ELDER MUSIC: Rain 2
An Old Age Better Than I Ever Expected

Elders' Tough Decisions

Some of you may recall late last year when I told you about Travels with Epicurus, a lovely little book about living a fulfilled old age written by philosopher Daniel Klein.

In his introduction Klein explains why, at age 72, he rejected his dentist's recommendation of dental implants in favor of dentures.

The implants, he knew, would be far superior but they would also involve more than half a dozen visits to an oral surgeon an hour's drive from Klein's home over the course of a year or more with a great deal of pain for several days after each visit. Not to mention an expense in the thousands of dollars.

So Klein asked himself:

”In my early seventies did I really care if I presented to the world an old man's goofy smile?

“And even more to the point, with my years of clear thinking and reasonable mobility dwindling as quickly as my jawbone, did I honestly want to dedicate an entire year to regular visits to an oral surgeon?

“I did not.”

Klein makes it sound like a quick-and-easy decision; he's even kind of funny about it but I doubt he got there without a personal struggle weighing the pros and cons.

While chatting with an old friend this past weekend, I was reminded of Klein's teeth.

Like many men in their mid-70s my friend, over the years, has had medical problems with his prostate and he knows that prostate cancer is the second most common cancer in men.

Surgery is the usual recommendation but there is a variety of serious risks and there is also reliable evidence that when prostate cancer has not spread beyond the organ, men on average live just as long without the surgery as with it.

Knowing all this, my friend is left finding a balance, should it become necessary, between what can be formidable negative side effects of prostate surgery against his expected longevity - of living out his normal life before the cancer has any affect on his well being. Tough choice without many signposts to guide him.

And it's not the kind of decision anyone wants to be wrong about either, given that it's a strange old person who doesn't want to reach the end of life having suffered as few health and medical difficulties as possible.

So if the choice becomes necessary, it is probably going to be a crap shoot.

On decisions of this magnitude, we elders don't arrive at old age with much useful experience. What prepares most of us for making advance directive choices and do-not-resuscitate orders?

Since we can't predict the circumstances or condition we'll be in when those documents come into play, how to decide? And can we be certain the proxy we've named to make those decisions if we are incapacitated will do the wise thing?

No, we cannot, and none of the other late-life decisions that come up are much easier.

No one gets to be old these days without knowing the late actor Bette Davis's dictum: Old age ain't for sissies.

She said that, by the way, following a period of 13 months during which she endured a double mastectomy, four strokes in quick succession and a broken collar bone. So more than many elders, she knew whereof she spoke.

Life isn't fair. Like Ms. Davis, some people are plagued with too many of the diseases and debilities of old age while others are granted passage through the late years with only minor inconveniences. But no thinking person can avoid the tough questions old age imposes on us.

In my two decades of reading, research, talking with experts and ordinary people, no one has mentioned these hard decisions elders must make, decisions for which we have little preparation and for which there are few blueprints.

We are mostly on our own and from what I've seen, we do remarkably well. Even so, I think we should talk more about it among ourselves because god knows younger people don't want to hear these things.


At The Elder Storytelling Place today, Vicki E. Jones: The Hummingbird

Comments

I'm thankful for my sisters and friends including our fellow bloggers, for giving us people to talk to especially in those moments when I really need a sounding board to sort out what's important. They are also an amazing fountain of resources.

That's not the only way in which we need a "How to Be Old" manual. There is so much to figure out. One that's plaguing me right now (and it's a time-limited luxury even to have this problem) is, how much do I push myself to keep having challenging adventures and how much do I give in to the pull of comfortable habit? If the latter is giving in to getting old, isn't the former a foolish pursuit of faux youth? . . . I swear, the lack of an instruction manual for this time of life is . . . almost like being young.

I second what amba said.

The dental issue is one I'm struggling with now. My upper teeth are in excellent condition; most with root canals, and all with protective crowns.

My lower teeth though are starting a slow decline. At present two of the back teeth need crowns, and though I'm having no pain, I can't decide whether to just let them be...and have extracted eventually and get a lower dental plate.

I'm 61, but know that trying to keep my lower teeth in good shape will be expensive, painful and...a lower plate, less expensive. I have dental insurance, but like all insurance, the copays/deductible still leave me with a huge portion of the bill.

I usually recall what my grandmother did...she lived to age 92. But honestly, we're living in such vastly different eras, there's not much in the way of solutions there.

Thought-provoking post today!

Re the young people not wanting to know, how young do you mean? Because I'm 59 and I have wanted to know for the past 10 years. I started my blog partly to discuss all this. True, the younger-than-50 crowd is averse, and so is the "I can be immortal as long as I pretend I'm not getting older" bunch.

Thought provoking indeed. On one small point however I differ. There really are an ever increasing number of so called instruction manuals for making decisions in our old age. Between WebMD, and other quality health information sources that are unbiased and quality controlled for the medical stuff, there is a wide array of high quality books on aging well and even dying well. Just a thought.

Cara, for what it is worth. I am told that upper plates are not a big deal, but a total lower plate is really hard to adjust to and deal with. Bridges are fine, just not a total lower plate.

