Dear Life

On Caring for the Elderly

Karen Hitchcock

• Publisher: Black Inc.
• Year: 2016
• ISBN:
  9781925203875
• Topic: Sozialwissenschaften
• Subtopic: Gerontologie

In this short, powerful book, Karen Hitchcock shines a light on ageism in our society. Through some unforgettable case studies, she shows what care for the elderly and dying is really like – both the good and the bad. With honesty and deep experience, she looks at end-of-life decisions and over-treatment, frailty and dementia. Dear Life is a moving and controversial argument against the creeping tendency to see the elderly as a "burden"—difficult, hopeless, expensive and homogenous. While we rightly seek to curb treatment when it is futile, harmful or against a patient's wishes, this can sometimes lead to limits on care that suit the system rather than the person. Doctors may declare a situation hopeless when it may not be so.We must plan for a future when more of us will be old, Hitchcock argues, with the aim of making that time better, not shorter. And we must change our institutions and society to meet the needs of an ageing population. Dear Life is a landmark book by one of Australia's most powerful writers.'The elderly, the frail are our society. They are our parents and grandparents, our carers and neighbours, and they are every one of us in the not-too-distant future … They are not a growing cost to be managed or a burden to be shifted or a horror to be hidden away, but people whose needs require us to change' —Karen Hitchcock, Dear Life Karen Hitchcock is the author of the award-winning story collection Little White Slips and a regular contributor to the Monthly. She is also a staff physician in acute and general medicine at the Alfred Hospital, Melbourne.

Sources

Thank you to all of my family, colleagues and friends who shared their stories with me and helped immeasurably with my thinking. I offer my particular thanks to Dr Michael Currie, Dr Lisa Mitchell, Dr Michael Oldmeadow, Leonie Oldmeadow, Professor Paul Komesaroff, Michael Cathcart, Dr James Olver, Professor Alison Mudge, Professor Joseph Ibrahim and the Feik family for your careful (often repeated) reading of drafts, and for your thoughtful comments. I am hugely indebted to you.

The names and identifying details of the patients mentioned herein have been changed to preserve anonymity. The clinical stories are from public hospitals I have worked in across three states of Australia.

1“We elders have learned a thing or two”: Roger Angell, “This old man: Life in the nineties,” The New Yorker, 17 February 2014.

3“Butler outlines”: Robert N. Butler, Why Survive? Being old in America, Harper & Row, 1975.

3“Simone de Beauvoir published”: Simone de Beauvoir, La Vieillesse (The Coming of Age), Gallimard, Paris, 1970.

3–4“The swelling ranks of ‘greedy geezers’”: Linda Marsa, “The longevity gap,” Aeon (online), 2 July 2014.

4“One of the most-read articles in the Atlantic”: Ezekiel Emanuel, “Why I hope to die at 75,” The Atlantic, October 2014.

18Simone de Beauvoir, “The Art of Fiction, no. 35”, Paris Review, interviewed by Madeleine Gobeil, trans. Bernard Frechtman, www.theparisreview.org/interviews/4444/the-art-of-fiction-no-35-simone-de-beauvoir.

19“The outcome was a report”: Baroness Julia Neuberger (chair) et al., More Care Less Pathway: A review of the Liverpool care pathway, UK government, July 2013; Raymond J. Chan, Joan Webster, Jane Phillips and David C. Currow, “The withdrawal of the Liverpool Care Pathway in the United Kingdom: What are the implications for Australia?,” Medical Journal of Australia, vol. 200, no. 10, 14 June 2014, p. 573.

20“a tick-box exercise”: Margaret McCartney, “Talking about death is not outrageous – reducing it to a tickbox exercise is,” British Medical Journal, vol. 349, 29 August 2014.

20“the declaration of futility, is neither simple nor clear”: P.R. Helft, M. Siegler and J. Lantos, “The rise and fall of the futility movement,” New England Journal of Medicine, vol. 343, 2000, pp. 1575–7.

