[Music] tonight on front line Americans 85 and older are now the fastest growing segment of the population I remember being repulsed by wrinkles and gray hair and now they're just a part of life medical advances have enabled us to live longer but not always better another bypass surgery another transplant nobody's bothered to think about what the repercussions are of trying to keep people alive longer and longer with such a limited ability to function it's an economic as well as a human Demand on strap middle-aged and middle class families they're still caring for their children when they're also caring for Mom and Dad but this is really a story about confronting the inevitable I keep trying to fix things and even though my head says I can't your heart your heart wants to fix everything and coming face to face with our own hopes and fears about living old I like life I like it but that is not to me it's not enough I'm Estelle strongen I was born on May 30th 1911. which of my arithmetic still serves me makes me 94 and a half all right so who else has it who else has it I'm what was once called a stockbroker by 500 each today we have the rather elegant title of financial advisor all right by 500 holx for a2836 and I still even though I'm 94 I still have Ambitions and one of them is to do the job well I know we're chasing it but they missed it so we're gonna chase it I was never one of the people to be horrified as the decades passed except I have to admit that 90 was a little intimidating I thought 90 meant thee and and I'm a little surprised that it hasn't I'm 99 years old I'll be 100 in two and a half months how's that feel to almost be 100 . no never never did I think I'd live so long I couldn't even think about ever living so long I I you know a little frightened I don't know I don't know anybody who was handed is there a change is there change yet we're on the threshold of the first ever Mass geriatric society and it is in many respects really a wonderful time to be old because people are not only living longer but they're living healthier into their 70s 80s in some cases even into their 90s that's the good news the bad news is the price that many people are going to be paying for this extra decade of healthy longevity is up to another decade of anything but healthy longevity in fact more and more people are living long enough to suffer from the as yet incurable diseases of body and mind [Music] thank you I think the biggest issue facing the population of patients is loss of function you begin to learn that not everyone has cancer not everyone has Alzheimer's or Parkinson's but almost everyone loses function [Music] and by function I mean it could be something as simple as slowly worsening vision or really bad arthritis in one knee that makes it harder to get around people want to live longer but they want to live longer in the self that they have at that moment and so if there was a way that we could keep you in your 40 year old body until you were 100 and then you drop dead that would be a major medical advance but unfortunately as time goes on these chronic diseases take a toll on the body foreign gradual loss of one's bodily Powers really our preparation for some of these long-term conditions of enfieldment and Frailty I want you to just simply tell the truth it's it no one wishes that for oneself or for one's loved ones the question is it's here if it's not going to go away how can we still make something out of it [Music] okay I'm going around here over the next 30 Years the number of people over the age of 65 will actually double to the point that they're about 20 percent of our population about 70 million people that's Chiller yes ma'am excuse me years ago people died of pneumonia and flu and tuberculosis infectious diseases and we've become much better at treating these sorts of things and now people are dying of their chronic diseases things like high blood pressure hypertension heart failure stroke diabetes these are all things that require management over time now we're dealing with older folks who have multiple chronic illnesses but are still kind of able to maintain their status quo but any little something's going to tip them over you know it's that uh Frailty where anything happens on top of it you you expose all of the underlying disease and disorder that was kind of masked by the other systems that we're compensating for it is our system is set up to treat with procedures and it's not set up to treat chronic diseases and to take time to figure out what's going on where do you want me to go I want you to have a seat right over here oftentimes you can't get to the heart of the problem on until 15 minutes into your conversation and with the way Health Care is today you may only have 15 minutes for your entire visit you have terrible what do you read yes what's happening with the urine I didn't know I make wet okay you can't hold it in no how long has this been going on for for a while like a few months or just a couple weeks a few moments okay does it happen every day yeah yeah let me close um door no I run this see I got if I can't that's okay it's all right take your time it'll come up it'll come up don't worry don't forget to use your cane the number of geriatricians right now that are in a training program for geriatrics and a two-year program the number that are in their second year that started this year is about 50. you know so it's nothing you know it's really nothing so one out of five people are going to be older adults and there's not really anyone trained