2008年8月26日

How Many of You Expect to Die?


Not long ago Dr. Joanne Lynn, a geriatrician who pulls no punches in her frequent critiques of America’s sorry system of end-of-life care, looked out from the dais of a Washington, D.C., ballroom at a sea of middle-aged faces: health policymakers, legislative staff, advocates for the aged and for family caregivers — an audience of experts.(Joanne Lynn/Rand Corp.)“How many of you expect to die?” she asked.
The audience fell silent, laughed nervously and only then, looking one to the other, slowly raised their hands.“Would you prefer to be old when it happens?” she then asked.This time the response was swift and sure, given the alternative.Then Dr. Lynn, who describes herself as an “old person in training,” offered three options to the room. Who would choose cancer as the way to go? Just a few. Chronic heart failure, or emphysema? A few more.“So all the rest of you are up for frailty and dementia?” Dr. Lynn asked.On the screen above the dais, she showed graphs describing the three most common ways that old people die and the trajectory and duration of each scenario. Cancer deaths, which peak at age 65, usually come after many years of good health followed by a few weeks or months of steep decline, according to Dr. Lynn’s data. The 20 percent of Americans who die this way need excellent medical care during the long period of high functioning, she said, and then hospice support for both patient and family during the sprint to death.

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