Dr. Kevin Most: Healthcare and Aging

Dr. Kevin Most

Last week it was reported that Prince Phillip was retiring at the age of 95. I never knew you could retire from being a Prince, but he is. In the past we have used celebrity illnesses to educate us about specific conditions, fortunately in this case he has no health concerns that we are aware of. However we can take this time to go over some issues that we will all face as we age and what we should all be doing now to prepare.

We do not know when a medical emergency will occur nor do we know how long we will have our good health. Because of those uncertainties there are a few things we should all do to be ready for the days ahead when tough health decision will need to be made.

We won’t talk about will’s from a financial view but having a State of Illinois Power of Attorney for health care form completed as well as a State POLST form. It is important to understand what these forms are for and what they allow to happen. We will discuss each form separately.

The Power of Attorney is very important in the healthcare setting. If you ever get to a point where you are unable to make your own decision or if you do not want to make your own decisions, This agreement allows them permission to do many things. Here is a short list
1. They can talk to physicians about your condition
2. They can review your medical records and approve others to look at them
3. Give permissions for tests, medications, surgery or other treatments
4. Decide to accept or withdraw treatments
5. Agree to donate your organs if you have decided prior
6. Decide what to do with your remains

As you read this you must understand that this is an important decision as well as a decision that needs to occur with a discussion of what your desire is for your care. What do you want to happen if you are in this medical situation . Making this decision and discussing your thoughts should be done well before you are ever ill and with time for a discussion that makes you feel comfortable that this individual will follow your desires not theirs.

This is very important as without this agreement many difficulties can occur, tension between family members about what the “think” you would have wanted, feelings of guilt in the individuals forced to make decisions without knowing the desires. Each of these scenarios are painful and can be avoided if the proper discussion and forms are completed. This is as much about the individual identified as the POA as it is the patient. Making clear how you feel about life support, organ donation and final arrangements put you at ease and allow the POA to make decisions that you would have made based on your thoughts and wishes.

The POLST form is an important form that conveys your desires about CPR and being placed on a ventilator as well as some other decisions about your health. POLST stands for Practioner Order for Life Sustaining Treatment. It is available on line, just google POLST form. This is a form that you fill out with your physician that shares your desires about CPR , Ventilators and other treatments. It is a form that you and your doctor complete and then it is scanned into the medical record so that it is available when needed. I also recommend that it is included in the record of any hospital that you may receive care from.

This is the form and information they will look for in an emergent situation, the POA form is used more in a chronic setting or hospital based setting.

This form can be rescinded and changed at any time, so as you advance you may change your mind or view about treatments and thus changing the form to your current desires is easily done.

Now that we have discussed what forms and legal documents you will need as you age, let’s discuss some medical treatment definitions that we all should know and understand. Some of the points we will discuss are often misunderstood and unfortunately that misunderstanding can lead to very difficult and uncomfortable decisions. The time to learn about these is not when a decision is needed immediately, the time is now so a plan developed and understood by the individual making decisions.

We hear about Hospice and Palliative Care and although they are very similar there are differences that we need to understand as the differences can cause distraught. The difficult thing is they cross over in their goals and thus can be confusing to patients and their families.

Let’s first discuss the concept of Hospice. Many of you have probably seen Hospice centers in the community but Hospice is more than a site of care. Hospice is a model of care for patients facing a life limiting illness, with the timing of life expectancy to be 6 months or less. For patients who decide to enter Hospice the treatment is for comfort and not curative. It limits extensive life prolonging treatments. Hospice care is a team approach to expert medical care, pain management and emotional and spiritual support tailored to the wishes of the patient. In many cases the care delivered is often delivered by the family and loved ones of the patient with expert medical support being available. The foundation of Hospice is that each of us has the right to die pain free with dignity and comfort, and that the emotional and spiritual support is present for both the patient and their family.

Many get confused when discussing Palliative care versus Hospice. In Palliative Care the goal is to improve the quality of life for a seriously ill persons life, this may continue to include curative treatments and to support the patient and their family during and after treatment. This treatment may last years versus Hospice where the time frame is much shorter usually 6 months or less.

Many think that Hospice stops all treatment and that is not true, only curative therapy is stopped, such as chemo that would be meant to cure. The goal is to achieve a level of comfort that allows the patient to focus on the emotional issues of death with their support group. If a Hospice patient contracts pneumonia we would still treat the pneumonia so we are not restricting normal care from the Hospice patient. The care restriction is on curative treatment, again it is about allowing the individual to die in comfort and in dignity often in their own home surrounded by family.

Many may find this as a morbid or downer subject but I assure you, having these discussions and having made these decisions will put you at ease, put your family at ease and your wishes will be honored.