to care for them [Music] with fewer doctors now available to care for the rising number of elderly many worry we're on the verge of a national crisis in care nobody's bothered to think about what the repercussions are of trying to keep people alive longer and longer another bypass surgery another transplant without anyone worrying about how do you get them Physical Therapy will they ever walk again can they swallow their food you know it's not a very thoughtful way I think of providing Health Care medicine has changed I think appropriately in terms of the technology that's become available and the fact that we can diagnose people and we can treat them and we can cure them in some instances the problem I think is that the pendulum swung too far and so the focus over time became predominantly diagnosed treat cure good morning how are you Dr janowitz even when there's nothing quote unquote medical to do you still need to be there for someone as more and more people are becoming too frail to leave their homes many doctors are once again making house calls good morning early today huh David Mueller one of the founders of Mount sinai's visiting doctors provides Medical Care to a growing number of the city's homebound elderly I was going to write in some notes I can at least say good morning for the past three years Henry genowicz has been wheelchair bound a former physician he is now nearly deaf and has severe arthritis okay yeah how about your knees pain here here no only here each of us whether we're in the baby boomer generation or not as parents and we watch our parents get a little bit older and even if they're relatively healthy and functional you sort of see the Slowdown and you anticipate you try to plan ahead for being able to be around and care for them and at the same time you've got a family of your own and kids and a job and career aspirations and so it's an unavoidable part of life and I haven't figured it out for myself either as far as my parents are concerned I'd like to believe that you know I'll be there and be available for them whatever they need and whenever they need it but I don't know if that's really going to be the case what are their expectations of you do you know have you had those conversations um we've had the beginnings of those conversations probably mostly because of the work that I do I think their expectations are very typical and very traditional none zero you know they don't have any expectations that they'll move in with us that don't have any expectations that we'll have to do anything extra for them they don't want to be a burden they'd like to stay independent Dr janowitz is a widower and his daughters live too far away to be involved in his daily care so he pays 150 000 a year for the 24-hour help that he now needs to stay home care has gone up because we have so many Medical procedures now and interventions that we didn't have before often they're you know really complex things going on that have to be done in the home hi good morning so it's become much more complex it's not just taking blood pressure and filling up medicine box how's she doing today that's good hi Mrs Enoch how you doing I'm just doing okay I'm Lillian the nurse yes I came to check your blood pressure and do your dressing on your leg all right all right okay I just got to lift your leg a little Mrs Enoch okay our goal is to make whatever time the person has left be the best and most comfortable that it can be because a lot of these things have been going on for years and years and years and they're never going to go away and everybody has the fantasy of dying you know by just going to sleep and everything you know not not feeling anything and everything's great you just don't wake up but it doesn't always happen that way sometimes people live a long time with serious serious problems ready okay baby nearly two years ago Ontario payaroso was sent home from the hospital with a tracheostomy and a feeding tube but even with the help of two homemades paid for by Medicaid his daughter Carmen still quit her job to care for him she gives him is really expert care I mean she's she hasn't had medical training but she's learned everything about his care to the nth degree so she knows how to take care of all of the equipment that he has she knows how to feed him she knows how to take care of his skin how to take care of his trachea time for food thank you I think about it I mean it's a one-to-one caregiver patient relationship 24 hours a day seven days a week you can't get that in any institution that he just never would have been taken care of that way okay all right okay baby huh tranquilo [Music] okay some people feel that their kids are their race in the hole they'll take care of them it's not always the case I don't have kids for instance [Music] I really seriously have to think about what's gonna happen to me when I get older and it's not it's it's kind of a scary scary question we all want to postpone it I know I do I don't really want to think about it right now but I'm faced with it every day because I see it in my work [Music] bye America is still a country which believes that the people who should care for the elderly are their members of their own family but that is now an increasingly difficult task for families people are having fewer children families are smaller less stable geographically spread out at the time of caregiving has gone from months before death to years and in some cases up to a decade or more where people simply are living longer in conditions that are