End of Life Decisions - No Good Choices

FormerHangie

FormerHangie

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FormerHangie
My mother... She's 86 years old. She had a stroke three years ago, but had recovered somewhat, had to walk with a cane, her mind was unaffected. Over the last few years her strength has declined and she has switched to a walker. Up until this January she'd been living by herself, with a helper coming in once a week. She'd moved to an assisted living facility the first of February.

I think what prompted the move is that she was diagnosed with severe aortic stenosis, and the weakness that comes with it. At the time she moved, she was still using the walker, but becomes fatigued quickly. It's a struggle for her to get down to the dining room at her ALF, which is maybe 100 feet total from her apartment. Shortly after she moved, she also developed severe reflux, and has difficulty eating and particularly drinking.

So, Tuesday I get a text from my sister, telling me that Mom has fallen in her apartment, and that she's going to the hospital. A couple of hours later, the diagnosis comes back, broken femur, or as we lay people call it, a broken hip, surgery scheduled for Wednesday. Wednesday comes along and her platelet count is low, and there are detectable cardiac troponin levels in her blood, so no surgery, she gets sent back to her room to see if she improves. Thursday comes along, when the nurse comes in to check on her, her breathing is noisy, so they suction her, move her to a different unit, and cancel surgery. As of now she's on a lot oxygen, on an IV drip, not allowed to eat or drink, and on pain meds.

There's no good end to this. The best possible result, at least medically, would be for her to get strong enough to have surgery, and then send her to rehab for a few weeks, then somewhere less intrusive. Reality is she was barely ambulatory when she came in, and even if they get her patched together she's not likely to be ambulatory when she gets out. She has limited heart functionality, hardly any metabolism, and can't process very much food. The bone broke because it is weak, I wonder if the surgery to put it back together will even work. If she survives this, most likely she'll be bedridden, and a prime candidate for bed sores and pneumonia.

I've suggested that we try to talk to an end of life counselor, but I'm not sure she's medically eligible for that since none of her conditions are considered terminal. There are just no good choices.
 
Hi. No advise, but I'm very sorry that you and your family are going through this.
 
Both my parents left me quickly after very full lives...never got to say good bye really...not sure if I am of any help but I can tell you we will say a prayer for you and your family for resolution and strength as you go through this.
 
I think about these things more and more as friends and family reach these years. Both grandparents on my dad's side are in their 90's and live at home, dad lives about 5 miles from them so they have easy help when needed. But they won't be around much longer. They both have lost a lot of energy in the last few years.

A very good friend in her 60s is struggling with a disabling pain and near blindness from immune system disorder. I see her almost every day and its heart breaking watching her health diminish. She has fought every possible way to keep what is left of her eyesight and treatment is has pretty awful side effects. I don't know how she keeps pushing.

**** is brutal.
 
As I age, I am becoming more & more aware of such stories.
Seems like few of the people in these circumstances are keen on pressing forth with all available medical care nor are they really interesting in continuing on with life.
I guess they do it because there is no alternative.

"Bam! I want to be hit by a speeding bus!", as I often say.
 
Every time I comment on these matters it always gets taken the wrong way (and I mean in real life, not just on the POA) so I will refrain as well, other than to express condolences and hope for the improvement of the situation.
 
This is why I have the living will and medical POA. Please talk to your older relatives and get it done now so choices are known if or when the time comes.

Good thoughts to Mom.
 
I'm sorry to hear about your situation. As you said, there just is no good solution.

We went through similar with my grandmother. She was living in a retirement community (unassisted living, but they did meals and had a nice campus, activities, etc.). She fell one year at Christmas and went into the nursing wing, from which she never recovered. Fell a few more times, I think had one or two surgeries, honestly it's been a while and I forgot. Ultimately it took 4 years for her to finally get to the point where her heart decided to stop beating. Her brain had effectively gone to mush from dementia, her hearing was poor.

My mother is heading that direction. She's in denial about her dementia and her physical state is deteriorating. We don't know which will give in first, but she refuses to let us help her or participate in her care, so we can only guess how bad things really are.

