Yeah, I finished it on Friday. It made me cry and generally be a bit tough to be around for a day. Thanks for telling me to read it.
I talked to my parents about it some, and they were already clear on the main points (autonomy > safety, and hospice not only making patients and families happier, but also helping patients live longer than aggressive treatment). My parents have always been pretty upfront about this stuff, so the conversation isn't too difficult in the abstract. But when morbidity and mortality become more pressing issues, I feel like Gawande's book will be really helpful in asking specific questions about priorities.
One thing that the book didn't really mention was full-time home health aides; I assume they're more expensive than the assisted living and nursing home situations Gawande talks about, but I suspect that they're not an order of magnitude more expensive. My mom's mother had one for several years before she died, and my aunt functioned as one for my dad's mom, and that allowed them to live at home until they died. It didn't give them the social group that Gawande portrays in the 12-room homes, but they did get to stay in familiar places and have as much autonomy as their bodies allowed.
I agree that the dementia question is frustrating. I am particularly afraid of angry dementia; of my two grandparents who experienced moderate dementia (not Alzheimer's), both were very sweet -- and that doesn't worry me too much. But if one of my parents developed Alzheimer's and became frequently angry and paranoid, that would be about the hardest thing I can imagine.
My dad mentioned a book, Younger Next Year, which includes the usual anti-aging advice, and which apparently articulates the goal of staying fit and healthy into old age and then dropping dead quickly rather than slowly rotting to death.
(From K)
I talked to my parents about it some, and they were already clear on the main points (autonomy > safety, and hospice not only making patients and families happier, but also helping patients live longer than aggressive treatment). My parents have always been pretty upfront about this stuff, so the conversation isn't too difficult in the abstract. But when morbidity and mortality become more pressing issues, I feel like Gawande's book will be really helpful in asking specific questions about priorities.
One thing that the book didn't really mention was full-time home health aides; I assume they're more expensive than the assisted living and nursing home situations Gawande talks about, but I suspect that they're not an order of magnitude more expensive. My mom's mother had one for several years before she died, and my aunt functioned as one for my dad's mom, and that allowed them to live at home until they died. It didn't give them the social group that Gawande portrays in the 12-room homes, but they did get to stay in familiar places and have as much autonomy as their bodies allowed.
I agree that the dementia question is frustrating. I am particularly afraid of angry dementia; of my two grandparents who experienced moderate dementia (not Alzheimer's), both were very sweet -- and that doesn't worry me too much. But if one of my parents developed Alzheimer's and became frequently angry and paranoid, that would be about the hardest thing I can imagine.
My dad mentioned a book, Younger Next Year, which includes the usual anti-aging advice, and which apparently articulates the goal of staying fit and healthy into old age and then dropping dead quickly rather than slowly rotting to death.