deeply needy thank you one study of very very telling study shows that only those people who have three or more daughters or daughters in law have a better than 50 percent chance of not finishing their life in a nursing home or an institution a policeman told us how to go oh and you're smiling the whole world smiles with you when you're laughing What People Like Us need is is I wrote to the Maharaja and I printed it up in the page so they will see it out you don't have to worry I don't have to they don't even know it's me I just didn't give them my name yeah even though I'm a nurse I never imagined that I would be in a nursing home as a patient came in and fractured him the been here seven years now no sense in them crying over spilled milk years take things as they come frightened of what's ahead not afraid I'd I don't want to live forever I I hate to I I don't know I tell you my daughter that's all because he's 72 now but she's she's doing all right [Music] oh my gosh Trio whatever questions nearly 60 percent of those who live past 85 will go into a nursing home and if they stay longer than six months the vast majority will never leave one person I visit on a regular basis in the nursing home calls it you know just the waiting room and and she views it as you know this is where we all come to wait to die in you know some perspective she's right I mean that's uh what happens you know um other folks I've seen people you know who Thrive there you know I've had patients that were at home and then went to a nursing home and they're much better off the socialization you know the participating in groups having all these people around for meals is tremendous and they live off of it and Thrive from it so it's not always you know a downturn for some people when I leave my home because I was lonely when I read 95 96. it was a little hard so I had a friend here so he said come over Clara come over it was all right she was on the seventh floor when I came I I said look you're not alone here they're not afraid they don't know how to be friends but they people they people and I have my I get beautiful magazines I get U.S news world report that for 50 years we have an hour home so I had the magazines I have the newspaper and the people they are people no should we increase the taxes or cutting the government program such as a food Foods stamps food stamps Medicaid [Music] housing housing the hardest time is I miss I miss my fault friends and I miss my home and then I say look you can have everything so I try to be happy I don't know if growing old is easier here in some ways I think it's more difficult it gets a lot harder in some ways to to keep your Independence here um so you're much more dependent on families giving up Independence is the worst it is what everybody fears it's what I fear you have the cane in your left hand and you move your cane forward and your right foot forward and then your left foot and Dr Bill Koch opened his practice in Upstate New York over 30 years ago he's one of the few Family Physicians left in the area and he sees thousands of elderly patients every year it's the doctor so where's mother she's in her inner chair okay yeah we still have lots of three generation households four generation households it's rare that people will give up and want to put somebody in the nursing home but the first sign of trouble most people will go through a long period of trying to take care of them in their own home or in the family home or even extended families Dr Koch how are you I'm happy to come out and see you here oh sorry yeah having a family really drives everything I think it really gives people a reason to be better it's really what what their life is about often at the end of life when their career is gone and um it's what's important to them [Music] try to sing and sing and think so that you won't forget it again do you hear me can't you do it can't you do it what you were gonna say you were gonna say very Christmas Merry Christmas to you Chester and rosemary hake married for 68 years now share a room in a nursing home both in their 90s he has advanced Parkinson's and she's been diagnosed with Alzheimer's all right for you you never do the thing the right thing right and the wrong thing wrong why do you do things like that I don't know because you can't see huh she has changed in the last two and a half years I guess she can't hear me out of these in the conversations who can you imagine not being in the same room with Mrs hake or would you first had Tucson when they brought me in the air why we didn't think any other my bed was here one bed was over here we push them together you know the cold and dancing so we made out all right he's different let's try to stand up okay ready on the count of three one two three three put your hands on the Walker right here where we usually hold right here okay maybe just walk over to the bed the hakes came into the nursing home three years ago so that Mr Hague could recover from a hospitalization but because of his wife's worsening dementia they were never able to leave well then lay down we took that in and Dr Koch sat down and was very kind but very Frank and explained it they would not be able to go back home he'll be coming there I don't think anyone wants their parent or a loved one to have to be in an institution no matter where it is no matter how nice no matter how great the staff is it's still an institution and as a child um I always feel like I can make them just a tad bit more comfortable I know their desires I know their