We aren’t very good at planning ahead, at least for some eventualities.
Most people I know are contributing to a pension, have a will and might even be saving-up for a summer holiday.
Few people are planning for things going wrong with their health.
For most of us, this isn’t really an issue – we are amongst the healthiest people ever to have existed – we live longer, free from life-limiting diseases; admittedly, there has been an increase in the numbers of people living with chronic or long-term conditions, but we, as a society have, by and large accepted this trade-off.
What this means, if you are 20 or 30 (or even 40 or 50…), is, the likelihood of something going wrong with you is quite small – that is not to say that young people don’t get sick, just, the proportion of people who are sick and dying in our society is progressively getting older.
I’m sorry if this sounds a little dark, and that, is probably part of the reason most people don’t want to go-here.
Nevertheless, if you look at older people (whatever or whoever they are – see), the chances of things going wrong are proportionately greater than for those who are younger; equally, those people who have long-term health conditions – diabetes, stroke, heart disease, asthma, arthritis, and so on, have an even greater risk of things going wrong.
Those people who have the highest risk of things going wrong are older people living with frailty – this is a popular area of discussion in health and social care and reflects a physical state where the chances of things going wrong with your health are greater than those going well and, when things do go wrong, you have a reduced chance of recovery.
If you combine frailty with a long-term condition, things are particularly precarious – for example, people living in nursing homes with dementia and heart disease are at high risk of both hospital admission and dying, within the following year.
It is to this subset of people that I appeal, or perhaps, their families or carers, if they are not able to participate – we need to plan ahead, consider that the risk of things going wrong is quite high and if we don’t do anything about it, the likelihood is that we will not be able to direct or even influence the outcome of what happens to us – admission to hospital, complicated tests and investigations, multiple medicines, etc.
Not that any of this is necessarily bad, but it is not what everyone, given an option would prefer – there is good evidence to suggest that if we are aware and follow peoples’ preferences, the outcomes of their healthcare experiences are more positive than they otherwise might have been.
My proposal is, therefore, if you are older and you have any of the features of frailty, consider talking with your family, friends or doctor about what you might want if things change, if things go wrong, if you become more unwell.
Perhaps you might not want endless CT scans, or equally you might like to receive thickened fluids and pureed meals or nutrition through a stomach tube – these are all important areas that far too few of us consider until it is too late and the decisions are made without our presence or involvement – when we have lost capacity and treatment plans are made in our ‘best interests’
Watch-out for the next post about Advanced Care Plans…