Guide looks at dying well

A new Canadian guide called End of Life Care for Seniors is a fascinating compendium of both practical and soulful information. For instance:

• The chapter called Maintaining Comfort is crammed with specific information about care and medical doses for the seriously ill.
  
• Another chapter, Aboriginal Issues, carries a detailled and poetic explanation about the seasons in nature lining up with the circle of life in the Medicine Wheel. 

The rest of the 200-page guide is crammed with information on a wide range of issues concerning living and dying well in later years. There’s a good balance of both scientific medical information with cultural, ethical and spiritual discussions.

“There’s never been any kind of guide to end of life care for seniors. There have been some guides for people with HIV and AIDS. And there are lots of good palliative care guides for younger people with cancer. But there’s never been a real end of life care guide for seniors,” according to Michael MacLean, the project director. He’s the Dean of Social Work at the University of Regina and director of the consulting company, Age Wise.

Posive approach
“Most older people don’t worry too much about the concept of death. They do worry about how they’re going to die-if they’re going to lose a lot of control and if other people are going to make decisions for them. But they’re not at all, in general, worried about the concept of death. So we take the view that end of life is essentially not a problem. We took a positive approach.”

Health Canada funded the guide with a $300,000 grant. About 18 expert authors prepared the various chapters. The main editors and co-chairs for the project were Margaret Ross in the School of Nursing at the University of Ottawa and Dr. Rory Fisher, from the Faculty of Medicine at the University of Toronto. 

“I think the health care professions have always focused on more of the curative aspects of health care. And the management of the dying has never been as prominent as it needs to be in health care delivery. We’ve seen advances in both palliative and geriatric care-and it’s time to bring them together to focus on the broader issues of management of dying patients, wherever they are, in their own homes, or in long term care facilities, or acute care hospitals. And not just from the health point of view, also from the other aspects of cultural, sociological and religious viewpoints,” says Dr. Fisher. He’s director of the geriatrics division in medicine at University of Toronto.

The 23,000 copies of the guide, (five thousand in French) have already been distributed across the country, mainly to health care professionals. The editors discussed the guide at the annual conference of the Canadian Association on Gerontology in Edmonton, October 26 to 28.

“We succeeded with the health care professionals, for sure. And we wrote the guide at that level, so perhaps we excluded some older people and family members from understanding what we were trying to say. There’s an organization called the Seniors’ Education Centre here at the University of Regina, so I’m linking with them to see if there’s any way we can take this guide and develop it for seniors and for their family members,” says MacLean.

Available online
Some of the medical terminology may not be easily understood by a general audience, says Dr. Fisher, but much of the content is. He says there are no more copies available for distribution, so his department has posted it on his department’s web site.

“Anyone with some patience to download a 200-page document can get it for free,” he says. It’s also possible to download just a portion of the 10-chapter guide. Michael Maclean says he wants the guide to be a reference for anyone interested or involved in end of life issues and care.

“We all know older people who have died a good death and people who have a horrible death and we know which one we would prefer for ourselves and for our loved ones. The guide is trying to give information so that when the time comes, we will have a good death. It may not be a cheerful note, but I’d rather have that kind of philosophy than have my head in the sand and think it’s never going to happen. Because it is going to happen,” he says.