Dr. Atul Gawande's book on making your last years enjoyable is a must-read.
I figure I have 10 to 20 years left on this planet and I want to make them productive and enjoyable. My husband and I now live in a senior complex 17 stories high with 200 people in different stages of dementia. After living in a cabin in the forest in Alaska, it's a real adjustment, but for my family it's reassuring.
Being mortal
I read the 2014 book "Being Mortal" by Dr. Atul Gawande, a surgeon, a professor at Harvard University and author.
With wisdom gleaned from many geriatric patients, Gawande writes on how an aging person can adjust to the loss of certain functions yet still enjoy a full life.
The independent self
This chapter covers how older people deal with aging, for instance, his grandfather.
"My grandfather could perform only some of the basic measures of independence, and few of the more complex ones," he writes. "But in India, this was not of any dire consequences. His situation prompted no family crisis meeting, no anguished debates over what to do with him. It was clear that the family would ensure my grandfather could live as he desired. One of my uncles lived with him, and a small herd of children, grandchildren, nieces, and nephews nearby, he never lacked for help," Gawande writes.
His grandfather lived to be almost 110.
This does not usually happen in the United States given the distance many live from their parents and grandparents.
But here there are many alternatives for seniors.
Independent living facilities offer in-house activities and a sense of community in a campus-like environment. Best for active, healthy seniors, they also offer exercise classes like yoga and tai chi. Usually there's also exercise machines like recumbent bicycles and treadmills.
Assisted living facilities offer more help with activities of daily living like showering and getting dressed. They may not need round-the-clock care but maybe some supervision to avoid falls. These are smaller facilities.
Memory care facilities are usually next to assisted living centers and help with memory loss like dementia and Alzheimer's in reviving memories and socialization.
Continuing care retirement communities offer a bunch of services combining independent living, assisted living and memory care. In this multi-level facility, it's easier for a client to move through each stage of aging in the same place.
Nursing homes provide care for people with more serious health conditions and also help with activities of daily living.
Hospice care is specialized end-of-life care by managing symptoms while keeping them in a comfortable situation as they age. Usually, a doctor must certify the patient has six months or less to live. The care can be done at home, or another facility. Many friends and family members have used this service and found it reassuring and helpful.
Things fall apart
"Life and health would putter along nicely, not a problem in the world. Then illness would hit and the bottom would drop out like a trap door..."
Gawande points out that modern medicine has changed aging.
"...increasingly large numbers of us get to live out a full life span and die of old age. Old age is not a diagnosis. There is always some final proximate cause that gets written down on
the death certificate-respiratory failure, cardiac arrest. But in truth no single disease leads to the end; the culprit is just the accumulated crumbling of one's bodily systems while medicine carries out its maintenance measures and patch jobs..."
He recommends keeping oneself as healthy and physically flexible as possible. Dental care is very important as the teeth are the highway to a healthy body.
I knew a woman in small town Alaska who had breath like something died in her stomach. She was afraid of dentists thinking visits were still painful. When she started to feel sick, she went to local clinic, and was told she was close to death because a tooth infection had gone to her heart. She was medically evacuated to Anchorage and lived.
Dentistry has come a long way from the time I went as a kid when there was no laughing gas, no injection, just an old foot pumped drill.
Foot care, he notes, is also very important.
Another doctor told Gawande, "You must always examine the feet." This is in case they have not been cleaned or the nails clipped and could lead to more serious problems and pain.
A better life
Gawande describes in this chapter a doctor who took over a nursing home and injected life.
"The inhabitants of Chade Memorial Nursing now included 100 parakeets, four dogs, two cats, plus a colony of rabbits and a flock of laying hens. There were also hundreds of indoor plants and a thriving vegetable and flower garden. The home had an on-site childcare for the staff and a new pre-school program."
A two-year study between Chade Memorial and a nearby nursing home found the number of prescriptions required per resident fell to half.
"The total drug costs fell to just 38 percent of the comparison facility. Deaths fell 15 percent," Gawande writes.
Dr. Bill Thomas, the nursing home's director, told Gawande, "I believe that the difference in death rates can be traced to the fundamental human need for a reason to live."
This is the decision we face as we age.
What makes us happy and feel at peace with our surroundings? What brings us joy?
Think about these two questions to find out how to bring your life into focus as it comes to an end.
