Abstract
Older people living with serious illness and multiple old-age related co-morbidities are regarded as a group in a highly vulnerable position when it comes to decision making at the end of life. They are largely unempowered and prone to medical paternalism and ageism. Their low functional status can lead to therapeutic pessimism.
Highlights
Though the authors did not address end-of-life care for the oldest old in Switzerland, they did find that old age seems to be a determining factor for the prevalence of some types of end-of-life decisions, regardless of cause of death, place of death, sex or marital status
The older person him/herself needs to have a say in the matter, if not at the moment of decision making, at least beforehand via, for example, advance care planning conversations. This is the best way to avoid ageist reasoning in end-of-life decisions for the oldest old, that is, attitudes that, all other things being equal, life in very old age is no longer as meaningful as it is in younger patients [3, 6]
The age-old balancing act for physicians between therapeutic tenacity on the one hand, and therapeutic nihilism and ageism on the other hand is intensified in end-of-life decision making for the oldest old
Summary
Swiss Medical Weekly boasts a highly interesting and time-relevant contribution of Hug and colleagues, titled “Medical end-of-life decisions in the oldest old in Switzerland” which examines the differences between the oldest old and younger patients in terms of the frequency of various end-of-life decisions such as intensified alleviation of pain and other symptoms and, most notably, withholding and withdrawing life-sustaining treatments [1]. Older people living with serious illness and multiple oldage related co-morbidities are regarded as a group in a highly vulnerable position when it comes to their medical care and decision making at the end of life.
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