For the Very Old, a Dose of ‘Slow Medicine’

[groovedaddy]

It was two decades ago that a group of culinary mavericks took a giant step backward down the evolutionary trail with the “slow food” movement. Instead of fast food produced by the assembly lines of giant consortiums, they championed products of small-scale agriculture — time-consuming to prepare, beautiful to behold, very good for you.

Now (and, some might add, at last) doctors are following suit, rejecting the assembly line of modern medical care for older, gentler options. The substituted menu is not for all patients — at least not yet. For the very elderly, however, most agree the usual tough love of modern medicine in all its hospital-based, medication-obsessed, high-tech impersonality may hurt more than it helps.

In its place, doctors like Dennis McCullough, a family physician and geriatrician at Dartmouth Medical School, suggest “slow medicine” — as he puts it, “a family-centered, less expensive way.”

This medicine is specifically not intended to save lives or to restore youthful vigor, but to ease the inevitable irreversible decline of the very old.

http://www.nytimes.com/2008/02/26/health/views/26books.html?th&emc=th

[Warpy]

1. My mother, herself, told her doctor it was time for a little

benign neglect. He didn't listen, of course, and insisted she stay on drugs that she was obviously not tolerating well and endure the colonoscopies. I tried to argue her off them, but the doctor was god and he knew her wishes, blah blah blah. It wasn't until they came in to insert the shunt for dialysis that she finally rose up and told them to get the hell out of her room. When she became bedridden, I went to Florida and assumed her care. First thing I did was take her off all medications except the comfort medications from hospice. She spent most of her time sleeping and was nonverbal, although she'd nod when I'd ask her if it was time for more pain medicine. Her passing was peaceful. I was there.

My dad's case was a little different. He'd only been slowing down for a few months before his final illness. When he told me he was tired and ready to go, I immediately assembled the team and got him to do his own advance directives. I had a medical power of attorney, but the hospital needed to hear it from him or I'd be put in the position of having to trip the code team on their way through the door. The man I'd signed into carotid surgery and intensive rehab ten years earlier was not the same man I saw then. He knew it was time and, although I wanted to keep him around a little longer, I listened.

Listening to our parents when they've had enough is one of the hardest jobs we'll ever have. I'd already talked to my folks years earlier about what they wanted and didn't want, so I had a pretty clear idea of what to do and when to do it.

I don't think being a nurse made it any easier, though. Sometimes knowing what is coming and dreading it is worse than going through it.

This is a good article, though, about getting our folks to open up and tell us what they want when the worst happens. It isn't, as I feared, an article about withholding care, only about not putting fragile people through care that does them little good at an advanced age.