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Our elderly deserve better than withdrawing care

October 18, 2009
Morning Journal News

The reports from two federal studies released this week are disturbing.

They set the stage for withdrawing care for the elderly in nursing homes.

"One found that putting nursing home residents with failing kidneys on dialysis didn't improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead..." an Associated Press story reported.

These conclusions were stated emphatically even though the study, funded by the National Institutes of Health, did not include a comparison group of patients who didn't get dialysis, so it's unknown if more elderly are dying after starting dialysis or not.

One thing is known for certain in the medical community. People whose kidneys fail and who undergo dialysis as a replacement effort will be dead within weeks without it.

While admitting many in the study had other health problems, the article seems to cite only the dialysis in connection with declining abilities.

In the dementia study of people whose average age was 85, only one in four died within six months. Half died during the 18 months they were studied. For Medicare-paid hospice care, it must be known the person has six months or less to live. The study report urges declaring dementia a terminal illness.

Several things are troubling about the study and the conclusions drawn from it.

Anyone who has moved from robust health to anything less has a quality of life issue. That is true whether they now must inject themselves with insulin, take heart medication or walk with a limp. When do they become too costly? And at what age?

Who is considered elderly and who decides the threshold?

In this obvious cost-conscious approach to health care decisions, will there be a distinction between self-pay nursing home residents and those on public assistance or is everyone at risk of being refused more aggressive treatment? Or conversely, are we creating a "pay to stay" society in which those with the means to afford private care (and perhaps keep themselves out of a nursing home) may continue to live while those who cannot may not.

Where might this lead? If dialysis for a few months or years is too costly, what about the younger person looking at decades of treatment? Will someone whose brain scan shows an early predisposition for Alzheimer's, for instance, be denied care?

Has any effort been made to find people with some of these health problems who remain engaged in their community and bring joy to others despite their circumstances?

Is this a proper thank you to the often praised Greatest Generation credited with strengthening and preserving our nation?

French historian and political scientist Alexis de Tocqueville, has said, "America is great because she is good. If America ceases to be good, America will cease to be great."

More recently, former President Jimmy Carter said, "The measure of a society is found in how they treat their weakest and most helpless citizens."

For goodness sake, America.



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