What happens in the emergency department . . . stays in the ED? Not really. A recent study stresses that ED visits have lasting effects on elderly patients from six months to a year! What often occurs in the ED says much about a patient’s upbringing, self-growth and self-determination. How do you hold up before, during and after stressful situations? Do you wait for someone else’s directive or do you have a plan of your own? Do you become more certain or more fearful with age? What’s the best strategy for aging ?
Stating, “I’m never going to get old” supports the anti-aging movement and promotes quality of life. Yet, the elderly are often more consumed with suffering than enjoying life. “It’s hell getting old,” becomes a self-fulfilling prophecy. Listening to your doctor say, “There’s nothing more I can do for you,” is incredibly heart-breaking. Having the ED doctor say, “I’m admitting you to the hospital,” often amounts to a fate worse than death .
Does your advance care plan depend on what the doctor tells you or what you tell yourself? Are you willing, able and ready to take life-and-death matters into your own hands? What does your advance care plan say about your upbringing, self-determination and spiritual nature? The purpose of advance care planning has little to do with the end of life and needs to prepare you for the next ED visit? Will you be admitted to the hospital or receive outpatient treatment at home? Can you know this in advance?
Patients like to have options along with having each explained in simple terms. They expect highly-trained physicians who rarely use common sense and often practice defensive medicine - talk with them in a straight-forward non-offensive manner. Are you a patient who can handle the truth that injury to a vital organ eventually leads to death? Do you prefer doctors prevent you from dying or permit you to die? Does your anti-aging strategy include becoming an “anti-patient,” who might choose to be treated as an outpatient?
Treating the anti-patient who prefers less medical intervention/suffering and more personal attention/serenity is at the heart of compassionate or “palliative care.” Palliative care is a necessary component of strategic aging ’s three-part plan developed by Dr. Kevin Haselhorst, an emergency physician and expert on advance care planning. He’s had a bird’s-eye view of patients’ lives from conception to death for nearly 30 years. Dr. Haselhorst is troubled by those people who don’t have an advance plan for whatever fate may have in store for them. He coaches those wanting to improve their lots in life by explaining the principles of strategic aging .
Strategic aging supports anti-patients through the three intentions of the Serenity Prayer:
1) Prioritize quality of life: courage to change the things I can
2) Manage chronic illness: serenity to accept things I cannot change
3) Appreciate palliative care: wisdom
to know the difference between courage and serenity
The wisdom gained through the Serenity Prayer is a gift to patients suffering from chronic illness who feel trapped. Patients who feel trapped have virtually no quality of life and no easy way out of no-win situations. The end of life is often perceived as losing the battle with an illness. What type of strategy does this become for the elderly? Why can’t these patients feel like winners crossing the finish line?
Changing the negative perception of the end of life begins with creating a positive experience with aging. People need to feel like they’re in control of the situation, making choices that suit their best interests. Patients often evolve from not needing to get better to simply want to feel better, leaving well enough alone. At the end of the day, we strive to unwind and rest. This type of daily intention supports strategic aging by reminding us that it’s important to release endorphins (positive energy) to better handle stress (negative impact) and create the overall feeling of wellness . Balancing chronic illness with quality of life is the primary purpose of palliative care.
“Is palliative care right for you,” a question that alludes most elderly patients in an ED. If patients have discussed this ahead of time, it’s more likely that they wouldn’t have called 911. Many elderly patients fear coming to the ED and dying in the hospital. These patients are usually convinced otherwise by physicians, but their fear is often justified. Receiving palliative care tends to imply patients are near the end of the road, but it’s really the go-to plan for strategic aging. The booklet, “Is Palliative Care Right for You?” is the best tool for understanding self-determination in the context of making personal medical decisions.
While strategic aging benefits patients experiencing chronic illness and desiring quality of life, this is the primary stepping stone to a good death . Most people believe the ultimate goal at the end of life is to “die in my sleep.” People near the end of life have a terminal illness and worry about their comfort and quality of death . Yet the struggle continues for those who do not plan ahead. These patients are scared to death with the end of life becomes a living nightmare. What does this say about their upbringing, self-interest and personal fulfillment? Basically, the answer implies that we can all become wiser with age.
While aging is inevitable, growing wiser is optional. The best way to grow wiser is to minimize pain and suffering, prioritize quality of life over quantity of years, and appreciate the “less is more” philosophy. A better understanding of palliative care will support your upbringing, self-determination and spiritual well-being. Growing wiser through strategic aging is the best way to achieve your life purpose of resting in peace .
Emergency physician, Kevin Haselhorst, MD, an expert on advance care planning, speaks to patients, family members and healthcare providers about advance directives, palliative care and dying with dignity. He’s the author of “Wishes To Die For” and “Is Palliative Care Right for YOU?”