In February 2007 at age 94 she breathed her last breath. It was a bit of a relief for everyone, I suspect including her. I don't want my end of life to be like that. Just give me a Duke and enough fuel to make it half way to Hawaii from LA.
 
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A health care POA and a living will can help with some decisions, but they don't help with the emotions or physical pain and degeneration.

I wish you, and her, well.
 
90% of the medical expenses in your life are spent the last 6 months.

End of life care is a disaster in this country. . . . our office practices in this area among other things - so I have first hand knowledge even if all I do is litigation.

You and the rest of your family need to speak with a hospice counselor. She is not in any way shape or form a surgery candidate.

If she has the mental capacity to make medical decisions she needs to make them - now. And put them to paper. And make sure everyone understands what SHE wants.

There is no way on God's green Earth you will find a doc or hospice willing to take her with a fracture that has not been repaired or reduced. You are on the right track - she will likely not recover to the point she has any quality of life- but with a fracture its impossible to get a good outcome on end of life care... .
 
comanchepilot said:
There is no way on God's green Earth you will find a doc or hospice willing to take her with a fracture that has not been repaired or reduced. You are on the right track - she will likely not recover to the point she has any quality of life- but with a fracture its impossible to get a good outcome on end of life care... .
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That's interesting and not something I knew about. So in the OP's case with a mother who is likely in the sunset of her life and thus what I would understand a candidate for hospice they won't take her because she hasn't had the surgery that might kill her and ultimately won't help things?
 
First, I'd like to thank everyone for their thoughts, prayers, and condolences.

Everskyward said:
Has your mom said anything about what she would like, either in the past, or now?
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Yes. She has been a member of a right-to-die society, and even mentioned something about assisted suicide to my sister the last time she went to the doctor. She's always been very independent minded and is not enjoying life. She mentioned something to my sister about refusing to eat, but now they've got her on an IV drip and isn't able to eat anyway.

Ted DuPuis said:
I'm sorry to hear about your situation. As you said, there just is no good solution.
I don't want my end of life to be like that. Just give me a Duke and enough fuel to make it half way to Hawaii from LA.
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I hear you. I've watched my inlaws, and now my mother, go through the slow fade. I saw my father in law go through two days of agonal breathing on his way out, and my mother in law feeling so bad that she wouldn't come to Christmas dinner even though we were just a few minutes away. It makes me wish I was a dog, at least someone would have me euthanized if I were suffering. One of the principals of the right-to-die group she was a member of wound up in a murder-suicide because he couldn't stand to see his wife suffer any longer, and wasn't willing to put up with the consequences of the law, so after he killed her he killed himself. I do believe that if she were offered assisted suicide she would take it, but she's in the clutches of the medical system now, and in Florida that's not an option.

comanchepilot said:
90% of the medical expenses in your life are spent the last 6 months.

End of life care is a disaster in this country. . . . our office practices in this area among other things - so I have first hand knowledge even if all I do is litigation.

You and the rest of your family need to speak with a hospice counselor. She is not in any way shape or form a surgery candidate.

If she has the mental capacity to make medical decisions she needs to make them - now. And put them to paper. And make sure everyone understands what SHE wants.

There is no way on God's green Earth you will find a doc or hospice willing to take her with a fracture that has not been repaired or reduced. You are on the right track - she will likely not recover to the point she has any quality of life- but with a fracture its impossible to get a good outcome on end of life care... .
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That's the problem, she has a fracture, but she's not in good enough shape to have surgery, and none of her ailments are considered terminal, so I don't know if she can get hospice care even if we get the fracture dealt with.
 
It is a very unfortunate situation which happens all the time, unfortunately. I had a great-grandmother and grandmother both go that same route: living alone, a bit of dementia/Alzheimer's, move to assisted-living community for a short stint, then to the nursing home where they end up falling and "breaking a hip". At that age, the recovery is excruciatingly slow, so most never recover. In your case, recovery in order to undergo surgery is even less likely in the short term. My condolences you and your family.
 
