It’s called “intubation,” and the term has become much more familiar in the roughly 90 days since the coronavirus became headline news. Now, according to this recent Kaiser Health News report, many seniors fearful of the procedure and its negative side effects are rewriting their living wills to include the words, “No Intubation.”
“No Intubation” Means Seniors Saying No to a Frightening Procedure
Judith Graham wrote the Kaiser article in which she profiles several seniors who have made their wishes about intubation much more explicit since the COVID-19 pandemic began. When a patient is intubated, they have a tube inserted down their windpipe and are hooked to a ventilator. “Used for people with respiratory failure, a signature consequence of severe COVID-19, these machines pump oxygen into a patient’s body while he or she lies in bed, typically sedated,” says Graham.
Intubation may be frightening, but the choice of whether or not to accept intubation is not a simple one. “For some seniors,” says the article, “this is their greatest fear: being hooked to a machine, helpless, with the end of life looming. For others, there is hope that the machine might pull them back from the brink, giving them another shot at life.” Graham calls ventilators “a fraught symbol, representing a terrifying lack of personal control as well as the fearsome power of technology.
“No Intubation” – but Is the Procedure Effective?
The real question, Graham says, is whether intubation treatment actually saves lives. On that, says one California anesthesiologist, “the data is really scanty,” with one New York study showing a survival rate among intubated patients of less than 12 percent. But many doctors doubt that real life results are that poor. Dr. Carolyn Calfee of the University of California – San Francisco, told Kaiser, “I would be very worried if people used that data to make decisions about whether they wanted mechanical ventilation.”
Nevertheless, the prognosis for a senior undergoing intubation is not particularly good, Graham writes. “A sobering reality emerges from studies published to date: Older adults, especially those with underlying medical conditions such as heart, kidney or lung disease, are least likely to survive critical illness caused by the coronavirus or treatment with a ventilator.” A big part of the problem with COVID-19 patients is the length of time they often have to spend hooked up to artificial breathing machines.
Intubation for COVID Cases Lasts Far Longer Than Usual, and Recovery is Uncertain
Dr. Douglas White, a professor of critical care medicine at the University of Pittsburgh, told Kaiser that “older COVID patients are spending considerably longer on ventilators ― two weeks or more — than is the case with other critical illnesses. If they survive, they’re likely to be extremely weak, deconditioned, suffering from delirium and in need of months of ongoing care and physical rehabilitation.” Another doctor said these patients face “a very long, uphill battle to recovery,” with many older patients never regaining full functioning.
The issue of a long and uncertain recovery has convinced many seniors that intubation is not for them, in part because they have no obvious caregivers to help them. This fear caused one Minnesota 61-year-old woman to reject intubation. She is unmarried and lives on her own. “I have to think about what the quality of my life is going to be,” she told Kaiser Health News. “Could I live independently and take care of myself — the things I value the most? There’s no spouse to take care of me or adult children. Who would step into the breach and look after me while I’m in recovery?”
Intubation Is Just One of Many Important Issues for Families to Discuss
Judith Graham calls the questions about so-called heroic measures “more important than ever” these days. One benefit of the coronavirus pandemic may be that people are more willing to talk about their care preferences. “People are thinking about what could happen to them and they want to talk about it,” Dr. Rebecca Sudore of the University of California – San Francisco told Graham. The issue is not about intubation per se but about quality of life.
“Some people may say my life is always worth living no matter what type of serious illness or disability I have,” Dr. Sudore said. “On the other end of the spectrum, some people may feel there are health situations or experiences that would be so hard that life would not be worth living.” Sudore helped create a helpful website called Prepare for Your Care with tools to guide patients and family through tough but essential conversations before hospitalization. The website now has a section specifically related to treatment for COVID-19.
Intubation Isn’t the Question, Says Rajiv Nagaich – It’s Really About Planning
In responding to this Kaiser Health News story, Rajiv Nagaich of AgingOptions reminds all of us to focus on the most important questions. “This story does remind us of why it is important to have up-to-date legal documents,” Rajiv concedes. “But what all these recent stories tend to miss is that, in the end, what you write will be less important than how effective the people who are your agents will be in advocating for you. There is this blind assumption that the document itself is the silver bullet that ensures your wishes will be respected. Not necessarily true!”
The fact is, says Rajiv, that there’s no one-size-fits-all approach to one’s care directives. “Living wills are taken into account only after all reasonable attempts have been made to save your life,” he cautions. “If you get rolled into the emergency room not breathing, I’m convinced that the law would require the medical team to use whatever measures they saw fit, including putting you on a ventilator, to try and get you stabilized.” In other words, adds Rajiv, “Just writing ‘No Intubation’ may not mean what you think it means.”
As with everything else in retirement, planning ahead is the essential element. “Get your plan in place,” Rajiv emphasizes, “and then turn your plan into a family affair. The better informed and prepared your loved ones are to advocate for you, the better your outcome is likely to be.”
Two Important Retirement-Planning Announcements from AgingOptions
At AgingOptions our chief desire is to help you prepare for the kind of retirement you’ve always dreamed of having. Toward that end, we want to share two important announcements that are designed to facilitate your LifePlanning process even during this period when most of us are required to avoid gathering in groups.
First, Rajiv Nagaich has scheduled several of his popular, free LifePlanning Seminars in the form of webinars that you can watch conveniently at home. Simply visit our Events Page and register for the webinar of your choice.
Our second announcement: in cooperation with our partners at LifePoint Law, we are excited to launch a ground-breaking new service called the LifePoint Law Emergency Legal Kit. Without leaving your home, you can now consult with a LifePoint Law attorney who will work with you to prepare and sign a complete set of vitally important legal documents including both Financial and Healthcare Powers of Attorney, a Living Will/Advance Directive, a Will or Trust, and much more. Click on the link or call us at AgingOptions and we’ll explain this excellent service to you.
Reliable information has never been more important – and that’s our promise to you at AgingOptions and LifePoint Law. Age on!
(originally reported at www.khn.org)