Managing Your Mortality
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When Planning Is a Matter of Life and Death
Barring medical marvels as yet unrevealed, we are all going to die. We try to keep ourselves and our loved ones in good health, but it’s important to be prepared for the eventuality of death.
While this is not a cheerful topic, considering these things in advance can help us manage a very difficult thing, when the time comes.
We’ve put this under “Psychology Sunday” as it pertains to processing our own mortality, and managing our own experiences and the subsequent grief that our death may invoke in our loved ones.
We’ll also be looking at some of the medical considerations around end-of-life care, though.
Organizational considerations
It’s generally considered good to make preparations in advance. Write (or update) a Will, tie up any loose ends, decide on funerary preferences, perhaps even make arrangements with pre-funding. Life insurance, something difficult to get at a good rate towards the likely end of one’s life, is better sorted out sooner rather than later, too.
Beyond bureaucracy
What’s important to you, to have done before you die? It could be a bucket list, or it could just be to finish writing that book. It could be to heal a family rift, or to tell someone how you feel.
It could be more general, less concrete: perhaps to spend more time with your family, or to engage more with a spiritual practice that’s important to you.
Perhaps you want to do what you can to offset the grief of those you’ll leave behind; to make sure there are happy memories, or to make any requests of how they might remember you.
Lest this latter seem selfish: after a loved one dies, those who are left behind are often given to wonder: what would they have wanted? If you tell them now, they’ll know, and can be comforted and reassured by that.
This could range from “bright colors at my funeral, please” to “you have my blessing to remarry if you want to” to “I will now tell you the secret recipe for my famous bouillabaisse, for you to pass down in turn”.
End-of-life care
Increasingly few people die at home.
- Sometimes it will be a matter of fighting tooth-and-nail to beat a said-to-be-terminal illness, and thus expiring in hospital after a long battle.
- Sometimes it will be a matter of gradually winding down in a nursing home, receiving medical support to the end.
- Sometimes, on the other hand, people will prefer to return home, and do so.
Whatever your preferences, planning for them in advance is sensible—especially as money may be a factor later.
Not to go too much back to bureaucracy, but you might also want to consider a Living Will, to be enacted in the case that cognitive decline means you cannot advocate for yourself later.
Laws vary from place to place, so you’ll want to discuss this with a lawyer, but to give an idea of the kinds of things to consider:
National Institute on Aging: Preparing A Living Will
Palliative care
Palliative care is a subcategory of end-of-life care, and is what occurs when no further attempts are made to extend life, and instead, the only remaining goal is to reduce suffering.
In the case of some diseases including cancer, this may mean coming off treatments that have unpleasant side-effects, and retaining—or commencing—pain-relief treatments that may, as a side-effect, shorten life.
Euthanasia
Legality of euthanasia varies from place to place, and in some times and places, palliative care itself has been considered a form of “passive euthanasia”, that is to say, not taking an active step to end life, but abstaining from a treatment that prolongs it.
Clearer forms of passive euthanasia include stopping taking a medication without which one categorically will die, or turning off a life support machine.
Active euthanasia, taking a positive action to end life, is legal in some places and the means varies, but an overdose of barbiturates is an example; one goes to sleep and does not wake up.
It’s not the only method, though; options include benzodiazepines, and opioids, amongst others:
Efficacy and safety of drugs used for assisted dying
Unspoken euthanasia
An important thing to be aware of (whatever your views on euthanasia) is the principle of double-effect… And how it comes to play in palliative care more often than most people think.
Say a person is dying of cancer. They opt for palliative care; they desist in any further cancer treatments, and take medication for the pain. Morphine is common. Morphine also shortens life.
It’s common for such a patient to have a degree of control over their own medication, however, after a certain point, they will no longer be in sufficient condition to do so.
After this point, it is very common for caregivers (be they medical professionals or family members) to give more morphine—for the purpose of reducing suffering, of course, not to kill them.
In practical terms, this often means that the patient will die quite promptly afterwards. This is one of the reasons why, after sometimes a long-drawn-out period of “this person is dying”, healthcare workers can be very accurate about “it’s going to be in the next couple of days”.
The take-away from this section is: if you would like for this to not happen to you or your loved one, you need to be aware of this practice in advance, because while it’s not the kind of thing that tends to make its way into written hospital/hospice policies, it is very widespread and normalized in the industry on a human level.
Further reading: Goods, causes and intentions: problems with applying the doctrine of double effect to palliative sedation
One last thing…
Planning around our own mortality is never a task that seems pressing, until it’s too late. We recommend doing it anyway, without putting it off, because we can never know what’s around the corner.
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The Mental Health Dangers Of Oversharing
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Oversharers can be fun and amiable; the life of the party. In and of itself, this something that can be considered “pro-social” and thus healthy.
But the problem for one’s mental health in the long-run lies in the “over” part of oversharing. Sometimes, if not checking in with the other person’s comfort, oversharing can be “trauma-dumping”, and push people away. Alternatively, if the oversharing exposes an unmet need, it can make the other person feel obliged to try to help in some fashion, which in the long run may also cause awkwardness and withdrawal.
