Take a look at our latest newsletter!
VanDyckLawGroup
QUARTER 3, 2024
VANDYCKFIRM.COM
PLAN WITH PURPOSE End-of-Life Directives for Quality of Life
Atul Gawande is a practicing surgeon who realized that much of what he learned in medical school was geared to keeping people alive but not to helping them die well. In his landmark book, “Being Mortal: Medicine and What Matters in the End,” he shows that many doctors avoid engaging in conversations with patients about end-of-life care, but focus instead on prolonging life — even when their efforts actually increase suffering. In recognition of Aug. 9 as National Book Lovers Day, I want to reflect on the impact Gawande’s book has had on my life, both personally and professionally. I have copies of his book at home and in our office. It speaks strongly to the need to think about end-of- life planning, to reflect on what you really want, and to make those wishes known to those who may have to carry them out. As Gawande writes, quality of life is sometimes more important than quantity of life. When extraordinary measures are used to keep someone alive at 98 years old, to what end? If you’re 98 years old, and the doctor says you can’t have cupcakes any more, or you can’t have your favorite soup because it’s too salty — to what end? One of my clients is caring for an aunt in the end stages of dementia. She doesn’t recognize family anymore. If she hadn’t had amazing medical care, she might not have lived so long. But at this stage, every time she falls ill, she is taken from her assisted living
facility to the hospital, often for invasive treatments. For her, living more years brings little enjoyment. At one point, my client and I looked at each other and said, “To what end?” The likelihood of a good outcome from extreme life-sustaining measures, such as aggressive CPR or mechanical breathing support, declines as patients age. Only slightly more than 15% of patients who receive CPR in the hospital actually survive even briefly, and the procedure often breaks clavicles, ribs, and other bones. To what end? Experience with the realities of end-of-life care leads even physicians to elect less invasive measures for themselves. Two studies of more than 800 Johns Hopkins University Medical School graduates over 12 years showed that the proportion of physicians who selected aggressive treatment in 1999 fell significantly over the course of the study. By 2011, those desiring the most intensive interventions dropped by nearly 60% and most participants opted for the least aggressive treatments. Patients and families can benefit from shifting their focus away from specific interventions to obtaining the overall health status and outcomes they want, researchers say. We apply this same principle when working with clients on estate planning by asking, “To what end? What is the final result you want?” A client who is angry at a child and is disinheriting them, for example, may choose to use language in their will that could potentially do lifelong harm to
that child. In such cases, I always ask, “To what end are we doing this?”
One of the documents we give to clients and patients is a medical directive by the Johns Hopkins University School of Medicine. It describes four different medical scenarios and treatment options to help people think in depth about what they want and explain their wishes to others. It is important to have these conversations with loved ones, and Gawande’s book offers help in transcending your fears and thinking about important big-picture issues. As you reflect on your own end-of-life care and that of your loved ones, I hope you have time to identify the outcomes you want and share them with those who need to know. -Fiona Van Dyck
1
609-580-1044
Published by Newsletter Pro • NewsletterPro.com
Podcast Wisdom
Turning the Page: Top Books to Guide You Through the Empty Nest Transition
‘The Empty Nest: 31 Parents Tell the Truth About Relationships, Love, and Freedom After the Kids Fly the Coop’ by Karen Stabiner This collection of essays offers a mosaic of perspectives on the empty nest phase, from the melancholy to the liberating. Compiled by Karen Stabiner, the book explores the myriad ways parents cope with this transition. It’s comforting to read about other’s experiences and see how they’ve embraced (or struggled with) the changes, making this book a great starting point for those fresh to the empty nest lifestyle. ‘The Joy of Less: A Minimalist Guide to Declutter, Organize, and Simplify’ by Francine Jay Now that the kids are out of the house, it’s the perfect time to declutter and simplify your home — a task that symbolizes this new chapter in your life. Francine Jay’s “The Joy of Less” isn’t specifically about empty nesting,
but its principles can help you clear out those now-unused spaces and make room for new hobbies and interests you previously set aside. ‘From Mom to Me Again: How I Survived My First Empty-Nest Year and Reinvented the Rest of My Life’ by Melissa T. Shultz Melissa T. Shultz shares her transformative journey from a full-time mother to a fulfilled individual with a life enriched by new pursuits and passions. Her story is inspiring and offers practical advice for making the most out of the empty nest period. It’s mainly geared toward mothers facing the daunting question: “Who am I now that I’m not a full-time mom?” Reading these books can provide comfort, inspiration, and practical tips for navigating life’s emotional and practical aspects after your children have grown up and moved out. It’s your time now — enjoy rediscovering yourself and embracing all the possibilities ahead!
