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It’s a difficult question, one most people would rather avoid, but will likely find they cannot: How do you ensure that your loved one, when nearing the end of their life, gets the care they need and want?

Surely, Dr. Atul Gawande would know. After all, in addition to being a professor at both Harvard Medical School and the Harvard School of Public Health, a practicing surgeon at Harvard’s second-largest teaching hospital, and heading two public health organizations, he thinks deeply about the human aspects of medicine. That thinking has made him a staff writer for The New Yorker, the author of several best-selling books, and the recipient of a slew of awards, including the prestigious MacArthur fellowship.

If anyone would know what to do when approaching end-of-life decisions, Atul Gawande would.

And yet, he found that he did not. Not when it came to guiding his patients, and not even when it came to caring for his own ailing father.

So he did what most of us cannot: he spent three years researching the issue. The result was a series of articles, culminating in a book called Being Mortal: Medicine and What Matters in the End.

What did he find out? Shockingly, it was that one should simply talk to the patient, honestly and compassionately, about what they want the end of their life to look like. It’s a conversation — or a series of conversations — that happens far less frequently than it should.

Being Mortal is a book every mortal should read, but for the sake of expediency, we will distill Gawande’s into the short list of “a few important questions,” as enumerated in an adaptation of his book, printed in The New York Times as an op-ed entitled “The Best Possible Day”:

1. What is patient’s understanding of their health or condition?

Too often, it is too little. This may be because of cognitive decline, or because the family simply does not have the heart to tell the full truth to their loved one.

2. What are their goals if their health worsens?

Who could be blamed for trying to avoid this question? But if the patient is not cognitively impaired, it must be asked. Sometimes, the patient has already written an Advance Directive, colloquially known as a Living Will, stating what measures they want taken in a situation in which they are not able to speak for themselves.

But end-of-life decisions are vexing and complex. Simple wishes, stated long before they will ever be implemented, may not be relevant in the patient’s current condition.

3. What are their fears?

Another question that is hard to ask — and often hard to hear the answer to.

4. What are the trade-offs they are willing — and not willing — to make?

If the patient is of sound mind, the answers to this and all the other questions must be honored.

The questions are hard to ask, but by asking them, Gawande says, the family can “often unlock transformative possibilities.” Dr. Gawande also suggests that all these questions be repeated as the patient’s health condition evolves.

Regency Nursing and Rehabilitation Centers prides itself on ensuring its residents have everything they need to design the life they want. We offer the very best of care in the most appropriate and patient-centered environment. This means always listening to our residents and patients and respecting their capabilities, while helping them to achieve maximum functionality and independence. And always maintaining the highest professional and quality standards in our staff and our facilities. Our 25 years of excellent care have led to us being awarded a Best Nursing Homes award by US News & World Today, a 5-Star rating by USA Today, and an A+ rating by the Better Business Bureau, among many other awards.

Contact us by clicking here to see which of our three facilities will best meet your needs or the needs of your loved one.

Cancer, the second leading cause of death in the US, disproportionately affects the senior population. More than 60% of people with cancer are seniors, and seniors have the highest mortality rate from cancer of any age group. Seniors with cancer have different treatment issues than younger people, yet their special needs are often ignored when researching — and implementing — cancer treatment.

The following 4 issues affect the safety and effectiveness of cancer care in older people:

1. Seniors are under-represented in clinical trials of cancer therapies.

Because of this, their response to new therapies goes unnoted. For example, many of the newer targeted treatments for cancer have side effects that disproportionately affect the senior population, yet remain unmeasured by clinical trials. Cardiotoxicity, in which the heart becomes weak and inefficient, is a treatment side effect that can be far more serious in an older person. However, while there is data to support the safety of a treatment with a side effect of cardiotoxicity in younger people, underrepresentation of seniors in clinical trials means that the safety of these treatments is unknown in older people, particularly those over 75.

2. The senior population tends to have other conditions in addition to their cancer.

According to the AARP, 91% of seniors have at least one chronic health condition, and 73% have at least two. These issues may include such chronic health conditions as hypertension and diabetes, and disabilities, whether physical, or cognitive. These conditions represent variables that are not generally accounted for when testing cancer therapies. Disabilities, in particular, can worsen with cancer treatment, and have been shown to lead to earlier mortality.

3. Seniors often have less ability to keep up with their care regimens.

Older people, particularly those who are frail and living at home, often have difficulty managing their medications, coordinating their care among a variety of healthcare providers — and even getting to their medical appointments.

4. Caregivers are under high levels of stress.

Added to these issues is the fact that most seniors with cancer are being cared for either by their children, who are also working, or by their spouses, who are also older and likely have their own medical issues. According to the National Institute of Health’s National Cancer Institute, the distress experienced by these caregivers is often found to be greater than the distress reported by the person with cancer.

At the Regency Nursing and Rehabilitation Centers, we specialize in geriatric care, and are best able to care for the unique needs of seniors with cancer, removing the burden of care from their loved ones.

We offer the very best of care in the most appropriate and patient-centered environment. This means always listening to our residents and patients and respecting their capabilities, while helping them to achieve maximum functionality and independence. And always maintaining the highest professional and quality standards in our staff and our facilities. Our 25 years of excellent care have led to us being awarded a Best Nursing Homes award by US News & World Today, a 5-Star rating by USA Today, and an A+ rating by the Better Business Bureau, among many other awards.

Contact us by clicking here to see which of our three facilities will best meet your needs or the needs of your loved one.

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