Some years ago, at our annual conference of the National Association of Professional Geriatric Care Managers, I was particularly impressed by a presentation by Dr.
Dennis McCullough, author of "My Mother, Your Mother.
" He espouses the philosophy of "slow medicine.
" Simply put, there comes a time in an elder's life, when the focus of care goes from cure to comfort.
We exchange the multitude of tests that can be performed to aggressively making the person comfortable.
This can include control of pain, providing oxygen so that breathing is not labored, and respecting the frail elder's refusal for food and liquid intake.
Another doctor, Dr.
John Sloan has recently published a book expanding on this same topic.
But before I explain his philosophy, let me list the primary signs that characterize frailty: A slowing down of overall abilities.
* A lack of interest in eating which results in weight loss.
* A low activity level, unable to walk very far or not at all.
* General fatigue.
A person can sleep on and off all day and then sleep through the night.
* Loss of strength requiring the assistance of others.
Dr.
Sloan's new book, "A Bitter Pill: How the Medical System is Failing the Elderly," talks about the need for medical treatment to be kinder in treating older adults.
It gets back to Dr.
McCullough's idea of slow medicine.
However, Dr.
Sloan goes beyond this concept and talks about functionality with regard to older adults.
It is a strength based approach to frail elders.
Building on those activities they can still do.
It may be as simple as a call to a grandchild, sending a birthday card, sitting on the porch or singing a favorite song, listening to a favorite author.
I recall wheeling a client to the piano.
A retired music teacher, her fingers delicately touched the keys as she played a favorite piece by Brahms.
My experience as an elder care consultant, is that family members have an easier time accepting the concept of functionality.
When it comes to withholding medical tests, a surgical procedure or accept a parent's refusal of food, these challenges are much harder for an adult child or spouse to say "no" to.
One of my goals is to help well-meaning families think about what their loved ones would want and determine whether the perceived outcome warrants the intervention.
A sensitive task for a geriatric care manager, a complex decision for a family.