Ah, the empty nest. It’s a bittersweet time when the kids finally fly the coop, and you’re left wondering what to do with all the newfound silence — and space. Whether you’re feeling lost or looking forward to rediscovering your own interests, plenty of books can help you navigate this new phase of life. Here are three top picks every parent of newly adult children should consider adding to their reading list.
Few people are fully prepared for the difficult decisions they may face when a critical illness strikes near the end of life. Choose the Life-Sustaining Treatments You Want Your Wishes Matter Physicians are trained to save lives and will usually deliver whatever life-sustaining treatment is needed to replace or support a patient’s failing organs. Patients, however, have a choice about what treatments are used, and those who make these decisions in advance can avoid having to make high-stakes decisions in a crisis. All 50 states have taken steps to encourage medical care providers and seriously ill patients to discuss and agree upon the patient’s wishes regarding end-of-life interventions. These interventions include mechanical breathing or ventilation, in which a tube is inserted through the patient’s mouth or nose into the airway, to force air into the lungs. Tube feeding replaces or supplements a patient’s eating and drinking by providing nutrients via a tube placed through the nose or directly into the stomach.
heartbeat stops. While CPR often saves healthy patients in drowning accidents and other mishaps, the success rate is far lower for patients near the end of life. Another intervention, dialysis, replaces the kidney’s life-supporting function of filtering excess fluid and waste from the blood. The dialysis process doesn’t cure kidney failure, but it can sustain a person who is otherwise healthy. Chemotherapy, blood transfusions, and major surgery are other examples of aggressive end-of-life care. Like many states, New Jersey has legislation supporting the Practitioner Orders for Life-Sustaining Treatment (POLST), a document outlining the patient’s wishes on end-of-life treatment, which also shields the physician from liability. Unlike living wills or advance directives, a POLST is designed for seriously ill patients and is more likely to be honored by emergency responders. If you haven’t thought about the kinds of interventions you might want in the event of critical illness, we encourage you to explore completing a POLST today. Making these decisions can be difficult. But if a time comes when you are unable to make decisions for yourself, completing a POLST is a gift to all those charged with overseeing your care.
Cardiopulmonary resuscitation entails using electric shock, chest compression, or medication to revive a patient when their breathing or
2
VANDYCKFIRM.COM
Published by Newsletter P
The Power of Purpose
Useful Tasks Aid Adults With Dementia Having a sense of purpose helps people of any age cultivate a sense of well-being. But it can be especially important for older adults in the early stages of dementia.
bed, setting the table, or sorting through and organizing a drawer. Making a scrapbook of old photos and mementos can be pleasurable for some seniors. Others enjoy cutting out magazine photos and making a collage or bulletin-board display. To the extent possible, adults with dementia benefit from choosing activities for themselves and persisting in them. Pursuits with a tangible outcome work especially well, such as volunteering in a community garden, threading beads, or making potpourri. The sensory stimulation afforded by these activities can help preserve basic skills. Relationships with children, in particular, help decrease anxiety and preserve physical health for older adults with dementia. Time spent with pets can help as well. And encouraging artistic expression through painting, writing, or music can serve as a rewarding source of self- expression, relaxation, and enjoyment. Identifying activities that engage an older adult with dementia may take some time and energy, but the rewards will be worth the effort!
