They're comfortable with dying, but ...

James M. Berklan
James M. Berklan

It's said America and Britain are two countries separated by an ocean and a common language. I'm reminded of it every time I see a lorry next to me in the car park after I've returned from getting petrol.

But on most fronts, we'll have to agree that there are primarily similarities between us and the Brits, especially when it comes to life and popping one's clogs.

That's what makes a British study I just learned about so interesting — and relevant to caregivers. In brief, the University of Cambridge-based study found that many of the “oldest old” are OK with dying. But nobody knows it. Well, almost nobody.

The study subjects, numbering just several dozen but a significant number nonetheless, said they were willing to talk about death, but it happens relatively rarely with their doctors and even less often with family members. Those ratios probably aren't too surprising to eldercare operators in the United Kingdom or in the United States, or many other countries.

But the point that might be missed is that there are compassion and caregiving opportunities being lost. Ignorance is definitely not bliss in this case.

“We know very little about the difficult decisions considering their end-of-life care,” notes study leader Jane Fleming, a member of Cambridge's public health and primary care department.

Most of the 95-plus-year-olds interviewed said they were prepared to die and didn't worry about the future too much.

In fact, the prevailing concern seemed to more about how they would die, rather than when. Cue the commercials touting the benefits of good palliative and hospice care services, though study authors cautioned that preferences for such treatments cannot be assumed.

The British study subjects expressed the preference of living at home, and in comfort, rather than heroic lifesaving procedures that might produce more pain down the road.  (And this differs from Americans … how?) Comfort was a key for them. Few wanted to be hospitalized.

They said they learned a lot from witnessing peers' end-of-life experiences, a perversely charming parallel to infants near the start of life wanting to model the behavior of others just ahead of them on the aging curve.

The lessons for caregivers (and family members) are clear, the researchers noted. There must be an effort to learn elders' priorities as they age, especially when they near what is perceived to be the latest stages of their lives.

It sounds easy typing the above lines, and the ideas have been uttered numerous times at long-term care staff meetings, and other places, including this recent reflective column by my colleague John O'Connor on Valery Hazanov's work. But it needs to be said more, whether it's conversation sparked by a psychologist, social worker, chaplain, you or any other person.

Just as people like control over their lives, their ultimate comfort can be control over their final days. It's attainable a lot more often than most caregivers and family members realize or care to admit. That's a shame — and correctable moving forward.

"Having these conversations before it is too late can help ensure that an individual's wishes, rather than going unspoken, can be heard," explains study co-author Morag Farquhar.

It's hard to misinterpret that, no matter which side of the Atlantic you learned your English.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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