What is important for the elderly and dying
What is important for young people and those not focused on the end of their lives is living, in fact, it should always be focused on living the best we can. So it might be work, hobbies, family or travel for younger people and those not living with life limiting conditions. And for some people who are living with life limiting conditions, they also have that focus and the work they do in managing their lives in working out how to live to the full and travel, work and have time for their family. Disability does not dehumanise anyone, but on occasions the reactions of others, seeing only the disability and not the person can dehumanise them.
Because the focus is often different in different stages of their lives, the elderly are often not as afraid of dying as others. They fear loss of control and indignity far more than dying. Or sometimes it can be the process of dying, but not being dead that they fear. This can create conflict with family carers and even with professional carers, whose focus is on preventing dying.
Dying is a natural part of life, unless it happens in an accident, in which case it can be traumatic, for those at the end of life, it is often a quiet and gentle process of the body slowly ceasing to function, with breathing slowing, until it stops. This is how Katherine Mannix, a palliative consultant describes dying in “With the End in Mind”, her book on dying well.
The elderly often feel that they have done their job, by living and having a family and having retired and come to the end of their life that dying is a natural part of life and that as their health is starting to fail that death is not such a bad option. This is contrasted with younger people who develop life limiting or terminal illnesses, they can sometimes feel that they are not ready, that they have not had a full life and that their opportunities are cut short. Hence the idea of the 5 stages of grief by Elisabeth Kübler-Ross and David Kessler (denial, anger, bargaining, depression and acceptance) and David Kessler has proposed a 6th of “finding meaning”. People do not go through the stages of grief in order, but hopefully eventually get to acceptance, but that still does not mean that the people around them have the same view and are as willing to welcome death as they might be.
It is important to understand both people’s perspective, that of the family who will be left behind as well as the elderly and dying. If they can have a conversation about what is the priority for the carer and what is the priority for the elderly or dying person, then hopefully a plan can be created that will acknowledge the needs of both.
It is key to understand the priorities of the elderly or dying person, so that they can experience the death that they want and live their last few years, months and weeks in a way that they want. And if they fear indignity or pain or admission to care far more than they fear death, this is a clearly expressed wish that should be taken into account. In order to know what their priorities are, the discussion needs to take place. Dying well really does matter.