When is enough, enough?

I have certainly had a number of patients like this. Some made the decision themselves others were considered anaesthetic risks i.e. their heart/lungs wouldn't stand a long operation. I can well remember a couple of patients who were admitted to a nursing home I was managing and with careful nursing and good nutrition they lived for several more years - both in their 90s. I would certainly never put a number on this. For me the first criteria is 'what does the patient want and do they have capacity to make the decision', secondly its a clinical decision based on the patients condition, ability to withstand the treatment and comply with the therapy and likelihood of the clinical outcome being positive.
It sounds as though you have a particular reason for asking trisher

My grandmother, who had been a very strong and fit woman all her 90 odd years, had a spontaneous femur fracture and it was operated on. After the surgery the hospital team talked to her about being in a nursing home as she would not have been able to cope on her own at home. From that moment on she refused all food and drink and effectively committed suicide. She certainly had mental capacity, so there was nothing anyone could do.

She was clear that she did not want all the rehab and certainly did not want to be anywhere but her own home.

She was a formidable lady!! - and much loved by me (but not her DIL - my Mum).

Thanks Teetime for yur objective post. I have a reason, but I don't do personal n GN so asked theoretically. It is good to get an informed answer from a disinterested party. I am thinking carefully about all you said.

trisher please pm me if I can be of any further help.

There isn’t any age limit that’s applicable to all/the majority. It depends on so much. If an individual is simply to be returned to their house, having to sleep in the living room, with a commode and only carers coming in to get them up, put them to bed, and sort out their basic needs, then I doubt I’d want to live like that.

If there were friends and family visiting on a regular basis, that might make a difference.

It would also depend on how limited my prospects of mobility were. Is there a possibility that the physio would give me back some quality of life? In that case I’d definitely give it a go.

And then it depends on the individual’s will to live.

I don't think age is a very good criteria to use. I'd have thought it comes down to the person's capabilities and wishes.

If the person has severe dementia, say, and is unaware of anything then family may decide not to proceed with treatment. Otoh, if the fracture is the only health problem the person has, then treatment may be very worthwhile.

I have met a woman who had a broken hip and didn't want any treatment. She wore a kind of girdle with reinforced hip pads, so that we could roll her without discomfort. I was amazed that she wasn't in agony, but she lived a couple more years, and was comfortable, and still had quality of life. She could sit out into an armchair beside her bed, and remained quite cheerful. She was in her late 80s, and in a care home.

Just before Christmas a 92 yr old lady who lived alone with no close family was admitted to hospital after a collapse (she wasn't hurt) just not managing at home, they did tests and discovered lesions on her liver and kidneys they wanted to do biopsies but she was too frail to withstand the general anaesthetic. She asked outright if this was cancer and they were non-commit all but she made up her own mind. She refused all food from then on and passed away peacefully a week later.
She just knew it was her time and made her own decision. She was my ex-mil and I'd known her for over 50yrs terribly sad but she did it her way in the end.

Thanks for the answers I think what it has brought home to me is that the elderly person makes their own decisions and it is best just to wait and see. Which isn't always easy to do. You tend to think you can take control and do things your way, but it has to be their way. Thanks everyone.

when should doctors and therapists treat and when leave alone?

When the patient asks them to stop treatment is one option.

When treatment/therapy is not working or is just prolonging life for the sake of prolonging life with no consideration given to quality of life. Tricky though.

I think we concentrate too much on "saving lives" and not enough on reducing suffering. There have been quite a few high profile cases of late about people who wanted to die because they had suffered enough but weren't given any help to do so. They were just kept alive for the sake of it.

Totally agree Baggs

Right to die, euthanasia should be available in this country.

My late grandma had 2 major operations in her 90's. One for a burst ulcer from which she came back as good as new. The second to remove a large cancerous lump from her neck and jaw (which resulted in chemo and radio therapies). Again she bounced back and even had further surgery for dental implants after the jaw surgery made it hard to wear dentures. I attended almost all of her appointments with her and each time she was asked if she wanted to carry on. She always said she did as she (and they) still felt she had a very good quality of life.

I don't think it's age but medical condition that counts. My father was 80 when he had a major stroke and many people now are still fit and active at that age. When the physio was trying to sit him up and do other exercises, I asked her if this was appropriate given he had been given a poor prognosis with lung cancer, and had other medical conditions. She said she had not read all his notes and in the circumstances, she stopped her treatment.

The patient is the only person who could make that decision which would be based on there medical condition and the information received from the health care professional dealing with them.

Can I go a step further and say I’d support an individual’s decision too. I’ve had to say recently ‘no, please don’t talk like that’ but have since decided that wasn’t the right thing to say, it was just my knee-jerk reaction to someone saying they’d ‘had enough’.

Next time I’ll ask them ‘why?’ and listen without interrupting wth platitudes.

It is hard though isn't it OldMeg maybe it is something to do with our fear of death and even talking about death. We should be able to do things better.