Saturday, February 04, 2012

Archive for the ‘Quality Of Life’ Category

End of Life Conversations: From A Doctor’s Perspective

My wife Janet shared with me a very moving article about end of life conversations from a doctor’s perspective entitled: Talking Frankly at the End of Life. Here is the link.

One of the most important aspects of the article is the issue of telling the patient the truth about their medical condition. “Am I doing more harm than good?” the author asks from her physician point of view. She cites a recent study in JAMA that asked 300 terminal patients “if their doctors had ever discussed care at the end of life.” As important, after the patients died, the researchers looked at the type of care the patients received prior to death and then interviewed the caregivers six months after the death to see how they were adjusting.

The results indicated that the patients who discussed care at the end of life were more likely to have a better quality of life at the end of their lives. They were not more depressed. They had less aggressive medical interventions. They went to hospice earlier. As important, their caregivers fared better.

What we want to know at the end our life is a personal choice. We all want some version of the truth but in different degrees and different doses. The key is being offered, more than once, the opportunity to hear it from the person who holds so much sway over our lives: the doctor. It is a natural part of our leaving, the slow dance we all take to step away from this life, preserving our dignity and saying our final goodbyes. Ironically, to do this we may need to remind the doctors who take care of our aging parents as well as ourselves, it’s okay to talk about the end, more than once…

The Power of Navigational Thinking

The journey between middle age and old age is a complex zone of developmental currents that are demanding and confusing yet unavoidable. Knowing the mission of where you are coming from and where you are going is essential but not enough. Even with this knowledge, all of us are going to get off course time and again trying to get to old age in good shape. We need something else. Part of that something else is “navigational thinking.”

Navigational thinking involves using questions that have the unique ability to get sixty-something adults back on track and keeping them there. The questions are simple and yet profound, and can be used in any situation to initiate and sustain a course correction. Their effectiveness lies in their uncanny ability to redirect the emotional intensity of transition currents into useful thinking. It is a similar process that pilots use during an in-flight emergency. They resist the natural response to panic by focusing their attention on a set of predetermined questions that lead them to useful thinking about the best course of action to save not only their lives, but also the lives of the passengers who are counting on them.

Navigational thinking helps redirect our natural tendency towards “problem fixation” through questions that help us focus on new insights, choices, and possibilities. The questions have no right or wrong answers; they are not a test. They simply offer a starting point for a new internal conversation about an experience, circumstance, feeling, or problem. Like all cognitive strategies, they are more effective when written down, annotated, reconsidered days later, and possibly shared. Here is an example of a navigational thinking question and how it is useful:

What is the big picture?

Between middle age and old age it is easy to lose sight of the big picture. There are just too many disorientating events pouring down on our lives. Once things take a turn for the worse, the big picture narrows or quickly vanishes. The “big picture” question offers sixty-something adults a way to hit the cognitive “reset” button and recover a more useful perspective.

The big picture of the “in-between” zone reminds us that it is a demanding, complicated, confusing, and stressful passage. The normal response is to feel disoriented and get easily knocked off course. But this is only half of the story. The big picture also reassures us that we will recover and get back on track. This is not wishful thinking. We have personally witnessed numerous cycles of setbacks and recoveries in our lives up to now. Some of them we deeply believed we would never get over. But we did. The big picture reaffirms that our “in-between” passage is just another version of this familiar though not always pleasant process of change. Given time, we will adjust to these unfamiliar currents and become surprisingly adept at navigating the uncertainty and ambiguity of being “in-between.”


Big Picture Take Home

Do not overestimate your capabilities to handle the transition currents. For most of us, they are impossible to navigate alone. False heroics only lead to bad outcomes. Partner up at every opportunity to increase your “collective capacity” to find successful course corrections as well as the invaluable comfort of family and friends.

Identify unreasonable expectations for what they are: unreasonable. The transition currents pile on wave after wave of complex demands. This is a terrible time to insist on perfection. Life is messy; allow yourself to have messy, totally human moments.

Accept the transition currents as “time in the wilderness” where there are no immediate answers or directions. Remember that life’s breakthroughs are always preceded by turbulence and doubt. You have done this before and you know that over time resources and solutions will emerge.

In my next blog I will look at other “navigational thinking” questions that are especially useful for being “in-between.”

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Communicate

No Money: No Comment

I was recently asked what to do about aging parents who had little or no savings but refused to discuss any aspect of their “money issue.” It reminded me that our role as adult children is not necessarily about problem solving; it is about compassionate containment. So many of the issues we feel compelled to “fix” have no clear answers. The best we can do is sort out what to accept from what we can actually change. Here was the advice I offered:

The issue of money, like so many other issues in the last phase of life, is about control. The best way to approach it is to reframe money as means of maintaining control. Lack of money takes away control. This link http://www.dsolie.com/articles/reframing.html will take you to an article I authored on “communicating touch choices” that offers a practical strategy for how to do this.

You may also want to consider three strategies that will help you “hedge” your parent’s financial risk:

1. Buy a long term care policy with a two years home care/two years nursing home benefit. This assumes they will cooperative with the process (i.e. signing the applications and answering questions).

2. Start funding a dedicated “side fund” for expenses that a long term care policy will not cover.

3. If you parents own their home, become familiar with how “reverse mortgages work and when they make sense.

Lastly, you need to began discussions with local area agencies on aging to determine what, if any, community resources can assist your parents if they run out of money.

This is a tough end-game, especially if you parents don’t want to talk about. The article will help you frame your conversations. Be patient but persistent in your discussions about control and your desire to help them maintain it.