FormerHangie said:
I hear you. I've watched my inlaws, and now my mother, go through the slow fade. I saw my father in law go through two days of agonal breathing on his way out, and my mother in law feeling so bad that she wouldn't come to Christmas dinner even though we were just a few minutes away. It makes me wish I was a dog, at least someone would have me euthanized if I were suffering. One of the principals of the right-to-die group she was a member of wound up in a murder-suicide because he couldn't stand to see his wife suffer any longer, and wasn't willing to put up with the consequences of the law, so after he killed her he killed himself. I do believe that if she were offered assisted suicide she would take it, but she's in the clutches of the medical system now, and in Florida that's not an option.
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The fact that she was a member of a right-to-die society I think makes her wishes well known, of course the legal consequences of helping her with it as you note are significantly problematic. I've always been a believer that it's your life and that you should have the right to choose when to end it, at least for the elderly and those facing terminal illnesses.

I'm very sorry for the situation your family is in. It just sucks and unfortunately almost all of us will be there at some point with older relatives. Hopefully we can avoid being there ourselves.
 
I would absolutely request a social service consult to discuss hospice, if not now for the future. At a minimum make sure she has a living will or "DNR" papers signed and also explained in detail. I've seen many of these forms filled out in which patients have checked off yes to chest compressions but no to intubation/mechanical ventilation??? Also, keep in mind DNR does not mean do not treat.
My wife's grandmother passed several weeks ago and I was very impressed with the level of comfort achieved through hospice. Best wishes for your family.
 
Best wishes for you and your family.
 
I'm sorry too. I just got back from a funeral 45 minutes ago. A high school buddy that I've hung out with for years. Always hard to let go....and trying to know what to do and say is even harder.
and I don't have much advice, except to just love on her while you can. Next to that, the other decisions are formalities that are maddening to try and figure out, because as you said, no easy answers.
Hope and prayers to you guys.

She's gonna get her wings!
 
FormerHangie said:
Yes. She has been a member of a right-to-die society, and even mentioned something about assisted suicide to my sister the last time she went to the doctor. She's always been very independent minded and is not enjoying life. She mentioned something to my sister about refusing to eat, but now they've got her on an IV drip and isn't able to eat anyway.
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If she is still in a place where she can make decisions for herself, I agree with those who say that you need to get in place items like a DNR, and what California (and I think other states) call a POLST. http://polst.org/about-the-national-polst-paradigm/what-is-polst/

Physician Orders for Life Sustaining Treatment - encourages patients and their health care professionals to talk about what patients want at the end of life. The conversation should include:

  • Patient's diagnosis. What disease(s) or medical conditions does the patient have?
  • Patient's prognosis. What is the likely course of the disease or condition? What will happen to the patient over time?
  • Treatment options. What treatments are available to the patient? How do they help? What are the side effects?
  • Goals of care. What is important to the patient? What makes a good quality of life?
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She can decide what measures she wants taken, or not, for example, no feeding tube, no intubation, etc.
 
I'm sorry you're having to go through all of this. I wish you and your family comfort and wisdom during this time and for the future.

Rich
 
I'm so sorry for your situation, my parents are getting older as well, my dad is 80 and has slowed down a lot in the last few years. I can't add much to what's been said, but the DNR and no feeding tube will expedite the process of her passing. It sounds cruel, but I'm not sure what's more cruel, slowly starving to death or living in misery with a feeding tube and no hope of recovery. Prayers for you and your family.
 
N747JB said:
I'm so sorry for your situation, my parents are getting older as well, my dad is 80 and has slowed down a lot in the last few years. I can't add much to what's been said, but the DNR and no feeding tube will expedite the process of her passing. It sounds cruel, but I'm not sure what's more cruel, slowly starving to death or living in misery with a feeding tube and no hope of recovery. Prayers for you and your family.
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Ditch the feeding tube, and give me high quality wine and cheese.
 
