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Generations: Get help for talk with parents on end-of-life wishes

Q My mother doesn’t like to discuss anything about end-of-life issues; she and I have started to talk about what her services should be like, and she periodically drops some ideas, but how can I more fully engage her in this important conversation?

A: You are addressing one of the complex subjects for discussion between you and your parent. Trained caregivers and elder law specialists say there is no one way to approach the conversation but a frank willingness to start is a very good sign for what may become a series of conversations that unfold in discussing end-of-life preparations.

At some point for everyone, it will be time to discuss the end of life. The reluctance of many to engage in this conversation is understandable because most do not like to think of their own mortality. But as the population ages and technologies appear that provide the opportunity for continued life, however one defines it, these discussions become more and more important.

There are many good local resources available in Tucson and also a lot of reputable materials online that you can consider to prepare yourself and learn about the basic tenets of advance directives.

You may choose to contact Pima Council on Aging by calling our Central Intake at 790-7262 to speak with a specialist or to schedule a phone or face-to-face confidential meeting. You can also read up about advance directives online to learn more about PCOA and allied community resources available to you and your parent.

Physicians have a prominent role to play in discussing end-of-life issues with patients. Because they are so intimately involved in the decisions that patients must make, physicians must be knowledgeable about such patient options as surrogate decision makers – also known as a durable power of attorney for health care – and advance directives.

According to the American Medical Association, physicians should encourage patients to document their treatment preferences or appoint a health care proxy in the event that a health decision must be made when the patient is unable to make it.

In the United States, death is increasingly the province of old age, and 73 percent of deaths occur among people age 65 or older. Although most would prefer to die at home after a short illness, most actually die in institutions after prolonged declines. Despite this discrepancy, elders and their adult children often do not discuss end-of-life preferences. Use of advance directives has not been widespread, and people often avoid the subject until a crisis. National and local experts say end-of-life care in the U.S. is mediocre at best and therefore is an emerging health concern.

That is one perspective on why Pima Council on Aging caregiver specialists, a team of compassionate, highly trained and experienced social workers, specializes in aging issues affecting families and individuals, including how to improve communications about end-of-life issues.

The experts who work at PCOA in the office of Elder Rights and Benefits Assistance can also help you and your parent navigate how to improve the conversations and understand the use of advance directives and the preparation of documents.

Knowing the obstacles to and aids for discussion between adult children and their parents can help everyone and also assist public health professionals to develop more personalized approaches for encouraging elders and their families to discuss preparation and preferences before a crisis.

People can increase the likelihood that end-of-life care will meet their wishes by communicating those wishes to others. Advance directives (i.e. a living will and a health care power of attorney) have been advocated since at least 1990 when Congress passed the Patient Self-Determination Act, but they still are not widely used because little is known about the process.

Experts agree that there are many important benefits of advance planning. They encourage you and your parents to take the opportunity to talk about health care planning, and how, why and when to make end-of-life decisions.

Today’s information is provided by Adina Wingate,PCOA’s public relations director. Visit online at www.pcoa.org

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