Some potential problems are purely internal, such the feelings of shame or anxiety that can come afterwards; “I should not have been so vulnerable”, “What if my friends think badly of me now?”, etc.
And of course, sometimes those fears are then validated by reality, if “friends” indeed take advantage of that, or withdraw their friendship. That’s a minority occurrence, but it doesn’t make it any less of a crushing thing if it happens.
Sometimes people overshare because of being a bad judge of what’s a socially-approved appropriate amount of sharing; sometimes people overshare out of a need for closeness, and perhaps the hope of hearing what one needed to hear previously.
The dangers of oversharing don’t mean that we should never speak about our experiences and feelings; in fact sometimes, it is the most healthy thing to do—be it because it’s something that needs communicating to a specific person, or because it’s something we just need to “get off our chest”.
In short, it can be good to share! It can also be good to do so judiciously, by conscious decision and not in response to a spur-of-the-moment impulse, and remember to prioritize our own safety.
Below, Alain de Botton explains more of the psychodynamics of this:
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10almonds tip, not included in the video: unsure whether your urge to share is too impulsive or not? Write a letter/email, and wait until the next day to decide whether or not to send it.
Want to read more?
Check out:
Breathe; Don’t Vent (At Least In The Moment)
Take care!
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Walking can prevent low back pain, a new study shows
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Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly 70% of people who recover from an episode of low back pain will experience a new episode in the following year.
The recurrent nature of low back pain is a major contributor to the enormous burden low back pain places on individuals and the health-care system.
In our new study, published today in The Lancet, we found that a program combining walking and education can effectively reduce the recurrence of low back pain.
PeopleImages.com – Yuri A/Shutterstock The WalkBack trial
We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control).
Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences.
The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls.
Low back pain can be debilitating. Karolina Kaboompics/Pexels The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program.
Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred.
People in the control group received no preventative treatment or education. This reflects what typically occurs after people recover from an episode of low back pain and are discharged from care.
What the results showed
We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services.
The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%.
Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group.
In our study, regular walking appeared to help with low back pain. PeopleImages.com – Yuri A/Shutterstock Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group.
This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings.
Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians.
Walking has multiple benefits
We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all previous studies have focused on treating episodes of pain, not preventing future back pain.
A limited number of small studies have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals.
On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care.
Walking has a variety of advantages. Cast Of Thousands/Shutterstock Walking also delivers many other health benefits, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases.
While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants reported that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently.
Why is walking helpful for low back pain?
We don’t know exactly why walking is effective for preventing back pain, but possible reasons could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which block pain signals between your body and brain – essentially turning down the dial on pain.
It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, no studies have investigated this.
Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.
Tash Pocovi, Postdoctoral research fellow, Department of Health Sciences, Macquarie University; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Mark Hancock, Professor of Physiotherapy, Macquarie University; Petra Graham, Associate Professor, School of Mathematical and Physical Sciences, Macquarie University, and Simon French, Professor of Musculoskeletal Disorders, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Loving Life at 50+ – by Maria Sabando
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What a pleasant mix of a book! Sabando writes about aging with a great blend of light-heartedness and seriousness, and gives extra attention to the important balancing act of:
- Indulging sufficiently to enjoy life
- Staying well enough to enjoy life
…because one without the other will not generally result in an enjoyable life! An American proud of her Italian heritage, she blends (as many immigrant families do) cultures and perspectives, aiming where she can for “the best of both” in that regard, too.
Nor is this just a philosophical book—there’s yoga to be learned here, chapter by chapter, and recipes peppered throughout. The recipes, by the way, are simple and… Honestly, not as healthy as the recipes we share here at 10almonds, but they are good and when it comes to those indulgences we mentioned, her philosophy is that strategic mindful indulgence keeps mindless binge-eating at bay. Which is generally speaking not a bad approach, and is one we’ve written about before as well.
When it comes to health advice, the author is no doctor or scientist, but her husband (a doctor) had input throughout, keeping things on track and medically sound.
The style is very casual, like talking to a friend, which makes for a very easy and enjoyable read. Absolutely a book that one could read casually in the garden, put down when interrupted, pick up again, and continue happily where one left off.
Bottom line: whatever your age (no matter whether your 50th birthday is in your shrinkingly near future or your increasingly distant past), there’s wisdom to be gained here—it’s not a manual (unless you want to treat it as one), it’s more… Thought-provoking, from cover to cover. Highly recommendable.
Click here to check out Loving Life at 50+, and love life at 50+!
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The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
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There’s a lot more to breast cancer care than “check your breasts regularly”. Because… And then what? “Go see a doctor” obviously, but it’s a scary prospect with a lot of unknowns.
Dr. Simmons demystifies these unknowns, from both her position as an oncologist (and breast surgeon) and also her position as a breast cancer survivor herself.
What she found, upon getting to experience the patient side of things, was that the system is broken in ways she’d never considered before as a doctor.
This book is the product of the things she’s learned both within her field, and elsewhere because of realizing the former’s areas of shortcoming.