I'm thinking about these things a lot too, with mom 90 and MIL 88. At 60 I'm feeling the decline myself and wondering how to avoid as you say, being caught "in the clutches" of a medical/legal system that just looks to me like a nightmare.

You might want to check with the hospice folks. I thought I read somewhere that you don't necessarily need to be terminal to get help from them. Also, no matter what she may have wanted in the past, she may have changed her mind so try if you can, if her mind is there enough to say, to keep up with her current thoughts about what she would like.

Best of luck to you, I feel for all of you.
 
I've been through this 4 times in the past few years, end of life stuff, with older relatives. First sorry for your mom, I know it's hard.

Here is what I suggest. It sounds as though you are based in reality and are already making great decisions. Your mom should easily qualify for hospice, I would talk to the doctors about it. I would tell the doctors that you want her kept comfortable and if she starts to come around then you can decide what treatment is appropriate. What I found was important is that a person in this condition needs an advocate, a vocal advocate. Listen, question, analyze and decide. After you decide, don't beat yourself up.

Ideally, were I in your shoes, I would get her the hell out of the hospital. I worked with an assisted living facility that catered to dementia clients, when the end was near they were very accommodating in allowing us to bring them home. The key for this was us being able to provide care round the clock, which we were able to do via hiring aides. The point here was to get them out of the hospital environment into a peaceful environment if possible.

The reality is trying to bring them back just prolongs the inevitable if it is their time. Conversely, sometimes people get better and thrive again, the hospice nurses and assisted living staff would tell me about people who have been in and out of hospice several times and snap back.

I would definitely go the hospice route, and I would be hesitant to do any more intervention to try and fix her, unless she wakes up, and expressly tells you she wants to try those things.

Best of luck, I hope you find some peace in all of this.
 
Hard to hear, so very hard to hear. . .others have better advice posted, but just a note for you: give yourself a break on guilt; everyone has it at time like this, but I bet she wouldn't want that for you, and isn't mulling over minor slights or imperfect behavior on some distant-past occasion. Think of the sum total of your time together, conjure up the good memories. She isn't alone, which is the about the best we can do for a loved one crossing over.

God bless you brother. . .
 
@FormerHangie the nurse of the household says you need to talk to a Hospice counselor, preferably one that works for a Hospice company that has a Palliative Care division. This is squarely in the palliative care realm.
 
P.S. the nurse of the house also says the most common mistake she sees families make is in NOT contacting Hospice sooner. They have resources besides Hospice care and they're the closest to that sort of need. And if palliative care happens to turn into Hospice care, they often can make that move a lot more seamless if they were involved from the start.
 
I spoke with my sister this evening. Mom is off of oxygen, awake and alert, and periodically coherent. She was given a pretty serious dose of atavan on Tuesday, and just now seems to be getting over it. She has no memory of the last 36 hours. She's seeing a gastroenterologist tomorrow, she has a stricture in her esophagus and if she is going to have surgery, they want to see if they can dilate it so they can intubate her to do surgery on Monday. As @comanchepilot said, she's going to have to get the broken bone treated to get out of the hospital. Assuming the surgery goes well, the next step will be for her to go to a rehab center for a couple of weeks. The bone that broke is on her left side, which is also the side that is weak from the stroke, and I just can't see that she'll be able to walk on it. I'm not sure I want her to try in case she falls again, but that's not my decision.

Once her term in rehab is over, then we'll see if she go go back to assisted living. She may be able to do so, especially if we get her some additional care, or she might have to move to another facility, and I suspect it will be in the palliative/hospice mode. I suspect she'll be bedridden after rehab and that won't sit well with her.

Thanks again for all your thoughts and prayers.
 
Reminds me of Kenny Rogers' song "The Gambler." "The best that we can hope for is to die in our sleep."

I understand perfectly where you are since I am in a similar situation. Prayers for comfort and guidance.
 
