Worst ways to die old?

January 17, 2007 12:03 AM

What are the worst (natural) ways to die as an old person in terms of how it must feel for them? Are there ways to die for which the symptoms cannot be alleviated by medical means and it's just a completely dreadful existence until death? What fraction of people die old horribly?

And if you do have a horrible terminal disease, what are the best ways to ensure you die as happily as possible?

posted by vizsla to health & fitness (31 answers total)

My godmother passed away at 94 a year ago. She was an educator and a brilliant, wonderful woman. At 88, she even traveled through Egypt -- she was an inspiration to me. Towards the end though, she degenerated to the point where she could barely speak. You could see in her eyes that her mind worked just as fast as ever (she was even still reading relatively intellectual books) but she just slowly lost her ability to communicate. She even tried sending me e-mails, but towards the end they would be blank. She couldn't type but wanted me to know she was thinking of me.

When she was transferred to a new rest home, her new caretakers had no frame of reference for what a dynamic creature she had been so they treated her like a vegetable. They weren't even calling her by the right name. When I saw this it upset me so that I ended up explaining to people who she had been and that she deserved respect, and I saw tears in her eyes when I did that. It was one of the last times I saw her, I think she just gave up and welcomed death because life without communication was such torture for her. It was too painful & lonely.

Lordy, I miss her.
posted by miss lynnster at 12:24 AM on January 17, 2007 [5 favorites]

Ovarian cancer is a horrible, painful way to go, but it only takes women. Pancreatic cancer is also painful, and prone to metastasize, so there is potential for spawning pain generating sites throughout the body, and it is essentially incurable. Lung cancer is no picnic, either, and is detected too late to treat effectively, in the majority of elderly patients.

Stroke involving paralysis can be awful, but if you can be made comfortable, is not being able to communicate so awful, compared to the wracking kind of pain, beyond all surcease that drugs can provide, that some disease processes can produce? When your only hope for sanity and ease is that surgeons cut your nerves, you have to hope the anesthesia itself will be fatal.
posted by paulsc at 12:46 AM on January 17, 2007

Miss lynnster's scenario is 'way up there on my list of ways I don't want to die. (Well, the scenario without ml is worse.)

There are also some diseases which cause agonizing physical pain that doesn't respond to analgesics but which kill you only very slowly (months or years). IIRC bone cancer can be like that.

And the third major category of "reasons why hattifattener thinks assisted suicide should be legal" is progressive dementia.
posted by hattifattener at 12:47 AM on January 17, 2007

There was an old woman in Sweden who lived alone. She fell and broke something, and couldn't reach the phone to call for help, so she died, slowly.

\Her social security check was automatically deposited in her bank account, and all her bills, including her rent, were automatically paid. Eventually her landlord needed to get into the house to do some repairs. He called her but got no answer, and so (under Swedish law) he went to court and got permission to enter, and found her corpse - four years after she'd died.

That's not the only time that's happened. What's the worst way for an old person to die? Living alone, socially abandoned, knowing that no one cares about them.
posted by Steven C. Den Beste at 12:54 AM on January 17, 2007 [1 favorite]

I agree... ovarian or lung cancer are two of the worst, very definitely. The one thing I was thankful for with my godmother was that she wasn't in serious physical pain beyond the whole "my body is 94 & doesn't want to work anymore" scenario.
posted by miss lynnster at 12:56 AM on January 17, 2007

Some poisonous mushrooms can destroy your liver function within 24 hours - you don't feel much while that's happening, but once the liver shuts down, the poisons start building up in your bloodstream, causing great pain until death, and there's nothing they can do for you.
posted by Jimbob at 1:30 AM on January 17, 2007

Oh shit. My answer is completely irrelevant because I missed the word old. My apologies. Unless old people have a habit of picking strange mushrooms in the forest...
posted by Jimbob at 1:31 AM on January 17, 2007

I'll throw a vote for any invasive cancercancer. Saw someone close spend that last years of his life in constant pain. Toward the end he was constantly, heavily sedated and still would groan in pain. This was the end of a life that spent the previous 15 years constantly fighting cancer by having his body ravaged by having pieces cut off, filled with poisons, and shot with radiation.

If I have lived a full life and my health is on a serious decline (example if I need a heart transplant while I'm not being productive in my life) I'd like to think I would have the courage say goodbye to my friends and sail off into the sunset. Literally. A friend says he would like to do something similar, but blow the remaining life savings on a fatal hedonistic romp. Fair enough, we have different preferences.

I used to have a great fear of dementia, but a complete failure of my brain would be a not bad way to go, personally. Bad for those who would have to care for me, but not for me.

