Category Archives: Elders

Bringing To a Close a Long Life Together

“Each of us is entitled to intimacy and pleasure in our life, regardless of how our body looks or at what stage of life we are at. The fact that we might be sick, elder, or dying need not cut us off from these precious life-enhancing things. However, we will most likely have to take the lead in defining what it is that we need and want, and then communicate that to those who are in a position to answer our need. We ought to have confidence that this will be as enriching for partner as it will be for us.”

Clare, 73, and her husband, Charley, have been married for fifty-three years. They have four children, nine grandchildren, and five great-grandchildren. Clare’s leukemia, which was in remission for over ten years, has recurred. This time it is considered untreatable. She has decided to forego any of the heroic, life-sustaining measures for which modern medicine is so famous. She and her doctors agree that hospice is her best option. “I’ve done my homework. I’ve shopped around. I interviewed all the hospices in town and have chosen the one I feel will honor my wishes for the kind of end-of-life care I want.”

our-livesClare has lived a rich and full life. “I was a career woman long before there was such a thing as a career woman. I’ve always been a take-charge kind of gal. This leukemia may very well kill me, but it will never get the best of me.” Her illness has made her very frail. Her skin is almost translucent. She has an otherworldly look about her, but there is no mistaking her remarkably robust spirit.

Her youngest son Stan, her one and only ally in the family, brought her to our meeting. Stan says, “Oh yeah, she’s feisty all right. There’s no flies on her, and the ones that are there are paying rent.”

Clare’s biggest concern is her family. They are pressuring her to fight against death even though she doesn’t want to. She wishes that they would join her in preparing for her death rather than denying the inevitable.

“I worry about how they will manage when I’m gone. And even though I’m ready to die, I feel as though I need their permission before I can take my leave.Elderly-couple

I try to tell myself that my Charley will be just fine after I’m gone. After all he does have our four grown kids and their families to look after him. But deep down, I know how lost he’ll be without me. Even after all these years, he still needs me to help him find a missing sock!

Whenever I try talking to him about how he’ll manage when I’m gone, he gets this awful flush across his face and starts shaking like a scared little boy. It makes me feel so terrible. I feel so bad for upsetting him like that.

I’m so confused! I want to talk to Charley about all of this. He’s my husband and has been my best friend for well over fifty years, but I honestly don’t know how to reach him on this one.”

Clare straightens herself up in her chair and continues.

“Stan, here, is the only one I can talk to. Everyone else, including my husband, won’t hear a word when I start talking about planning my funeral or who will get my antique Tiffany lamp. They just say, ‘Oh, mother, stop talking like that, you’ll outlive us all.’

I know they mean well. They’re just scared and upset. But boy oh boy, it’s really getting under my skin. I know I only have a short time left to live, so I want it to be real. I’m sick of always having to smile and pretend when I’m with them. It’s about time for them to start considering my feelings for a change.”

reason to smileClare’s immediate concern and the reason for our get together is her husband Charley. She is afraid that they are drifting apart right when they need each other the most. I ask her for a little background on their intimate life together.

“I was well into my thirty’s when the woman’s movement began. It was a time of great awakenings for me. Charley was threatened, of course, but I was able to win him over in time. It was only then that our sex life started in earnest. I finally realized that sex could be about pleasure and not simply about duty. What a liberating experience that was!

Even now Charley and I are intimate, or were until the last couple of months or so. After we both turned 60 our sex wasn’t like when we were youngsters, all heated and hormonally driven, but it’s just as special. Oh, I’m so glad I am able to talk about this with you.

My main concern is the medications I’m taking for the pain. I’m woozy when I take them, but irritable without them. I want to be more available to Charley for the closeness that’s so important to each of us, but I’m often too out of it. This is a problem for Charley too, because he doesn’t know how touch me anymore. And so, I’m afraid, he keeps his distance. This only makes matters worse for the both of us.

How do I change this? Or maybe there’s no changing it. Maybe it’s just over. What a terribly sad thought that is.”

I reach out for Clair’s hand. “I am touched by the loving depiction of the intimate life you’ve had with your husband over the years. It can’t be easy for either of you to see this wind down. However, the closeness and tenderness you’ve had throughout your marriage need not stop now.eldery hands

May I ask; do you still sleep together in the same bed? Would you be comfortable initiating a little cuddling with Charley? Good! Then I’m going to suggest a regiment of spoon breathing and guided-hand touch that I’m sure will work for you both. You will, of course, need to take the lead role in this since, as you say, Charley no longer knows how to touch you, but once he gets the hang of it and he has your permission to do so, he can continue even when you’re not able to reciprocate or even respond.

Allow me to quickly explain spoon breathing. Here’s what you do; lay on your side with Charley on his side close behind you like two spoons. Then see if you can match one another’s breathing pattern. You will be amazed at how calming and comforting this will be for you both. It will also be a very effective way to reestablish a threshold for what is possible between the two of you now, in this final stage of your life.

