Some say there is arguably no better time in history to be old. This is in part because the power between generations has been renegotiated and the aging have not lost control over their own existence.
When we lose our independence due to health issues, we either fight back or give in.
Many of us are unprepared to deal with this type of situation.
For the dying, scarcity of time takes on overwhelming significance since it threatens the self. Contrary to widespread belief, fear is not necessarily the outstanding feature in the psychological anticipation of death, it is dying alone. Ultimately, beliefs about the final transition are deeply personal and often shaped by cultural, religious and individual perspective. The question of what happens after death remains the fundamental and existential aspect of the human experience; a subject few middle-aged people want to discuss.
People with incurable diagnoses can do remarkably well for a long time. In essence, however, the normal process of aging can be slowed through diet and exercise, but it cannot be stopped.
In Western society, we don’t like to talk about dying. It is uncomfortable, so instead we avoid it. Even medical professionals don’t like talking about death since they are taught to fix and save lives.
The problem with not talking about it however, is that we have no idea what to say, what to do, or how to act when this inevitable part of our lives approaches, whether for ourselves or someone we love.
When you are young and healthy, you believe you will live forever. You do not worry about losing any of your capabilities. You are willing to delay gratification—to invest years in gaining skills and resources for a brighter future. If you or a loved one has a significant health issue, or if you are one of the many people thrust into the role of caregiving, or if you simply want to plan so that you can get back to enjoying midlife, researches encourage us to have (and document) a conversation that covers some of the important items below.
To get started, choose the right time and place by finding a quiet and comfortable setting where you can have privacy and uninterrupted time to talk. Prepare yourself. Reflect on your own feelings and concerns about the topic. Be empathetic, patient, and ready to listen. Recognize that this conversation may evoke strong emotions for you and others.
Begin by framing the conversation. Gently introduce the topic of care by explaining why it’s important to discuss. You can say you want to make sure you are prepared for any situation and that your loved one’s wishes are respected. Encourage the person to share thoughts, feelings, and concerns by using open-ended questions such as: “Have you thought about what kind of care you would like in the future?” Or “Is there anything specific you want to make sure is in place as you become more incapacitated?
Honor the person’s autonomy and preferences and let them lead the conversation at their own pace.Offer information about care options, such as hospitals, advanced care nursing facilities, independent living, hospice, palliative care, advance directives, and legal matters like wills and power of attorney. Be prepared to answer questions or guide them to appropriate resources. Ask about after death preferences such as burial vs. cremation, green burial or other. Quality of life questions should be addressed, keeping in mind that a physician’s role is to ensure health and survival. “But,” according to Dr. Atul Gawande, author of Being Mortal, “it is larger than that. It is to enable well-being, and well-being is about the reasons one wishes to be alive.” Sometimes that entails making the difficult decision to let one go.
If to be human is to be limited, or in limbo between life and death, then the role of caring professionals and institutions ought to be to aid people in their struggle with those limits. “Whatever we, as physicians, can offer, our interventions and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. One of the most meaningful experiences is helping others deal with what medicine cannot do as well as what it can,” Gawande acknowledges. If you are a caregiver, it may be very difficult to take time away from your role, yet being good to yourself is one of the most important things you can do to extend your effectiveness.