20“as in the United Kingdom”: Nat Lievesley, Ageism and Age Discrimination in Secondary Health Care in the United Kingdom: A review from the literature, commissioned by the Department of Health, carried out by the Centre for Policy on Ageing, 2009.

25“Diligently taking ten different prescribed medications has made them very sick”: David G. Le Couteur, “Pharmaco-epistemology for the prescribing geriatrician,” Australasian Journal on Ageing, vol. 27, no. 1, March 2008, pp. 3–7; Doron Garfinkel and Derelie Mangin, “Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy,” Archives of Internal Medicine, vol. 170, no. 18, 2010, pp. 1648–54.

29“a satirical novel”: Samuel Shem, The House of God, Richard Marek, New York, 1978.

31“the frail elderly do better in wards dedicated to their care”: Michael A.H. Cohen, “Integrated care results in fewer elderly people dying in hospital,” British Medical Journal, vol. 345, 16 July 2012; Alison Mary M. Mudge, Charles P. Denaro and Peter O’Rourke, “Improving hospital outcomes in patients admitted from residential aged care: Results from a controlled trial,” Age and Ageing, vol. 41, no. 5, September 2012, pp. 670–3; A. Mudge, S. Laracy, K. Richter & C. Denaro, “Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: Enhanced multidisciplinary care,” International Medical Journal, vol. 36, no. 9, 2006, pp. 558–63; L.Z. Rubenstein, K.R. Josephson, G.D. Weiland, P.A. English, J.A. Sayre, R.L. Kane, “Effectiveness of a geriatric evaluation unit: A randomised clinical trial,” New England Journal of Medicine, vol. 311, 1984, pp. 1664–70; I. Scott, “Optimising care of the hospitalised elderly: A literature review and suggestions for future research,” Australia New Zealand Journal of Medicine, vol. 29, no. 2, 1999, pp. 254–63; A.E. Stuck, A.L. Siu, G.D. Wieland, J. Adams, L.Z. Rubinstein, “Comprehensive geriatric assessment: A meta-analysis of controlled trials,” The Lancet, vol. 342, no. 8878, 1993, pp. 1032–6.

31“The single most important aspect of care”: C.P. Denaro and A. Mudge, “Should geriatric medicine remain a specialty? No,” British Medical Journal, vol. 337, 12 July 2008.

32“One reason aged patients do poorly”: Jan Savage and Cherill Scott, “Patients’ nutritional care in hospital: An ethnographic study of nurses’ role and patients’ experience,” RCN Institute, final report, May 2005.

33“inappropriately prescribed”: Denis O’Mahony, David O’Sullivan, Stephen Byrne, Marie Noelle O’Connor, Cristin Ryan and Paul Gallagher, “STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2,” Age and Ageing (online), 4 July 2014.

33“Twenty to thirty per cent of all hospital admissions”: Libby Roughead, Susan Semple and Ellie Rosenfeld, Australian Commission on Safety and Quality in Health Care Literature Review: Medication Safety in Australia, August 2013.

34“three things the hospital environment specifically hinders”: Alison M. Mudge, Prudence McRae and Mark Cruickshank, “Eat Walk Engage: An Interdisciplinary collaborative model to improve care of hospitalized elders,” American Journal of Medical Quality (online), 22 November 2013; NHS, Five Year Forward View, 23 October 2014.

36“hospitals precipitate adverse outcomes”: Morton C. Creditor, “Hazards of hospitalization of the elderly,” Annals of Internal Medicine, vol. 118, no. 3, 1993, pp. 219–23.

36“concept of futility”: P.R. Helft, M. Siegler and J. Lantos, “The rise and fall of the futility movement,” New England Journal of Medicine, vol. 343, 2000, pp. 1575–7.

