Dying Older Adults

How would you like to die?  Gilbert Meilaender from Valparaiso University in Indiana suggested a one-word answer: Suddenly!  The idea is to live as long as we can at the peak of our powers, then fall off a cliff.  Doubtless he is right about contemporary attitudes toward death. If we have to go, let it be quickly and painlessly.

Last month a local woman, Sharlotte Hydorn, gained a measure of negative notoriety by offering to mail you, for only $60, a package containing a plastic bag, medical tubing, a canister of helium and instructions on how to commit suicide—by placing the bag on your head and filling it with helium which deprives the body of oxygen. The State of Oregon, one of the few states where physician assisted suicide is legal, was exploring the possibility of suing her.

These two perspectives point to the schizophrenic relationship many of us have with death. What we say we want is frequently quite different from how we deal with death. Since more than a quarter of us will likely die in an emergency room, our final departure might look more like a medical failure rather than a dignified release of life.

Despite the availability of hospice care—both at home and at hospitals, which often involves palliative care targeted to relieve pain—most older adults still experience widespread distress in the final stages of life. We have few guidelines how to deal with death or bereavement in older adults—even when death is not only inevitable but desired. The now classic Kubler-Ross’s process of bereavement—involving phases of denial, anger, rationalization and acceptance—was developed by her observation of children’s reactions to death.

Sherwin Nuland, an American surgeon, has made the point that death in older age is often a protracted affair, rather than a clear-cut process that allows patients and those bereaved to go through the classic end of life stages. He quotes an elderly patient as saying, “Death keeps taking little bits of me.”

Ever since it was eliminated as an official “cause of death” in 1951, we cannot die of old age. We have to die of a disease or trauma. In truth, there is only one real cause of death—oxygen starvation to the brain. The cause of death listed on death certificates is really the cause of the cause. As simple as this might seem, formalizing a definition of death was not easy, but we have been pioneers in California.

In 1973 hospitals threatened to cease organ transplants since criminal defense attorneys argued that harvesting a victim's organs while his heart was still beating caused the death. Dixon Arnett (R-Redwood City) introduced emergency legislation to recognize death when brain activity ceases.  This definition of death is now accepted across the world.  Despite such advancement, we still have difficulty preparing for death. Dying suddenly and painlessly might be our ideal, but we do very little as a society to give older adults that option.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com