living your best to the end

I want to know what to plan for

personal decisions

What to expect over time, living with a chronic or terminal condition

“Dying is more a process than an event, and illness and death are a family process”

Barbara Okun, a professor of counseling psychology at Northeastern and a clinical instructor at Harvard Medical School

“When does dying begin?” This is a question often asked and just as often, there’s no satisfactory answer to be given

There are some health conditions whose journey can be predicted to a certain degree.

From Best Practice Guidelines for End of Life (Registered Nurses Association of Ontario-RNAO)

1. For most cancers: a short period of obvious decline leading to death.

2. For patients with chronic organ failure (kidney, liver, lung, heart): long-term disability with periodic worsening and unpredictable timing of death.

3. For those with frailty and dementia, a slow dwindling course to death.

More than one ailment or illness (in medicalese: ‘co-morbidities’) can be common, and interactions between illnesses and their treatment can affect the course and outlook (in medicalese:’prognosis’) making it even harder to ‘plan’, but always worthwhile to ask about possiblie crisis points along the journey.

Examples of co-morbidities:

  • Arthritis plus heart disease, diabetes and chronic obstructive pulmonary disorder (COPD–also called lung disease)
  • Neurological disorders (Parkinsons, ALS, Huntington’s) plus depression, stomach disorders
  • Dementia (Alzheimer’s, Vascular Dementia, Lewey Body Disease) plus cancer and bladder infections
  • Chronic kidney disease plus congestive heart failure and diabetes
  • Mental Health (depression, anxiety, bi-polar) plus rheumatoid arthritis and cancer

Interesting reading: Infections in the Elderly: are antibiotics always the best treatment?