She gives a step-by-step guide, from diagnosis onwards, advising taking as much as possible into one’s own hands—especially in the categories of information and action. She also explains the things that make the biggest difference to cancer outcomes when it comes to eating, sleeping, and so forth, the best attitude to have to be neither despairing and giving up, nor overconfident and complacent.
She does also talk complementary therapies, be they supplements or more out-of-the-box approaches and the evidence for them where applicable, as well as doing some high-quality mythbusting about more prescription-based considerations such as HRT.
Bottom line: if you or a loved one have a breast cancer diagnosis, or you just prefer knowing this sort of thing than not, then this book is a top-tier “insider’s guide”.
Click here to check out the Smart Woman’s Guide To Breast Cancer, and take control!
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Health & Happiness From Outside & In
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A friend in need…
In a recent large (n=3,486) poll across the US:
- 90% of people aged 50 and older say they have at least one close friend
- 75% say they have enough close friends
- 70% of those with a close friend say they can definitely count on them to provide health-related support
However, those numbers shrink by half when it comes to people whose physical and/or mental health is not so great, resulting in a negative feedback loop of fewer close friends whom one sees less often, and progressively worse physical and/or mental health. In other words, the healthier you are, the more likely you are to have a friend who’ll support you in your health:
Read in full: Friendships promote healthier living in older adults, says new survey
Related: How To Beat Loneliness & Isolation
Kindness makes a difference to healthcare outcomes
Defining kindness as action-oriented, positively focused, and purposeful in nature, this sets kindness apart from compassion and empathy, when it’s otherwise often been conflated with those, and thus overlooked. This also means that kindness can still be effected when clinicians are too burned-out to be compassionate, and/or when patients are not in a state of mind where empathy is useful.
Furthermore, unkindness (again, as defined by this review) was found in large studies to be the root cause of ¾ of patient harm events in hospital settings. This means that far from being a wishy-washy abstraction, kindness/unkindness can be a very serious factor when it comes to healthcare outcomes:
Read in full: Review suggests kindness could make for better health care
Related: The Human Touch vs AI, The Doctor That Never Tires
The gift of health?
🎵 Last Christmas, I gave you my heart
Which turned out to be a silly idea
This year, to save me from tears
I’ll just get you a Fitbit or something🎵Health & happiness go hand in hand, so does that make health stuff a good gift? It can do! But there are also plenty of opportunities for misfires.
For example, getting someone a gym membership when they don’t have time for that may not help them at all, and sports equipment that they’ll use once and then leave to gather dust might not be great either. In contrast, the American Heart Association recommends to first consider what they enjoy doing, and work with that, and ideally make it something versatile and/or portable. Wearable gadgets are a fine option for many, but a gift doesn’t have to be fancy to be good—with a blood pressure monitoring cuff being a suggestion from Dr. Sperling (a professor of preventative cardiology):
Read in full: Oh, there’s no gift like health for the holidays
Related: Here’s Where Activity Trackers Help (And Also Where They Don’t)
How you use social media matters more than how much
A study commissioned by the European Commission’s Joint Research Centre found that while the quantity of time one spends on social media is not associated (positively or negatively) with loneliness, they did find a correlation between passive (as opposed to engaged) use of social media, and loneliness. In other words, people who were chatting with friends less, were more lonely! Shocking news.
While the findings may seem obvious, it does present a call-to-action for anyone who is feeling lonely: to use social media not just to see what everyone else is up to, but also, to reach out to people.
Read in full: Unpacking the link between social media and loneliness
Related: Make Social Media Work For Your Mental Health Rather Than Against It
Gut-only antidepressants
Many antidepressants work by increasing serotonin levels in the brain; a new study suggests that targeting antidepressants to work only in the gut (which is where serotonin is made, not the brain) could not only be an effective treatment for mood disorders, but also cause fewer adverse side-effects:
Read in full: Antidepressants may act in gut to reduce depression and anxiety
Related: Antidepressants: Personalization Is Key!
Take care!
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Felt Time – by Dr. Marc Wittmann
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This book goes far beyond the obvious “time flies when you’re having fun / passes slowly when bored”, or “time seems quicker as we get older”. It does address those topics too, but even in doing so, unravels deeper intricacies within.
The author, a research psychologist, includes plenty of reference to actual hard science here, and even beyond subjective self-reports. For example, you know how time seems to slow down upon immediate apparent threat of violent death (e.g. while crashing, while falling, or other more “violent human” options)? We learn of an experiment conducted in an amusement park, where during a fear-inducing (but actually safe) plummet, subjective time slows down yes, but measures of objective perception and cognition remained the same. So much for adrenal superpowers when it comes to the brain!
We also learn about what we can change, to change our perception of time—in either direction, which is a neat collection of tricks to know.
The style is on the dryer end of pop-sci; we suspect that being translated from German didn’t help its levity. That said, it’s not scientifically dense either (i.e. not a lot of jargon), though it does have many references (which we like to see).
Bottom line: if you’ve ever wished time could go more quickly or more slowly, this book can help with that.
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