needs they don't have to tell me so I've worried about everything even the Linens the pillows um the heat in the room The View the food um but most of all that I've let them down by having to make the decisions we've made well that isn't perfect how are you gonna make that perfect with my mother it's it's been a slow process but the last few months seemed for whatever reason things have escalated and it's difficult some days when I'm not sure if she doesn't eat because perhaps she's forgotten how to use her utensils or does she not know how to swallow what what do you remember I keep trying to fix things and even though my head says I can't your heart your heart wants to fix everything that's good my Sleeping Beauty [Music] and sings to you will you wake up again you will all right I'm Gonna Get Lucky even with my nursing background and caring for elderly and terminally ill nothing has prepared me for taking on the role of caring for my mother I said all right now okay you want your glasses on hi Norma you waiting for lunch it's a little early to wait for lunch you're just sitting here doing word puzzles oh that's okay I thought there's a band in here [Music] morning [Music] Mr Sandman I'll be a dream you are make him the cutest that I've ever seen give him the work that I'm not a broker the town I'm so alone don't have nobody to call my own good morning Kayla aren't you gonna sing with us Mr Sandman bring me a dream it needs a little louder back here just a little bit when you're young you want to live forever you want to at least live to be old but many people don't want to live forever when they're old in fact that's their fear [Music] I will tell patients that I think you know that it's time to stop Curative treatments whether they go in hospice or not and just focus on on function and comfort [Music] often that's what a person needs is somebody who knows them who has an idea of who they are of what their goals are and all the other things that have impacted on their illness to tell them what to do be that an individual or family and they would give up a certain amount of years at the end to to have a good debt problems I'm going to turn the television off if that's okay um so tell me how things are going not good not good oh I am exhausted all the time I I don't feel really sick it's not true I haven't had any no takeout no we've got quite a cough yeah yeah it's loose yeah but I don't really bring anything up you know he takes the oxycodone twice a day and yesterday I started the morphine uh the coughing after he was diagnosed with lung cancer that was just a few months ago Dr Katz said I don't want to do anything invasive and he said Wayne I don't believe that you would come through a lot of these tests that have to be and Wayne accepted that and I did too I think that uh none of us want to see him suffer much more he's been a very sick man really for the last last year it's been quite bad he had that infection and he wanted to be home so badly and we wanted him home okay Jude do you have any anything you wanted to talk with me about before I check in no you said something about a year uh uh I don't know you know Let It Go a year or not you mean I told you you had a year yeah yeah did we bet on that I'm not gonna bet with you anymore you never pay off yeah I know um well your time is limited and how long it is I I don't know no one knows no but if you could be short yeah well I mean it could be weeks or it could be weeks you know we don't know well well but um well let me check you here are you holding up already yes I get tired but that's I don't know I expect I would [Applause] so there's the morphine it'll be kind of tough on Lois probably you know but [Music] yeah it's it's a [Music] kind of hard to think about it you know all I think about it really two weeks later Wayne Elliott would die as he wanted at home [Music] [Music] you know most people say they want to die at home but most people die in the hospital I mean that's not what happens all right thank you every day you see someone in the hospital you have to ask yourself you know why does this person still have to be in the hospital there's lots of problems with with you know confusion disorientation Falls and affections one thing that we talked about because medicines with IVs with tests with all sorts of things and sometimes you know you order a test because it's easy because it's there but then you kind of opened up Pandora's Box and now you found something you weren't looking for and oh boy now what am I going to do about it well you do another test and then you do another test and you say well in order to figure it out I actually need to go stick a needle in your bone now and take out some stuff and then you're okay well and you start getting into trouble after you know I had that terrible sir originally okay good so you do remember the surgery and I shouldn't have had that you don't think so no why not people don't have cloth surgery I call it cloth surgery what's cloth surgery pulling clothes out of your nose and out of you years and just talk and stuff like that jigsaw and cloth through your body I don't like that do you do you remember what the surgery was for Georgia days was in the early stages of dementia when doctors removed a cancerous tumor but the hospitalization made her dementia worse and now Dr Farber is concerned about her recovery yeah okay so we took it out yeah that was a few weeks ago but now it looks like you know you're having trouble really still eating and putting some weight back on eaten