Articles Posted in Aging

If you have a son, daughter, sister, brother or parent living alone for whom you are responsible, and they unfortunately become incapacitated or die, apart from the emotional and medical burdens, you may have significant legal and financial troubles.  A little planning in advance for these contingencies will go a long way in making any such dire situation much easier to handle.

If they rent, then make sure they notify their landlord, in writing, that you have their permission to access the apartment.  Also get a key to their apartment or home or at least know where you can get one (such as from a neighbor).

A power of attorney will allow you to handle their legal and financial affairs during any period of disability.  However, a power of attorney automatically ceases on death.  Once someone dies, only the executor under the will may handle legal and financial affairs and it may take months and sometimes years to become appointed executor by the Surrogate’s Court.  A properly created and funded living trust, on the other hand, gives you immediate control of their affairs upon death.

According to the New York State Bar Association, “medical aid in dying is a medical practice that has been adopted in ten US jurisdictions (WA, MT, VT, CA, CO, D.C., HI, ME, NJ, NM) that allows a terminally ill, mentally capable adult with a prognosis of six months or less to live to request from their doctor a prescription for medication they can decide to self-ingest to die peacefully in their sleep.” New York’s MAID law will be considered by the legislature this year.

Protections in the proposed law include (1) a requirement that two physicians confirm the person is terminally ill with a prognosis of six months or less months to live, (2) the individual is informed of palliative care and hospice options, (3) there is a mandatory mental health evaluation if either physician has any concerns about the person’s mental capacity, (4) the request be in writing witnessed by two people, neither of whom stand to benefit from the person’s estate, and (5) anyone attempting to coerce a person will face criminal prosecution.

MAID is inextricably tied to hospice and palliative care, of which a core value is patient dignity and autonomy. New York ranks last in the country for hospice utilization due to health providers failing to provide information and counseling on these end of life options. Options will now be required to be discussed under a provision requiring “informed consent”.

Published this year, “The Good Life” reports on the Harvard Study of Adult Development, the longest scientific study of happiness ever done. Tracking the lives of hundreds of participants for over 80 years, the report concludes that it is the strength of our relationships with friends, relatives and co-workers that most determine quality of life, health and longevity.

Regarding older adults, the authors note that time is suddenly very precious. Questions arise such as:

• How much time do I have left?

Each one of us experience countless injustices in the course of everyday living. Like other experiences, it is not the experience itself so much that counts, but how you process it. The Mayo Clinic addresses the health benefits of “forgiveness” which they define as “an intentional decision to let go of resentment and anger”. Letting go of grudges and bitterness can lead to:

• Healthier relationships
• Improved mental health

In his best-selling book, “Successful Aging”, Daniel J. Levitin, Professor Emeritus of Psychology and Neuroscience at McGill University (your writer’s alma mater), shows how the brain is formed and how it changes, in surprisingly positive ways, as we age.

The author notes that Freud said that the two most important things in life are healthy relationships and meaningful work.

Socialization is crucial to maintaining our mental acuity. “Navigating the complex mores and potential pitfalls of dealing with another human being, someone who has their own needs, opinions, and sensitivities, is about the most complex thing we humans can do. It exercises vast neural networks, keeping them tuned up, in shape, and ready to fire. In a good conversation, we listen, we empathize. And empathy is healthful, activating networks throughout the brain.”

According to the National Institute on Aging (NIA) polypharmacy is the use of multiple drugs to treat diseases and other health conditions.  Polypharmacy is common in older adults, many of whom have two or more chronic conditions, and about a third of whom take five or more prescription drugs. Often, these different powerful drugs have been prescribed by different doctors.  Some drugs mask or neutralize others, some are dangerously incompatible with others and some may worsen conditions that naturally occur in the aging population — such as loss of appetite, less efficient digestive systems and increased cardiovascular risk.

Inappropriate polypharmacy — the use of excessive or unnecessary medications — increases the risk of adverse drug effects, including falls and cognitive impairment.  Harmful drug interactions and drug-disease interactions may also occur, where a medication prescribed to treat one condition worsens or creates a new one.

Enter the new field of “deprescribing”.  The NIA is developing a network of scientists to advance the field of deprescribing to improve the quality of care and health outcomes for older adults. According to Parag Goyal, MD, “despite its role as an integral part of patient-centric and goal-concordant prescribing practice, deprescribing is not frequently incorporated into routine clinical practice”.