Talk to some people who have them, and see what they say. It may be worth the effort to keep some of those lowers intact.

For the moment, I'm in the stage that amba describes -- eagerly engaging in every adventure I still can and wondering whether I'm just trying to pretend that I'm not aging as I so evidently am.

On my recent hiking trip, the first day I wondered -- have I really overdone it this time? But then the prep I'd done enabled me to get to the level of fitness I needed and it was fabulous. For the moment, challenging myself (sensibly) seems possible.

I wonder if the practice of doing this will serve me as I face more drastic health decisions as I age? I hope so.

Having the conversation with those who will be making decisions for you is the single most important lesson I've learned from being the pastrami in the sandwich between my gently-dementing-90-yr-old-mother and my delightful 28 year old daughter. We listen, we ask questions, we push the envelope of comfort... but I have the general impression that I am doing well by mom and showing my daughter how she can treat me when her turn comes.

It's not easy. It's just necessary.
a/b

My husband at age 85 has been given a bill for $25,000 worth of dentistry. I've just been given one for over $10,000 at age 81. It is ridiculous, but what to do? A lower plate is no fun, as the commentators say.

For me, the decision making on issues like you described, Ronni, becomes easier the older I get. I lost a tooth last year and I had to decide whether to dip into my limited resources to have an implant or to have a temporary tooth made to fill in the gap. The decision was much easier at my age because it simply didn't make any sense to put over $1,000 in my mouth when I could get by for $175. Vanity is no longer something I can indulge in with the wrinkled, sagging blotchy face I present to the world so a gaping hole in my smile doesn't bother me so much if I forget to put my tooth in.

That decision would have been harder fifteen years ago when I would have been embarrassed to be seen without a tooth.

My conclusion is that the ease of making decisions involving money is dependent on one's financial circumstances and age. If you are wealthy enough to take the option of possibly prolonging your life (as in a decision on having cancer treatment) or if the actuary tables say you have a good chance of living another ten years it would make sense to me to do whatever is necessary to do so.

In the end, it's a crap shoot as you said, Ronni. So whatever you decide to do is the right decision for you.

I faced a somewhat similar problem. I’m 71. When I went to a cardiologist about my diagnosed tachycardia he told me I could even have atrial fibrillation without knowing it. He wanted me to wear a five-electrode monitoring apparatus for three solid weeks, to discover the exact locus of the arrrhythmia in order to – perhaps – burn it out of the heart tissue with catheter ablation. I declined. I’m more aware of the tachycardia now and it might be getting worse, but it’s going to have to be a LOT worse before I put myself through those ordeals. Until then, I’ll stick with pills.

I am 68 years old. Since I lost my husband two and one half years ago I have been traveling between the US and Argentina where my only daughter lives.

Just this morning I was thinking --- how does this old age thing work? While I am healthy I feel like I should be on adventures or be doing something productive and not wasting precious time. Should I just continue on as though I will live a long time until I don't?

– A couple of days ago I did one of those Buenos Aires “”tumble to the ground” (really bad sidewalks here) while walking and was able to get back up and continue on without needing help. I think that started my thoughts on the vulnerability of one’s life when one is on ones own and how it can change quickly.

They say life is what happens on your way to somewhere, but I guess it happens when you are not on your way to somewhere too. Too many variables to ponder.

Whatever we do, we should not leave it for the "kids" to decide. My dear 98 yr. old mom had a rough time last year with a severe case of shingles. My younger sister cared for her for 3 months & there was a problem with the transition from sick mom to well mom & my mother was totally aware of the issue. So we had a meeting.......mom, & me & my sister & my mom opted for a nursing home. As we prepared her for the move we discovered that all her bases were covered & almost 100% of her affairs were in order. We just had to make arrangements for a funeral in the future with clear instructions from her. She has had a POA & health care POA in place for many years.......she's my sister's & my role model. Dee

Younger people may not "...want to hear these things" but they still need to. Because, like it or not, we elders are the only role models they have for how to live elderhood.
Like Ashleigh, I have a delightful daughter (mine's 45) who is genuinely interested in how the whole aging process feels for me. After all, she learned to eat with a knife and fork by watching me, learned how to use the toilet by watching me, learned how to be a woman and a mom by watching me...and now she is learning how to get old. Not just by watching what happens on the outside but by hearing me talk about the process and how it feels to me on the inside.
My guidance may not always have been brilliant (she's actually a far more patient parent than I ever was!) and she may handle her own dilemmas and decisions differently when they arise, but I did my best. As a result, she not only understands a lot about aging and its issues but she also knows me very well and understands how I tick. And that means that if the time ever comes that she has to make tough choices about me, like turning off the ventilator or something, she'll know exactly what to do and it will be right.

And one other thing.....at about age 90 (& in good health)my mom signed a DNR directive & told us not "to do anything to prolong her life." She always claimed she was ready to see our dad. She told me yesterday that "she prays every night for a peaceful death." Dee

Given our genetic heritages, there is a substantial likelihood that my spouse will outlive me by years, maybe quite a few years.

I worry about making sure resources will be in place to make his years as comfortable as possible, and I am not talking only about finances. I feel guilty about leaving him.