FormerHangie said:
I spoke with my sister this evening. Mom is off of oxygen, awake and alert, and periodically coherent. She was given a pretty serious dose of atavan on Tuesday, and just now seems to be getting over it. She has no memory of the last 36 hours. She's seeing a gastroenterologist tomorrow, she has a stricture in her esophagus and if she is going to have surgery, they want to see if they can dilate it so they can intubate her to do surgery on Monday. As @comanchepilot said, she's going to have to get the broken bone treated to get out of the hospital. Assuming the surgery goes well, the next step will be for her to go to a rehab center for a couple of weeks. The bone that broke is on her left side, which is also the side that is weak from the stroke, and I just can't see that she'll be able to walk on it. I'm not sure I want her to try in case she falls again, but that's not my decision.

Once her term in rehab is over, then we'll see if she go go back to assisted living. She may be able to do so, especially if we get her some additional care, or she might have to move to another facility, and I suspect it will be in the palliative/hospice mode. I suspect she'll be bedridden after rehab and that won't sit well with her.

Thanks again for all your thoughts and prayers.
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Good news that she is awake.. I'm pretty sure she doesn't have to have the hip fixed to get out of the hospital, that's a discussion you want to have with her doctor, preferably her regular doctor and a hospice person. No one can force you to do a treatment or to stay in the hospital, remember that.

Reread your first post, then decide if you wish to put her through all that to end up where you think she will end up in the first post. Sorry if I'm sounding harsh, but I have been through issues like this with my elderly relatives and it is tough.

I think if I were in your shoes, I would explain to her what they wish to do, what the repercussions are and let her make the decision if she is able. Someone who isn't eating well is going to have a hard time healing up from surgery. I think she will surprise you with her decision if she cognizant. If she says no to treatment, then that would be the last word were it my mom.

Again, sorry for your troubles, you and your family are in my prayers.
 
PaulS said:
I think if I were in your shoes, I would explain to her what they wish to do, what the repercussions are and let her make the decision if she is able. Someone who isn't eating well is going to have a hard time healing up from surgery. I think she will surprise you with her decision if she cognizant. If she says no to treatment, then that would be the last word were it my mom.

Again, sorry for your troubles, you and your family are in my prayers.
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Same. And the nurse in the house just nodded and said "uh-huh" multiple times to that paragraph above.
 
My thoughts are with you, your sister, and other family members. I pray you will find peace and retain the good memories of your mom after she passes. Losing your mother is an incredibly painful experience, and you have my sympathies.

This October it will be six years since my mom left us. At 75 she was still fine mentally, but was in so much pain from arthritis and joint afflictions she made the decision to refuse food and just drink water. Mom died eleven days later. Even today I am sometimes flooded with grief and the tears spontaneously fall.
 
PaulS said:
I think if I were in your shoes, I would explain to her what they wish to do, what the repercussions are and let her make the decision if she is able. Someone who isn't eating well is going to have a hard time healing up from surgery. I think she will surprise you with her decision if she cognizant. If she says no to treatment, then that would be the last word were it my mom.
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I have seen both ways. My aunt was a fighter. When she broke her "hip" she underwent the surgery, rehab, and we all thought this would be the end but she decided, against all advice, to move back into her house. She had a pacemaker installed, and several other medical interventions and each time wanted to fight to stay alive and furthermore, go back to her home. She made it work by bringing in aides to help her. She continued on for many years like this when the last trip to the hospital finally did her in from just multiple failures of everything.

Then there are those who really don't want to go through all that, particularly when their spouse dies, they just want to go join them. It's a tough position to be in to be the one responsible for making the decision for them if they can't do it themselves.

I'm glad to hear she is off the oxygen and is awake. I really feel for your predicament. I hope things become clear and the decisions a little easier. I guess all you can do is try to gather as much information as possible and then go from there, one day at a time.
 
Retired physician, both parents expired late in life with lingering illnesses....,
To all who said above that your Mom is not a Hospice candidate - not true and uninformed.
Get Hospice involved ASAP! A good Hospice (and not all are - ask for local recommendations) can help with care AND assist in your decision making.