Now the guided-hand touch; take his open hand in yours and guide it to where you like to be touched. Show him how you like to be touched where he is touching you. Long strokes, slow strokes, short strokes, soft strokes, or just having his hand rest on you, whatever. Show him the kind of pressure you are comfortable with where he is touching you. Once you’ve established a simple routine of breathing and touching, give Charley permission to carry on even if you happen to fall asleep. Because this breathing and touching technique is so gentle and loving, it should be able to serve you even as you are actively dying. But you’ll have to let Charley know that this is what you want and need. You could tell him that you want to die in his arms. What an ideal way to bring your life together to a close. Do you think Charley will accept your invitation?”

“I can’t say for sure, but I think if I suggested it to him in a way that lets him know that he would be doing it for me, it might work. But I’m not sure about what I should say.”

everyone dies“When words fail to communicate what is in your heart, you can always rely on touch. Maybe you will find that nothing needs to be said at all, Clare. Draw him close and keep him near you with touch. Something tells me Charley will find this irresistible. It could be the fondest of farewells. Something he’ll never forget.

This is my philosophy. Each of us is entitled to intimacy and pleasure in our life, regardless of how our body looks or at what stage of life we are at. The fact that we might be sick, elder, or dying need not cut us off from these precious life-enhancing things. However, we will most likely have to take the lead in defining what it is that we need and want, and then communicate that to those who are in a position to answer our need. We ought to have confidence that this will be as enriching for partner as it will be for us.”

We’re programmed to die

Well there ya have it!

programed to die

A DNR Tattoo? Really? Great Teaching Image for Geriatrics or Palliative Care

by: Alex Smith

Perhaps you have said, or heard someone declare, “I want DNR tattooed across my chest!”

Well, someone actually had it done. See this image in JGIM of the tattoo and the unusual story behind it. In this case, the DNR tattoo was the result of a lost bet in a drinking game – bad idea jeans – the patient actually wanted to be full code!

In an accompanying editorial, Bernie Lo and I describe the problem with actually tattooing DNR across your chest. As we say, the idea is intuitively appealing, but flawed as policy.

This could be used a teaching image about respecting individuals’ rights to avoid resuscitation. The idea is to provoke a thoughtful discussion. Questions for trainees could include:

  • What is behind the idea of the DNR tattoo? Why would someone say that, or do it?
  • Imagine you are seeing a new patient who arrests in front of you. Preparing to do CPR you see a DNR tattoo on the chest. How do you respond? Why? Should DNR tattoos be respected?
  • What can we do to protect the interests of people who really do not want to be resuscitated?
  • Should we as a society put greater ironclad protections in place for people to irrevocably fix their code status at DNR? What are the risks? What if someone codes from anaphylaxis? Chokes on some food in front of you?
  • What do you think about allowing leeway or flexibility in decision making? In all cases? Giving the surrogate leeway? The clinician? Do the advance directive forms or POLSTs you use allow for leeway? Should they?
  • What do you think about Ulysses contracts? (Then Ulysses said, “Eurylochus, come quickly! Tie me to the mast, for I shall hear the Sirens song and live!”). Caringadvocates offers such documents (run by frequent GeriPal commenter Stan Turman). Example: do not give me food or water when I have advanced dementia, no matter what I say or do.

Feel free to share your teaching experiences in the comments. I think the geriatrics and palliative care communities really appreciated the discussion about how to use this video from a previous post as a teaching tool.

Complete Article HERE!

Care homes ‘deny elderly people sex’

Care homes often deny elderly people the basic right, and one of their few remaining pleasures, to continue having sex, according to a new study.

Many older people, including those with early stage dementia, enjoy sex while they live at home, but this changes once they move into residential care, said the Australian authors of a paper in the Journal of Medical Ethics.

They blame a lack of privacy, age discrimination and fears about the legal implications should a patient be found mentally incompetent to give consent.

“The formation of relationships, physical intimacy and the expression of sexuality are a basic human right and a normal and healthy part of ageing,” wrote the authors from the Australian Centre for Evidence-Based Aged Care.

Yet most facilities do not have formal policy guidelines or staff training aimed at allowing residents to continue being sexually active.

“Privacy remains a problem, with residents often not able to lock their doors and most rooms equipped only with single beds,” said the paper.

“For residents with dementia, sexuality is viewed with even greater anxiety, either being labelled ‘inappropriate’ or a ‘challenging’ behaviour or as a risk to the resident.”

The team acknowledged the difficulties in determining the legal threshold for informed consent in elderly patients with dementia, but argued this should not be an excuse for denying them their rights.

“It is important to remember that dementia is defined in stages, with early or mild dementia manifesting as mild forgetfulness or confusion that is often mistaken for a normal part of ageing,” they wrote.

“Clearly there is a significant difference between the capabilities of a person with mild dementia and one with advanced or final-stage dementia and, therefore, a single approach to sexuality and ‘people with dementia’ is inappropriate.”

Complete Article HERE!

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