Researchers and health advocates have long been encouraging people to make their end-of-life wishes known. While most people say they want to die a natural death at home, few actually put those wishes into writing.
But at least equally important is thinking about how to enjoy quality of life while aging. A new book seeks to help people address these questions. Kaiser Health News interviewed Nortin Hadler, the author of “Rethinking Aging.”
I especially like the book's tagline: "Growing Old and Living Well in an Overtreated Society." Hadler is concerned about the medicalization of aging. “We’re taught and marketed that all changes in appearance and in function in older people are forms of disease that demand treatment," he told Kaiser Health News. "But often, that isn’t true. Much that is termed a disease is a normal aspect of this time of life and needs to be viewed as such.”
The Kaiser Health News interview goes on:
Q: You talk a lot about the importance of older people making informed medical decisions.
A: For the first time in the history of medicine, we have a tremendous amount of information about efficacy: what makes sense to do medically and what doesn’t.
What I want to teach people is that it's perfectly appropriate for patients to ask their doctors, "How certain are you that what you are offering me will produce meaningful benefits? What does the evidence show about the possibility of harm?"
Q: Can you suggest some other questions people might ask?
A: People should want to know the likelihood that death will be postponed by doing something. What is the likelihood of the same outcome, or close to the same, if one doesn’t have the treatment? Out of every 100 people, how many are helped by this intervention?
This last point--how many are helped by an intervention--is particularly relevant. The doctor is referring to relative risk. You might hear a drug ad claim that “twice as many people” avoided a heart attack, stroke or some other dire health consequence. But if the likelihood of that dire thing happening to you was only one in 100 to begin with, do you really want to try an intervention and risk the side effects that go along with it?
In the interview, Hadler also puts the issue of informed medical decision making into context for people with a serious, life threatening illness:
You want to know whether a proposed intervention will be effective given your context: your age, your degree of frailty, other illnesses that you have. How much benefit will you get: an extra three months, an extra year? If it’s a year, what kind of year will it be? Will I feel absolutely awful? What will the quality of my life be?
I once took care of a very, very famous physician. He was an octogenarian with heart disease, but he was very active and sharp as a tack. Well, he found out that in his belly was an expanding aortic aneurism – a surgically treatable potential killer. He and I had multiple conversations about what to do and each time he would say, “I’ll be damned if I let them do surgery on me.” He knew there was a high risk of surgical mortality because of his age and his frailty. He knew that urological complications were almost guaranteed and cardiac complications were probable. He didn’t want to try to live through that. And he didn’t have to because he died of a stroke, unrelated to the aneurism, several years later.
You can read the entire interview here.