yeah now do you know about the procedure that we want to do tomorrow no okay 19882 tickled a lot being cut on again I know I know that's what I wanted to talk with you about this is is a small incision and they put a tube in from the outside and then we can give you all the medicines all the nutrition the food the vitamins the minerals the water I don't know would you say the name of it it's called a feeding tube feeding right there right about there they don't put a hole in me and put the tube right there a small hole but yeah a hole right there oh boy decision making is a big issue for older adults and deciding upon a course of treatment is a big ordeal someone who gets diagnosed with a cancer when they're older you know it's a real question of well wait do we want to do the standard of care which is surgery and then chemo or is that really not what's best in this case are they really too sick and dying from other things and it wouldn't be in their best interest to even you know go through a surgery like that yeah hi Mrs Fuller it's uh Dr Farber calling I just came from seeing your mom and you know I talked with her about stuff including the procedure which is scheduled for tomorrow okay I know you wanted to know it's scheduled for tomorrow the feeding tube would help Georgia days regain her strength but the cancer had already spread so she would be moved to hospice care when the choice needs to be made whether it's the patient making it or the patient's family kinds of decisions they have to make sometimes are completely unexpected I had a patient with severe severe Parkinson's disease and one of the manifestations of his Parkinson's was that he could no longer swallow so I had this long conversation over the course of weeks with his family and basically what I try to help them understand is his body can sustain life anymore he can't swallow food so if we choose not to feed him he'll die from his Parkinson's disease if we choose to put a feeding tube into him he won't die now we'll have to wait for a medical catastrophe it'll have to be an enormous infected bed sore it'll have to be a stroke it'll have to be a overwhelming urinary infection aspiration pneumonia it'll have to be some that's what I try to term a medical catastrophe because we've actually caused it to happen we've let the person live long enough that the only way for them to die because we didn't let them die from their natural illness is some medical medicalized catastrophe and some families accept that it's very hard to do because they're letting someone die and lots of families can't they cannot accept that when something happens that ends life that's okay but until that happens they need to do everything they can to sustain someone okay who is ready to to Lost somebody for the family especially the mother I'm not ready I don't know I know will be one day but for the past year Dr Farber has been working with Lucia panesco to keep her mother Maria out of a hospital and at home okay now 96 Maria is slowly deteriorating from chronic heart and vascular disease that was mama that okay yeah just tell her I'm here it's Dr Farber yeah I am good you have a very nice smile can you tell her [Music] she know she never recovered a few days ago she was very very very sad and she looked at me after she have a lot of pain and the pain calmed down after the medication and when I asked her what do you feel you feel better she say yes and she looked at me and she say you try to cure me but you never can do that okay I give her everything what I have but I don't know what to do and that is the hardest part because I don't like her to suffer but now when she moves the leg can you can meet me yeah all right sorry and she's very limited you know she has really severe arthritis and a lot of her joints including the hips and at this point she's getting contractures she can't breathe anymore for the pain okay her mother's getting sicker overall and we've been spending a lot of time talking about what to do when her time comes and and how you know it's very clear she doesn't want her to go to the hospital she doesn't want someone to call 9-1-1 so she filled out one of these uh do not resuscitate orders at home to put on the fridge but it's very hard for her to kind of picture and accept the fact that that she is so old and frail and and you know not gonna be around forever [Music] the bright lines that used to guide us when death was Swift technology didn't get in the way those lines have become blurred by lots of things loving families begin to wander is it love or is it cruelty to treat this pneumonia in my father who is suffering from cancer and has begun to lose his appreciation of all of those things that made his life worth living [Music] lots of us now want to spare our children those kinds of burdens one hears it said over and over again I do not want to be a burden to my loved ones [Music] and people write living wills and make other kinds of Arrangements precisely hoping to spare the burden not only of care but even of decision making about what should be done with us when we get to be old and infirm and incapable of deciding for ourselves but the fact of the matter is that it's really impossible to describe all of those circumstances that one is going to face and for most of the decisions of long-term care you can't write those things There Was You Jennifer was opportunity every day I meet a friend an acquaintance a relative who is caring for their parents and making these difficult decisions that no child wants to make isn't that