People in hospice are living longer than expected, according to a recent Washington Post article.В Why is that?В ItвЂ™s because for-profit hospice companies are recruiting less ill patients, or patients not really dying. In my experience as a geriatrician, many chronically ill people have lost most incentives to keep them alive.
Why might Hospice Cure a dying person?
In my experience as a geriatrician, I saw that seriously ill patients often became isolated. As we become ill we cut back on our social contacts. With a cold or flu that is certainly wise. However, after heart attack or stroke there is no reason to avoid social contact. Yes it might take more effort, but can yield benefits that make it worth it. Have you ever gone to a party feeling bad only to enjoy yourself and forget your ills?
As we get older our bodies stiffen up. We are aware of more aches and pains. Most people past 60 have some osteoarthritis but for some people it doesnвЂ™t cause problems.В Doctors canвЂ™t explain this. I have seen very deformed knees that did not ache and seemingly normal knees that were crippling.В It seems that some people with osteoarthritis have adapted very well and others not as well. Those who adapted live full lives, the others are shut up in their illnesses.
What are the benefits or remaining active?
The main benefit of an active life is the self-image of health. When I can shop and do other things by using a bus I donвЂ™t feel the loss of driving. When I get to the gym I am among others who are enjoying strengthening their bodies.
There is a large social benefit from getting out. I go to a book group regularly. The others bring their printed books. I recall what I heard while listening to the book and my thoughts about the book. In the time I have attended this group I have made several friends. If I had let the difficulty of transportation and low vision stop me, I would have missed out on the friendships.
Those who are shut in by illness are cut off from friends and family.В When people recognize that they are dying, they enter hospice, which brings renewed support. The hospice teams are available in person and by phone. They have a network of supporters who will sit with a person and do chores.
Hospice changes the focus from Cure to Care. This was the biggest change I noted when I became a Geriatrician. No longer could I expect to cure an illness. In fact I often had to decide which symptom to address, recognizing that other illnesses would be left to run their courses.
Our society is very isolating. We no longer live in multigenerational groups. Families are separated by distance. Many divorced or widowed people live alone with personal contacts limited to what they can organize.В If someone misses a group gathering, soon they will be forgotten.В The news of their entry into hospice may bring renewed contacts.
Humans are social animals. Infants who donвЂ™t get physical contact with care givers soon die. Kids are always in contact with each other. They wrestle and roll together on the floor. Adults too need physical contact. Hugs are usually welcomed and enjoyed. Even a hand shake can enhance the experience of meeting a stranger. We can take stock of someone we meet by the strength of the handshake. Physical labor makes oneвЂ™s hand strong and well-muscled. Confidence is communicated by willingness and taking the lead.
Thus the social supports and contacts Hospice Care provides might be just the Cure a person needs.
As All Ways, Seek Joy,
Coach Dr. Dave,
Author of the forthcoming book: вЂњRecipes for Lemonade (thriving through disability): Dr. Dave
S Personal RecipeвЂќ