Being Mortal: New Book Highlights End of Life Challenges, Opportunities
Surgeon and medical writer Atul Gawande’s remarkable new book, “Being Mortal: Medicine and What Matters in the End,” provides both warning and optimism about the results of advances in medicine and public health. While life expectancies were only about 50 years just over a century ago, life spans have lengthened dramatically. By the middle of the twentieth century, individuals over the age of 80 constituted only 1 percent of the population. By the middle of this century, the percentages of individuals over 8 and under 5 should be about equal.
That’s the good news. The bad news, Gawande points out, is that, while human longevity increases, society has not kept pace in providing truly humane care for an older and more dependent population.
Much of Gawande’s book focuses upon nursing home and hospice care, and he provides numerous examples of program innovators who found ways to improve the quality of life for residents or patients through dignified care that allowed productivity in even the most compromised individual.
My favorite example Gawande provides is that of a small nursing home in upstate New York, that turned the concept of institutional care on its head through the vision of Dr. Bill Thomas. When he became medical director of Chase Memorial Nursing Home in 1991, he began to care for 80 severely disabled residents, about 80% of whom had Alzheimer’s or other dementia.
Thomas was disheartened by what he referred to as The Three Plagues of nursing home existence: loneliness, boredom and helplessness. To contact these problems, he looked for ways to literally bring life into the nursing home environment. Green plants began to fill every room. The grounds gave way to vegetable and flower gardens. And the halls and rooms were filled with a menagerie of animals, from a greyhound called Target to over 100 parakeets, as well as an assortment of cats, laying hens, and rabbits. Employees brought their children in for after-school activities and built a playground.
In addition to a great deal of anecdotal evidence about the program’s effectiveness, researchers compared numerous measures for Chase’s nursing home residents with those of residents at a comparable nursing home. Among other findings was the remarkable result of a decrease in prescriptions per resident by 50% over the control group. Medications for agitation decreased most significantly. And deaths fell by 15 per cent!
When asked the probable reason for this difference, Bill Thomas stated, “I believe that the difference in death rates can be traced to the fundamental human need for a reason to live.” Whether interacting with children, tending gardens, listening to birdsongs, or caring for pets, Chase residents found a renewed reason to live with meaning and dignity. That is a lesson which all of us who work in the senior care field need to remember.
If you would like to read more about Bill Thomas’ pioneering work, a recent British review highlights this program.