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How and when?

Posted at 5:25 PM on July 9, 2008 by Bob Collins (7 Comments)
Filed under: Surveys and trivia

How do you want to "go?" Quickly or slowly?

Yes, it's creepy to talk about it but fascinating nonetheless as Jen Gross proves on the New York Times' blog The New Old Age. She writes this week about a recent presentation that asked people when they wanted to die. Most, as you might expect, chose when they are "old."

Then the presenter asked : When the room was not thrilled with cancer and then heart disease, they were told that they'd just chosen "dementia and frailty."

"How many of you expect to die?" she asked.

The audience fell silent, laughed nervously and only then, looking one to the other, slowly raised their hands.

"Would you prefer to be old when it happens?" she then asked.

This time the response was swift and sure, given the alternative.

Then Dr. Lynn, who describes herself as an "old person in training," offered three options to the room. Who would choose cancer as the way to go? Just a few. Chronic heart failure, or emphysema? A few more.

"So all the rest of you are up for frailty and dementia?" Dr. Lynn asked.

On the screen above the dais, she showed graphs describing the three most common ways that old people die and the trajectory and duration of each scenario. Cancer deaths, which peak at age 65, usually come after many years of good health followed by a few weeks or months of steep decline, according to Dr. Lynn's data. The 20 percent of Americans who die this way need excellent medical care during the long period of high functioning, she said, and then hospice support for both patient and family during the sprint to death.
Deaths from organ failure, generally heart or lung disease, peak among patients 10 years older, killing about one in four Americans around age 75 after a far bumpier course. These patients' lives are punctuated by bouts of severe illness alternating with periods of relative stability. At some point rescue attempts fail, and then death is sudden. What these patients and families need, Dr. Lynn said, is consistent disease management to head off crises, aggressive intervention at the first hint of trouble and advance planning for how to manage the final emergency.

The third option, death following extended frailty and dementia, is everyone's worst nightmare, an interminable and humiliating series of losses for the patient, and an exhausting and potentially bankrupting ordeal for the family. Approximately 40 percent of Americans, generally past age 85, follow this course, said Dr. Lynn, and the percentage will grow with improvements in prevention and treatment of cancer, heart disease and pulmonary disease.

Comments (7)

Very interesting topic given Dr. Lynn's analysis or rather illustration of death scenarios; I hope to read many comments from people in response to this post.

It is not hard for me to put Dr. Lynn's basic dilema into perspective. Denny, my mentor and a fellow poet, has been a vibrant individual during the entire time I've known him - full of life is a perfect phrase describing Denny, and not used as the blanket statement one hears time and time again - and at this late stage of his life he has begun to slip away as a result of alzheimers disease. As I am sure most can imagine, watching a poet slowly loose his or her mind is an especially gruesome scene to witness. Most painful are the times when I can tell that Denny recognizes this fading grasp. This display of intellectual degradation has lead me to consider Dr. Lynn's basic question many times; I must say that I don't know what to think.

Posted by Tyler Suter | July 10, 2008 12:45 AM

My hope is that Quietus will be legal by the time I reach old age.

Posted by Mac Wilson | July 10, 2008 2:47 AM

well all i gotta say is that we are spiritual beings within a shell. and its just a shell. knowing this, for me it doesn't matter how THE ENDING of this existence happens.

i just visited someone who is over 85 and dying of cancer and dimentia is setting in. they said that they are ready to go now because they feel just stupid that they can't remember sometimes. i told that person that it didn't matter whether they could remember certain things. its ok even if they forget my name or who i am. all that mattered was that they were there with me at that moment and we were spending some time together. that is what is important.

Posted by c | July 10, 2008 6:58 AM

c, that is what is important to YOU. During and just after college, I worked in nursing homes and as a home health aide. I actually really loved this work -- it is amazing what you can do for people when you let yourself care about them -- but as far as choosing dementia? Or dismissing it as "not important"? Some impressions from my side:

- Spoon-feeding an adult, and having to remind them to swallow each bite.

- Trying to calm someone I was caring for in her home because she did not remember that I was supposed to be there and was terrified, even though she had just asked me to make her a sandwich.

- Listening to a bed-ridden resident chant, "Help me help me help me help me help me help me kill me kill me" for an entire shift.

If it's just a shell, and the person is ready to leave it, does what's important to anyone else really matter?

Posted by Heather | July 10, 2008 10:43 AM

Heather-
I was a medic and i have had lots of experience (training with elderly in units such as and not limited to geriactrics, psych ward, icu) so i am aware of what goes on. i have served lunch to a very bitter old blind women.....even. i have my own share of stories from the hospital.
what i was saying was that i do not care if they do not remember my name, in other words, i do not think less of them or that they are stupid for not remembering my name. this person in particular felt as though others must think of them as stupid, (they had dforgotten my name and i am close to this person)...it was a self esteem issue and i was trying to be supportive.

/If it's just a shell, and the person is ready to leave it, does what's important to anyone else really matter?/

bob was asking what we thought about dying one way or the other and i was merely stating how i felt about the issue. i never said "HOW THE ELDERLY OR PEOPLE IN GENERAL SHOULD FEEL ABOUT DYING IN ONE PARTICULAR WAY OR ANOTHER"
lay off the coffee heather

Posted by c | July 10, 2008 12:22 PM

/c, that is what is important to YOU. During and just after college, I worked in nursing homes and as a home health aide. I actually really loved this work -- it is amazing what you can do for people when you let yourself care about them -- but as far as choosing dementia? Or dismissing it as "not important"? Some impressions from my side:/

HEATHER
Frankly I ahveno idea how you concluded any of those thoughts posted in the above about what I wrote. I said nothing like that.

Posted by c | July 10, 2008 12:31 PM

C, I got my ideas directly from your original post. In the first part, you answer Bob's question. Then, instead of leaving it at that, you go on to share a story about someone you know who is suffering from some level of dementia. That part is what I was responding to.

In the second part, your phrasing makes it sound as though you may have minimized the significance of the other person's inability to remember certain things. "It's ok if you forget my name" is not the same as "I don't mind if you forget my name." While it might not matter to you, the person doing the forgetting might feel very differently about it.

In any case, I certainly didn't mean to offend you, and I wish your loved one the very best.

Posted by Heather | July 10, 2008 2:21 PM

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