she wouldn't have enjoyed that.

Yes, it is very complicated and emotional.
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