Good luck...none of this is easy, but take most consolation knowing that you're doing what's in HER best interest as her loving son.
 
somorris said:
Reminds me of Kenny Rogers' song "The Gambler." "The best that we can hope for is to die in our sleep."

I understand perfectly where you are since I am in a similar situation. Prayers for comfort and guidance.
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I'm sorry to hear that. We all know it's coming, but that doesn't make it any easier when it happens.

PaulS said:
Good news that she is awake.. I'm pretty sure she doesn't have to have the hip fixed to get out of the hospital, that's a discussion you want to have with her doctor, preferably her regular doctor and a hospice person. No one can force you to do a treatment or to stay in the hospital, remember that.

Reread your first post, then decide if you wish to put her through all that to end up where you think she will end up in the first post. Sorry if I'm sounding harsh, but I have been through issues like this with my elderly relatives and it is tough.

I think if I were in your shoes, I would explain to her what they wish to do, what the repercussions are and let her make the decision if she is able. Someone who isn't eating well is going to have a hard time healing up from surgery. I think she will surprise you with her decision if she cognizant. If she says no to treatment, then that would be the last word were it my mom.

Again, sorry for your troubles, you and your family are in my prayers.
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She and my sister have been discussing what the best course of treatment, and my mother chose the surgery. The problem with not having surgery is that with an open fracture she's pretty much immobilized, because every time she moves the bones shift. Assuming the surgery is successful, and it should be, she will be able to sit up and move around in bed, and move from place to place with assistance. The rehab folks think there's a possibility she will be able to use her walker to get around, but I'm skeptical.

3393RP said:
My thoughts are with you, your sister, and other family members. I pray you will find peace and retain the good memories of your mom after she passes. Losing your mother is an incredibly painful experience, and you have my sympathies.

This October it will be six years since my mom left us. At 75 she was still fine mentally, but was in so much pain from arthritis and joint afflictions she made the decision to refuse food and just drink water. Mom died eleven days later. Even today I am sometimes flooded with grief and the tears spontaneously fall.
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I'm so sorry for your loss, I can't imagine what that would be like.

wrbix said:
Retired physician, both parents expired late in life with lingering illnesses....,
To all who said above that your Mom is not a Hospice candidate - not true and uninformed.
Get Hospice involved ASAP! A good Hospice (and not all are - ask for local recommendations) can help with care AND assist in your decision making.

Good luck...none of this is easy, but take most consolation knowing that you're doing what's in HER best interest as her loving son.
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My wife told me that same thing last night. Both of my inlaws received hospice care in their assisted living facility towards the end of their lives, and neither had any one illness that would be terminal on its own. We're going to look into that once we get her out of the hospital and into a rehab center.
 
Just a caveat - utilize/mobilize whatever resources you can while she's still hospitalized. Hospital Social Workers/discharge planners/resource managers tend to have more resources at their command. Once in a Rehab Facility you and she may be a bit more limited in choices (corporate preferences/alliances/etc)
Good luck going forward.
 
FormerHangie said:
I'm sorry to hear that. We all know it's coming, but that doesn't make it any easier when it happens.



She and my sister have been discussing what the best course of treatment, and my mother chose the surgery. The problem with not having surgery is that with an open fracture she's pretty much immobilized, because every time she moves the bones shift. Assuming the surgery is successful, and it should be, she will be able to sit up and move around in bed, and move from place to place with assistance. The rehab folks think there's a possibility she will be able to use her walker to get around, but I'm skeptical.



I'm so sorry for your loss, I can't imagine what that would be like.



My wife told me that same thing last night. Both of my inlaws received hospice care in their assisted living facility towards the end of their lives, and neither had any one illness that would be terminal on its own. We're going to look into that once we get her out of the hospital and into a rehab center.
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You sound like you and your family have this well under control. Keep your seatbelt fastened, it's going to be a wild ride. And rest assured, you and your family's involvement in this are bringing her more comfort than you will ever realize. And never forget, hindsight is a great thing, but it is useless as you go through something, what your family and she decide now is what is important, if it doesn't go to plan, then it wasn't meant to be, you still did the right thing.
 
