WINNEMUCCA - Alzheimer's is the sixth leading cause of death. While death rates from other killers like heart disease and many cancers are on the decline, a lack of treatment, medication, and longevity on the rise, Alzheimer's may catapult to the top.
According to Lauran Neergaard, AP medical writer, one in three seniors die with/from Alzheimer's disease or other types of dementias.
This is frightening news as our aging population is impacted by these mind-destroying diseases. Dying with Alzheimer's refers to having dementia but dying from other maladies, such as diabetes or congestive heart failure.
Dying from Alzheimer's means the disease winds its course to the end point where the victim's mind has been robbed of its reflexive ability to swallow making ingesting food and water impossible. Some call this starvation; medically it is labeled as "failure to thrive."
Severe dementias limit the ability of individuals to move around and remain active. This increases the risk of pneumonia, a common disease linked to Alzheimer's death. Alzheimer's victims may also forget to take medications that are critical for those with diabetes or high blood pressure.
Also, the victim may not be able to explain symptoms as feeling analysis decreases and pain threshold increases. All of these lead to a blurred distinction in cause of death.
But sometimes, caregivers especially must consider whether surgeries and advanced medications to extend life are the answer to a dementia victim whose abilities are diminishing at an astounding rate. Are open-heart surgery and a pacemaker the best choices economically, health-wise and ethically? Quality of life versus quantity of life is a tough battle.
In her book "Knocking on Heaven's Door," Kate Butler describes the seven years of dying of her father with dementia. A cardiologist had recommended a pacemaker for him but Jeffrey suffered a stroke before it could be installed.
The primary physician who had been the doctor of the family for years did not recommend a pacemaker after Dad plateaued in his stroke recovery. However, the cardiologist overrode this wish and it was later implanted.
While neither wife nor daughter wanted Dad dead, neither did they want to see the multi-year decline as he forgot friends, family, familiar routines, and ended life full of anger and anguish as he could no longer communicate verbally or survive independently.
While many points are made to assist and support victims of Alzheimer's and their caregivers in her book, the quandary of the pacemaker became the focus.
As Jeffrey's abilities and cognition plunged, his heart ticked on. At age 84, he was incontinent, wobbly, sleeping for hours and confined to his home. Frequent falls brought paramedics, but only extensive pleading kept them from taking Jeffrey to the hospital for a life further prolonged with machines and medications.
Mom, in exhaustion, finally accepted help from others to assist in Dad's care and to explore the possibility of stopping the pacemaker, permitting Dad to die a more natural death.
Declared incompetent of making health decisions, Kate wonders, "To which of my fathers did I owe my allegiance? To the semi-intact man who'd come with me on a shuffling walk after his stroke... to the silent, ancient parrot my father had become?" What would Jeffrey want?
Doctors refused to turn off or remove the pacemaker - some referring to this act as euthanasia. Others recommended waiting until the battery went dead (in five years). Finally, the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society determined that "it is morally and legally acceptable
- See ALZHEIMER'S, Page 24 -
to deactivate a pacemaker if the patient wishes." This act would not be considered assisted suicide or euthanasia. In Kate's Dad's case, the responsibility fell on his wife as his legal guardian, no simple decision especially with love and best intentions involved.
In hospice care Kate and her mom joined with workers in not providing food and water allowing Dad to die without wrangling the legal tangle of pacemaker deactivation. As the author describes his passing, "Love can look heartless." She details her mom's agony and pain as they watched death to arrive rather than prolonging it.
I found the book to be profound while distressing. Butler has researched her subject and shares her experiences with legal and medical professionals and her vast knowledge of Alzheimer's scrambled with loving and loss. Her writing though painful to read and ponder, confronts our mortality in a society that encourages us to ignore it rather than facing its reality.
Gini Cunningham facilitates an Alzheimer's support group in Winnemucca. Contact her at gini. cunningham@sbcglobal.net
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