A major obstacle for people experiencing cognitive decline is a sense of helplessness and loss of identity. Many give up doing what they used to enjoy and lose any sense of purpose, leading to depression and loneliness. Seniors who lack a sense of purpose tend to have more functional disabilities, a 30% faster rate of cognitive decline, and a higher incidence of depression, according to an 18-year study of 1,475 older adults published in 2015 in the journal Developmental Psychology. They also have a substantial decrease in life expectancy. An adult’s sense of purpose is measured by whether they feel good about what they are doing and have a sense of direction in their days. Many adults in cognitive decline feel like a burden to others, so finding small tasks that allow them to make a contribution can be helpful, such as folding laundry, making the
TAKE A BREAK
Summer Pizza Inspired by AllRecipes.com
INGREDIENTS • 1 lb pizza dough • 1/4 cup pesto • 1/3 cup shredded quesadilla cheese
DIRECTIONS 1. Preheat grill to high heat on one side. 2. Reduce the flame on half of the grill burners to low. 3. Roll out pizza dough into a circle. Place dough on the grill over high heat. 4. Close the cover and let dough grill for 1–3 minutes until bottom is slightly cooked and shows char marks. 5. Use tongs to flip crust over and move it to the low-heat side. 6. Brush dough with pesto, sprinkle with cheese, and evenly distribute veggies and bacon. 7. Grill for about 3 minutes until cheese is melted; then carefully remove. 8. Optional: Combine butter and seasoning. Brush crust edges with butter glaze and place pizza in broiler until golden.
• 10 thin slices of zucchini • 10 thin slices of summer squash • 2 mini bell peppers, thinly sliced • 1 thin slice of red onion, diced • 1 strip cooked bacon, chopped Butter Glaze (optional) • 1 tbsp butter • 1 tsp steak seasoning
BACKPACK BEES MELON MOON MUSTARD OLYMPICS
PEACH SANDCASTLE SCHOOL TWINS
VACATION ZUCCHINI
3
609-580-1044
Pro • NewsletterPro.com
PRST STD US POSTAGE PAID BOISE, ID PERMIT 411
707 State Road, Suite 102 Princeton, NJ 08540 VANDYCKFIRM.COM | 609-580-1044
Inside 1
Atul Gawande’s ‘Being Mortal’: A Guide to Better End‑of-Life Care
2 Inspiring Books for Parents Entering the Empty Nest Phase
The Benefits of Weighing Life-Saving Treatments in Advance
3 Activities to Benefit Seniors With Dementia Summer Pizza Take a Break 4 Endearing Date Night Ideas for Older Adults
AGELESS ADVENTURES Fun and Memorable Date Ideas for Older Adults
For those of a certain age, it can be too easy to forget to prioritize the connection between us and our partners. While snuggling into pajamas and watching a familiar favorite on TV is convenient, breaking up the routine and embarking on a romantic outing is a great way to brighten the flame between you and your significant other. With these date night ideas, older adults can rekindle the warmth and love they share in fun new ways. Court with a class. With a little searching, you can easily find a variety of educational, culinary, and hobby classes available. From learning how to prepare and roll your own pasta to mastering painting, you have ample opportunities to enjoy learning a new skill together. If you are so inclined, you can even go to a PaintNite event, where fun-seeking couples paint
along with a tutor, in-person or virtual, while enjoying the adult beverages of their choice.
Pitch the perfect picnic. On a clear and sunny day, a daytime picnic can be an ideal way to enjoy nature and leisure at the same time. Pack a flavorful dinner and head out to a park or pristine plot of nature, then sit down, reminisce, and enjoy! Alternatively, you can head out near sunset and watch as the sun drifts down and the stars light up. A stargazing picnic can make for a memorable and romantic rendezvous. Rerun the first date. Recapturing the magic of the past can be magical in itself. Few events are more cemented in a couple’s memories than their first romantic encounter. Why not celebrate the love you two share by reliving the
experience of the first date? If the two of you met at a restaurant, book reservations for two; if you saw a movie, snuggle together on the couch and rewatch it together. The experience will bring back memories from the birth of your romance and the incredible legacy of love you have built with your partner in the years since. This can also be an excellent way to celebrate an anniversary and may prove popular enough to become a yearly tradition!
4
VANDYCKFIRM.COM
Published by Newsletter Pro • NewsletterPro.com
Page 1 Page 2 Page 3 Page 4Made with FlippingBook Ebook Creator