I'm old and admitting to it. 77, and still of relatively sound mind, or so I'd like to think. Some days I have my doubts. I try to keep as mentally alert and active as I can at this age. OTOH, I know a guy who says Alzheimer's ain't all bad because you get to meet new people every day. I know he's kidding and I think differently. Thank God I know he is jesting.

I realize that most men, after age 75 are living on borrowed time. Some may live to ninety but most will not. That's just a statistic most of us refuse to acknowledge. I
was amazed at my mom's funeral to see one of my dad's cohorts who was born in the early 1900's. He was 99 years old and still living alone and fending for himself. Unfortunately, he fell just a few days short of the century mark. I ain't gonna see that.

The statistics are not in our favor. My former employer and best friend is four months younger than I and in spite of living the good life and taking care of himself has heart problems. They are resolvable, but at cost, both economic and the wear and tear on his physique. He has never smoked, is only an occasional drinker and is not a woman chaser. I have often chided him about the latter. Yet, we both admit to being in the "sunset years" of our lives. One never knows when the man upstairs will come calling for you. Things are no longer what they were when we were in our thirties and we have to learn to live with that.

Some of what happens to us before death boils down to genetics. Fortunately, my dad gave me and my siblings some good ones. My mom', family wasn't so fortunate. Her sisters and brother lost it mentally long before they passed; Sad but true.

I can only hope to die in my own bed while asleep, or as the cowboys said, with my boots on. My mom passed during a nap after dinner. I would be pleased it that were the path chosen for me. I dread the thought of rotting away in some hell hole unable to think for or care for myself.

In the overall scheme of life my avatar applies. "I know nothing". I was born with no knowledge and will pass when I',m called.

Sgt Schultz out.
 
Norman said:
I'm old and admitting to it. 77, and still of relatively sound mind, or so I'd like to think. Some days I have my doubts. I try to keep as mentally alert and active as I can at this age. OTOH, I know a guy who says Alzheimer's ain't all bad because you get to meet new people every day. I know he's kidding and I think differently. Thank God I know he is jesting.

I realize that most men, after age 75 are living on borrowed time. Some may live to ninety but most will not. That's just a statistic most of us refuse to acknowledge. I
was amazed at my mom's funeral to see one of my dad's cohorts who was born in the early 1900's. He was 99 years old and still living alone and fending for himself. Unfortunately, he fell just a few days short of the century mark. I ain't gonna see that.

The statistics are not in our favor. My former employer and best friend is four months younger than I and in spite of living the good life and taking care of himself has heart problems. They are resolvable, but at cost, both economic and the wear and tear on his physique. He has never smoked, is only an occasional drinker and is not a woman chaser. I have often chided him about the latter. Yet, we both admit to being in the "sunset years" of our lives. One never knows when the man upstairs will come calling for you. Things are no longer what they were when we were in our thirties and we have to learn to live with that.

Some of what happens to us before death boils down to genetics. Fortunately, my dad gave me and my siblings some good ones. My mom', family wasn't so fortunate. Her sisters and brother lost it mentally long before they passed; Sad but true.

I can only hope to die in my own bed while asleep, or as the cowboys said, with my boots on. My mom passed during a nap after dinner. I would be pleased it that were the path chosen for me. I dread the thought of rotting away in some hell hole unable to think for or care for myself.

In the overall scheme of life my avatar applies. "I know nothing". I was born with no knowledge and will pass when I',m called.

Sgt Schultz out.
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Norman, everyone dies, having seen the ravages of dementia in close elderly relatives and judging from your writing, I don't think you have any signs of dementia, my layman's opinion.

The only suggestion I have is that if you have not done so yet, get your affairs in order. A will, a living will, durable power of attorney and healthcare proxy. Make your wishes known to the people who will fulfil these roles. It's never too late or too soon to take care of this stuff as long as you are of sound mind. If someone is slipping cognitively it can still be done, but it gets harder. I'm 20 or so years younger than you and I have it all done. I was amazed at what a painless process it actually was.
 
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