Making lives meaningful in old age

“The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul… Making lives meaningful in old age … requires more imagination and invention than making them merely safe does.”

Atul Gawande

“In 1991, in the tiny town of New Berlin, in upstate New York, a young physician named Bill Thomas performed and experiment. He didn’t really know what he was doing. He was thirty-one years old, less than two years out of family medicine residency, and he had just taken a new job as medical director of Case Memorial Nursing Home, a facility with eighty severely disabled elderly residents. About half of them were physically disabled; four out of five had Alzheimer’s disease or other forms of cognitive disability….

The staff at Chase saw nothing especially problematic about the place, but Thomas with his newcomer’s eyes saw despair in every room. The nursing home depressed him. He wanted to fix it. At first, her tried to fix it the way that, as a doctor, he knew best…. He set about doing physical examinations of the residents and ordering scans and tests and changing heir medications. But, after several weeks of investigations and alterations, he’d accomplished little except driving the medical bills up and making the nursing staff crazy…. “I was confusing care with treatment,” he told me. He didn’t give up, though. He came to think the missing ingredient in this nursing home was life itself, and he decided to try an experiment to inject some…

They ordered the hundred parakeets for delivery all on the same day…. When the delivery truck arrived, the birdcages hadn’t. The driver therefore released them into the beauty salon on the ground floor, shut the door, and left. The cages arrived later that day, but in flat boxes, unassembled. It was “total pandemonium,” Thomas said. The memory of it still puts a grin on his face… He, his wife, Jude, the nursing director, Greising, and a handful of others spent hours assembling the cages, chasing the parakeets through a cloud of feathers around the salon and delivering birds to every resident’s room. The elders gathered outside the salon windows to watch. “They laughed their butts off,” Thomas said…. They were so patently incompetent that most everyone dropped their guard and simply pitched in – the residents included…

“People who we had believed weren’t able to speak started speaking,” Thomas said. “People who had been completely withdrawn started coming to the nurses’ station and saying, ”I’ll take the dog for a walk.” All the parakeets were adopted and named by the residents. The lights turned back on in people’s eyes. IN a book he wrote about the experience, Thomas quoted from journals that the staff kept, and they described how irreplaceable the animals had become in the daily lives of residents, even ones with advanced dementia:

Gus really enjoys his birds. He listens to their singing and asks if they can have some of his coffee.

The residents are really making my job easier; many of them give me a daily report on their birds (e.g., “sings all day,” “doesn’t eat,” “seems perkier”)…

The inhabitants of Chase Memorial Nursing Home now included one hundred parakeets, four dogs, two cats, plus a colony of rabbits and a flock of laying hens. There were also hundreds of indoor plants and a thriving vegetable and flower garden. The home had on-site childcare for the staff and a new after-school program.

Researchers studied the effects of this program over two years, comparing a variety of measures for Chase’s residents with those of residents at another nursing home nearby. Their study found that the number of prescriptions required per resident fell to half of that control nursing home. Psychotropic drugs for agitation, like Haldol, decreased in particular. The total drug costs fell to just 38 percent of the comparison facility. Deaths fell 15 percent….

The most important finding was that it is possible to provide them with reasons to live, period. Even residents with dementia so severe that they had lost the ability to grasp much of what was going on could experience a life with grater meaning and pleasure and satisfaction. It is much harder to measure how much more worth people find in being alive than how many fewer drugs they depend on or how much longer they can live. But could anything matter more?”

From ‘Being Mortal’ by Atul Gawande

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