your partner oh yes I don't know and every day there is a decision even if it's a little decision like well um do they need an antibiotic you know my parents do have a living will and a health care proxy but when push comes to shove are you going not going to fix that fractured hip are you not going to fix those fractured ribs are you going to allow your father to choke or are you going to make sure that he doesn't have popcorn and and things of that nature are you ready I never had anticipated being in this position nor having my parents in the situation they're in good job get up come on tuck your bottom under there you go straight up our daily struggle is to continue to try to assist them in having a purpose in life because there's no question that in many aspects they've lost the quality of life don't put it out too far right foot push through those hands good walker yeah and we had everything all set here we had drawn oils we set up across Sons for the kids everything was shut and this happened okay good walker right foot listening oh get that left foot right up there there you go I'm trying to learn to walk with hard I press Wheels here and she and I both can't if we were scared because she can't run one night I can't run the other hand we can't run two wheelchairs or one person so I don't know what to look forward to I don't really look forward to anything old ages for the birds yeah dude do you think you could find an x-ray for me two seven four six three [Music] a lot of what I am and I think a lot of people is what we do and if you can't do anything then what are you [Music] to me being unable to drive a car to make music to think clearly is just I don't have anything to do with it thank you I mean probably at least once a week and sometimes every day people say you know if I ever get like that take me out behind the barn because I don't want to live that way [Music] in their practice are confronted with situations where patients are are really in desperate need and they say look when this happens I want to be very clear [Music] I don't want you to prolong my life or I want you to make something available for me that will you know help me to be more comfortable and end it when I want to or even sometimes you know will you help me to do it when the time comes because of these experiences I've had these discussions with my wife too about my own end and she and I are at Polar Opposites in terms of what our expectations are I mean I would clearly want to be given that option if I were terminally ill or I had a progressive illness a degenerative Progressive illness that was kind of gradually take away all of my function I would want to be able to opt out I want that control and I don't know whether I'd ever use it but I definitely would want it and to her that's it's just inconceivable that someone could think like that life is life my son who has power of attorney in case anything happens to me asked me to sign a paper that would authorize termination in case of hopeless looking condition and I said no I'm not signing that uh there are a lot of cases where doctors have said this patient has three months to live and they've lived 30 years I don't think that medicine knows everything perfectly and that while there's life There's Hope and it's part of my general optimism I guess and confidence that if it were that hopeless my heart would intervene and say the end and I'm willing to let it go with that why do you think so many people are prepared to sign though because they don't want to see their children suffer and I said to them I don't care suffer how long would you like to live Mr singer how long would you like to live they have a question I never thought of it [Music] whatever I like I I like life I like crying foreign [Music] I like it but it's that it's not to me it's not out [Music] it's I think simply not true that we can know in advance how we ourselves will feel about many of these things once we find ourselves not 45 and fit but 75 and viewing life with a different lens I'm trying to accept the coming limitations with a certain amount of Grace I have this perverse occupational interest to see whether having thought about it all this time I can age better rather than worse and be a kind of decent example to my children and to my grandchildren it's not simply in my control um it's a time of life that interests me a lot hi Mrs Golf all right how you doing for the first time in history those 85 and older are the fastest growing segment of the population hi Luella and within 25 years there will be over 70 million elderly Living in America I'll be back next week we haven't even begun to contemplate what this means socially in terms of the meaning of having all these years stacked up at the end of life it's a lot easier for the country to think about the economic aspects we've not yet begun to face up to what this means in human terms [Music] [Music] next time on Frontline I got the World on a String Americans with credit cards 185 million interest and fees paid to the credit card companies 101 billion big Banks holding all the cards priceless some things money and power can buy for everything else you want to know about credit cards there's Frontline [Music] to order front lines living old on video cassette or dvd call PBS home video at 1-800 play PBS thank you [Music] funding for Frontline is provided by the park Foundation committed to raising public awareness Frontline is made possible by contributions to your PBS station from viewers like you thank you foreign [Music]