38“reams of data show”: Terri R. Fried, John O’Leary, Peter Van Ness and Liana Fraenkel, “Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment,” Journal of the American Geriatrics Society, vol. 55, no. 7, July 2007, pp. 1007–14; E.P. Cherniack, “Increasing use of DNR orders in the elderly worldwide: Whose choice is it?,” Journal of Medical Ethics, vol. 28, no. 5, October 2002, pp. 303–7.

39“good data on treatments such as cardio-pulmonary resuscitation”: S. Cooper, M. Janghorbani and G. Cooper, “A decade of in-hospital resuscitation: Outcomes and prediction of survival?,” Resuscitation, vol. 68, no. 2, February 2006, pp. 231–7; P.S. Chan et al. “Long-term outcomes in elderly survivors of in-hospital cardiac arrest,” The New England Journal of Medicine, vol. 368, 14 March 2013, pp. 1019–26.

44–5“Take, for example”: Louise Aronson, “The human lifecycle’s neglected stepchild,” The Lancet, vol. 385, no. 9967, 7 February 2015, pp. 500–501.

48“The truth is dying”: Peter Saul, “A conversation that promises savings worth dying for,” The Conversation (online), 29 April 2013.

49“their regular use of hospitals and doctors generally, declines”: Alastair Gray, “Population ageing and health care expenditure,” Ageing Horizons, no. 2, 2005, pp. 15–20.

49“We spend mostly the same amount”: Australian Government Productivity Commission, An Ageing Australia: Preparing for the Future, research paper, 22 November 2013; M. Seshamani and A.M. Gray, “A longitudinal study of the effects of age and time to death on hospital costs,” Journal of Health Economics, vol. 23, no. 2, 2004, pp. 217–35.

49“not in fact very much”: Michael D. Coory, “Ageing and health-care costs in Australia: A case of policy-based evidence?”, Medical Journal of Australia, vol. 180, no. 11, 7 June 2004, pp. 581–3.

49“Data from New South Wales”: Katina Kardamanidis, Kim Lim, Cristalyn Da Cunha, Lee K. Taylor and Louisa R. Jorm, “Hospital costs of older people in New South Wales in the last year of life,” Medical Journal of Australia, vol. 187, no. 7, 2007, pp. 383–6.

49“costs associated with the last year of life actually fall”: N.G. Levinsky, W. Yu, A. Ash, M. Moskowitz, G. Gazelle, O. Saynina, O. & E.J. Emanuel, “Influence of age on Medicare expenditures and medical care in the last year of life,” Journal of the American Medical Association, vol. 286, no. 11, 2001, pp. 1349–55.

50“currently rising at a far slower rate”: Australian Institute of Health and Welfare, Health Expenditure, Australia 2012–13, media release, AIHW, 23 September 2014.

50“according to another AIHW report”: Australian Institute of Health and Welfare, Healthy Life Expectancy in Australia: Patterns and trends 1998 to 2012, media release, AIHW, 21 November 2014.

50“seek to minimise current financing”: Michael D. Coory, “Ageing and health-care costs in Australia: a case of policy-based evidence?,” Medical Journal of Australia, vol. 180, no. 11, 2004, pp. 581–3.

50“real areas of waste”: S.R. Hill, D.D. Henry and A.J. Smith, “Rising prescription drug costs: whose responsibility?,” Medical Journal of Australia, vol. 167, no. 1, 1997, pp. 6–7.

51“widespread international agreement”: N. Goodwin et al., “A report to the department of health and the NHS future forum. Integrated care for patients and populations: improving outcomes by working together,” The King’s Fund and Nuffield Trust, London, 2012; Gareth Iacobucci, “NHS plan calls for new models of care and greater emphasis on prevention,” British Medical Journal, vol. 349, 2014; Jeremiah A. Barondess, “On the preservation of health,” Journal of the American Medical Association, vol. 294, no. 23, 2005, pp. 3024–6; David Oliver, Catherine Foot and Richard Humphries, “Making...