Monday, January 4, 2010

Frailty and the Elderly.

GeriPal looks at how we fail to prepare the elderly for the frailty that often comes at the end of life.

Paula Span raises a number of interesting issues in this post on the NY Times New Old Age Blog. She presents the story of an active 70 something man who was very comfortable discussing the possibility of his death, but seemingly unable to discuss the possibility of being frail and needing help caring for himself.

As the post notes, most people will have a period (often quite long) of frailty at the end of their lives in which they will need the help of another person for some tasks of daily living. I think the popular media and many in the medical profession sometimes try to suggest otherwise, suggesting that frailty is avoidable if you just do the right things. The evidence overwhelmingly suggests otherwise. It is certainly right to encourage good health habits, including good nutrition and exercise. But it is more likely that healthy living will delay frailty--not avoid it.

I think even in Geriatrics, we sometimes oversell our ability to prevent functional decline and frailty. In our enthusiasm, we point to some intervention studies that have reduced the risk of disability. These intervention can clearly enhance the well being of older persons, and it is a shame they are not more widely implemented. But if one looks closely at these studies, the effect sizes tend to be modest, and they slow down trajectories of decline rather than stop these trajectories.

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Blogger Jan said...

My 91 year old mother also had great difficulty grasping that one day she might need help with daily living routines. She preferred to believe that she would not live long enough for this to be a reality. She fought using a cane, then a walker, then a wheelchair. When a stroke took her eyesight we thought she would give up. She is now in a facility, talking as if she can walk, see, and still do all the chores she used to do.


January 5, 2010 at 2:56 PM  
Blogger L A Neumann said...

Thanks for writing, Jan. She sounds like one tough lady.

I think beyond family conversations about care choices, our society is going to soon have to address the new realities of elder care. Just having skilled practitioners, dignified laws, and affordable services is not enough. Until the idea of how we die approaches the reality, we'll be challenged with those who are unprepared for the unavoidable.

January 5, 2010 at 6:26 PM  
Anonymous Jan Heinen said...

You're right, L.A. Perhaps our younger generations will be more prone to discuss and act on these realities, out of necessity.


January 15, 2010 at 5:30 PM  
Blogger L A Neumann said...

Or perhaps it would be a fine legacy of the baby boomer generation, this de-mystifying of death. Heaven knows we will have to reckon with it in some way as they grey.

Thanks for your comments, Jan. And please continue to keep me updated on your mother!


January 15, 2010 at 5:48 PM  

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