Senior Care: Health Care Advocate Required

Written by Hiland - Senior Lifestyle Expert on Monday, July 25, 2016

According to NPR New Hampshire , today’s seniors are more concerned with the quality of their lives than the quantity of years lived. This determination is supported by a far-reaching study from the Dartmouth Atlas Project which used claims data provided by Medicare to arrive at their findings.

Ironically, I was on the way for testing for an injury  at Dartmouth Hitchcock Hospital in Lebanon, New Hampshire, when I discovered this report. I have come to realize that decision-making about the future and healthcare are pretty intimidating when you do not feel well. It often seems like physicians throw everything but the kitchen sink at ailing seniors. The end result is that seniors can be overwhelmed with choices that detract not only from their quality of life but with their overall well-being.

The Senior-Caregiver Hard Talk

According to NPR, the Dartmouth Atlas Project revealed that many physicians are uncomfortable having the hard talk about tough realities with senior patients. As a consequence, the physicians prescribe more and more testing upon the senior that often serves to mislead the ailing senior patient. These tests can lead the patient to believe there are non-threatening remedies for certain irreversible conditions.

One solution is for the senior to take the physician out of the hard talk dilemma by engaging a healthcare advocate. The advocate/caregiver can make tough decisions regarding healthcare, hospice and end of life scenarios that rely on accurate diagnosis from physicians but in essence remove the physician from decision making.

This conversation is not one we look forward to but is one that takes pressure off all parties. The advocate is a critical player in the senior’s quality of life. Seniors might be surprised how their children will respond to this responsibility. Most do not want to be responsible for end of life decision for loved ones but whether they decline the responsibility or not, the senior should make sure the healthcare advocate keeps the family in the loop and advised. Seniors do need to give their advocate the guidelines they need to arrive at difficult decisions. Often the guidelines are conveyed to the advocate after the family has considered the senior’s wishes.

Five Common Quantity-Driven Treatments

The Atlas Project identified five specific areas where physicians tend to recommend quantity-based treatments for seniors rather than make tough quality of life decisions. Two are based upon preventive care:

  • Screening for breast cancer
  • Screening for prostate cancer

Three are based upon end of life management:

  • Late referral to hospice
  • Time in intensive care in the individual’s last 6 months
  • Placement of feeding tube sin dementia patients

Julie Bynum, an associate professor at Dartmouth Institute for Health Policy and Clinical Practice in Lebanon NH, says: “Where there are harms and benefits and people judge them differently, that's where the shared decision-making comes in.”

One of these scenarios recently stared me in the face. An MRI of an ailing hip revealed an enlarged prostate. I was unsure what that meant and surprised that my physician seemed nonplussed. When I inquired about a possible cancer screening, his response was along the lines of, “Well, if there was cancer it would take 20 years or so to affect your health. But, if you want the screening, I can set it up.”

I decided to think about it. I doubt my life expectancy is 20 years and would be delighted to make 10 and ecstatic to make 15. So, we are going to pass on a prostate screening, at least for the time being.*

What this scenario did emphasize to me is the need to choose a healthcare advocate. It would be a relief to have a friend or family member to talk to about the future and give me the assurance that future healthcare decisions we were making were informed and in keeping with my quality of life goals vs. quantity of life wishes.     


*The views expressed in this blog post are based on personal experience of the author, and are not meant to provide medical recommendations of any kind, as he is not a physician.