My out-of-town friend that I had not seen for quite some time informed me last October that she was going to have a lung transplant operation while she was still within the age range (before 70) for approval.

She had been using a portable oxygen concentrator for the past couple of years and walked with a limp most of her life due to polio many years ago.

I received a phone call this past July informing me that Jane died. I don’t know any of the details because Jane wished no wake/funeral, etc. However, I did hear it said that she felt satisfied with her life of 69 years and decided not to go through with all it entailed.

This entire issue becomes more complex when you deal with health problems which leave you in constant pain, too weak to leave your chair or bed for days at a time, and your spouse is equally disabled. We have Living wills, Medical directives and DNRs on file with our doctor.

Neither of us is afraid of death, though we know from experience with family that dying can be a messy and uncomfortable business. His only brother went with ALS at 61, my sis-in-law had Alzheimers.

Like Linda, I'm afraid of leaving my husband alone. He can't care for himself and I worry what his life will be like if I go first.

For me some of the significant factors are (1) too many doctors pushing grueling end-of-life care which--according to recent studies--they would not choose for themselves; (2)the recent Frontline expose about "memory care" facilities run by a particular company; and (3) the fact that there is no good way to diagnose, treat, or cure Alzheimer's disease, but lots of advice about things that may (or may not) stave it off.

I manage my own health as well as I can, and my husband and I plan to see an attorney about DNR directives and take certain other steps should either of us begin showing early signs of dementia.

I..at age 70...am so appreciative of this site and then the many books that have been recommended. There is so much out there to help us...guide us. Although my children (who do not live close to me) in my opinon don't seem ready to see) We do Skype but it is hard to connect with their schedules. I live in WA(state) and they are in CO and CA now. My girls in CA want me to come back to CA...but my husband does not want us to do that! I think I'm going to have to figure out how I could make visits. Re dental work...I just keep putting it off since we have no dental insurance. ((hugs)) to all. ~Tricia

As I understand it all dental work is necessary to avoid infection and should definitely not be neglected.

There are aspects of aging that are thoroughly depressing. There must be some joy, right?

I need to divest myself of material possessions that nobody else will want. I do not want to saddle anyone else with the job of sorting through my stuff and getting rid of it when I die.

Of course dental work is necessary and "should" not be neglected, but what does a person do if there's simply no money to pay for it? I've never heard of a dentist who donates the type of complex services elders usually need. Lack of affordable dental care is a major hole in the safety net for elders.

Fortunately, we're not in that situation (yet), but I wonder if anyone else is dealing with making the (proactive) decision to move from a home they thoroughly enjoy to a "55+" community? Our lovely townhome has stairs and a steep driveway that ices over in the winter. My husband and I, at 83 and 76 respectively, are still able to cope, but we started thinking about how we'd do 5-10 years from now. The answer? Maybe not so great, so we're in the midst of selling our home (we hope!) and will be moving in a month or so to a place on one floor with a very short driveway.

Moving in one's 70s and 80s is NOT as easy as it was earlier in life, but it would be all that much harder if we'd waited until we were sick or frail and had to do everything under duress.

Bottom line: moving and trying to outfit a new place--like everything else--is WILDLY expensive!

My ex husband is 79. We are good friends. Last summer his PSA number came back outrageously high. He was told that the number could not be that high without it being cancer. He is the type of man who wants to continue living for sure--so he went to several follow up appointments. He kept me in the loop and I'd be lying if I said the whole thing didn't shake me up. I know he is "older" but, of course, my idea of what is old-old is changing the older both he and I get. No one is wanting to go anywhere yet!

Eventually a doctor told ex h that the PSA test is not advised after 75 years old...(because many men will have a high number at that age). Current thinking is if the symptoms are mild (which they are in ex's case)--"watchful waiting" is the way to go. This feels a lot better than constantly thinking about surgeries and medications--and it seems mature! Watchful waiting seems smart not only for a high PSA, but for other conditions too. (Of course, not with teeth problems....that is something that can't ever improve with time!)

Our usual modus operandi is to have a dog until it dies of old age. I have been thinking about what to do after our current dog dies. Would it be irresponsible for us to get another pet, knowing it might outlive us? I don't know what is the right decision.

That is a tough question, Jim, that I face about my cats. I think it's important to find someone who will promise to take them if they outlive you.

To Jim: Get the pet, but leave instructions on which rescue to contact if you become unable to care for it. Find one close (look on Petfinder.com) and post the name and phone number right on your fridge, or in your freezer with your directive. If you don't make that simple effort, your pet will go to a shelter because that's all emergency personnel know to do unless they have guidelines.

Before making a decision about a particular health care question, it would be wise to find someone to talk to who has gone through it if possible. I broke a tooth and had to lose it. I chose implant without really knowing much about it except I did not like the alternatives. It was expensive. I saw the surgeon once to have the old broken tooth removed and the post put in. I saw him a second time 3 1/2 months later to get the OK to see my dentist for the actual tooth. I took a painkiller the first night after the tooth was removed in anticipation of pain as the novocaine wore off. I never had a pain of any kind. Maybe I was lucky. I was 76 at the time. I'm glad I did it.

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