"What fraction of people die old horribly?"
Define 'horribly', then we can talk.
posted by Ookseer at 2:19 AM on January 17, 2007

Alzheimer's.
posted by slimepuppy at 3:40 AM on January 17, 2007

Lung cancer is pretty painful. Throw in a dash of emphysema (generally the two go hand-in-hand, but not always), and you're in a world of hurt.
posted by Civil_Disobedient at 4:45 AM on January 17, 2007

And if you do have a horrible terminal disease, what are the best ways to ensure you die as happily as possible?

Hospice.
posted by LoriFLA at 5:02 AM on January 17, 2007 [1 favorite]

My grandmother had a very rough go during her final months. She was a very spunky woman but also incrediably modest the same time. She was very active until the last few months of her life. She spent many hours volunteering at hospitals and with the Red Cross. She was an excellent seamstress, making quilts, clothing, and little baby things.

She died incrediably slowly. First, her hearing went, so she had to get very expensive hearing aids. Then she started to lose her vision, due to glaucoma and catracts. This quickly put an end to her sewing (which she did completely by hand and never used a machine). She had to move out of the house she had lived in since she was married (her husband died many years before I was born) and live with my aunts in a condo.
My aunts are huge assholes. They did nothing but bitch and moan that she was living with them and controlled what she could eat or drink, often changing their minds in a blink, and wouldn't drive her to the places she wanted to volunteer. She was also having many physical problems, gastrointestinal for the most part, with a side dish of severe arthritis. For the last year or two of her life when she was living with my aunts, she was on over 20 medications for all the different ailments she was having.

One night, she had a very severe nosebleed and diahrrea. My aunts shipped her off, first to a hospital and then to an "assisted care facility" that had more violations than beds. She started to forget things, such as if she'd taken her medication, or turned off the stove, what day it was. She could no longer recognize faces. She withdrew from all of her friends and family because she was ashamed at having to be "taken care of".
She died about 2 months after being put into assisted care, unable to control her body, in pain, unable to eat, and unable to anyone. Within the first month she was there, she caught numerous infections. Every time one infection was treated, another one would pop up. She was restricted to the facility and could no longer attend mass (Catholic Orthodox) or go to confession.

I think that one of the worst ways to die old is to no longer be in control of yourself and your life. Combine that with Alzheimer's and pain and feeling alone--I can't even imagine what she must've felt like.
posted by sperose at 5:05 AM on January 17, 2007

Not that this is a death pissing contest or anything, but I'm going with Amyotrophic Lateral Sclerosis / ALS / Lou Gherig's disease (miss you much, Grandma). The spinal nerves wither away, causing muscle atrophy, while you remain fully aware mentally, eventually suffocating to death because your diaphragm no longer works, or choking on food because you lack the strength to swallow.

Yes, Hospice is a Great Thing, and something I think people often don't explore early enough. Doctors also often view death or dying as failure (this is VERY slowly changing), so they don't always consider "comfort care" until late in the game.

Die happily? You know, it's very different for people when you ask them: some want to be alone, some want all their loved ones around them, others would like to just not wake up from sleep. One way I absolutely do NOT want to die: in an ICU.

(If you are reading this and do not have a living will, or a durable power of attorney -- or your loved ones and/or parents don't -- do it now. Let your loved ones know your wishes, please -- otherwise we must assume you want all life-saving measures done, and often I wonder if it causes more prolonging of suffering.)
posted by gramcracker at 5:18 AM on January 17, 2007 [1 favorite]

And if you do have a horrible terminal disease, what are the best ways to ensure you die as happily as possible?

I can only answer this as one datapoint that has considered some of the possibilities-- If I develop a terminal illness and am in great pain, with no hope of recovery, I have strongly considered taking a serious overdose of heroin. The insufflated or injected heroin shuts down the lungs and causes them to fill with fluid, basically drowning one from the inside out. However, having become blissfully comatose long before this actually takes place, the subject drops off into a quiet sleep, never to wake again.

Painless, and while not necessarily appearing dignified, it would be my choice, and I feel that the dignity lies in that-- in being able to choose when and where to go in the face of hopelessness.

Downsides include procurement and dosing problems-- I think it might be harder for an older person to score a schedule I drug, and one runs the risk of doing too little, or passing out before a second dose can be administered, but especially for older people, a single heroic dose should do the trick.

I'm not suggesting that anyone else consider this, just that I have, as a thought experiment, and found it potentially acceptable.
posted by exlotuseater at 5:50 AM on January 17, 2007 [1 favorite]

And this is why I've always hoped I get mowed down by a bus before I retire.
posted by allkindsoftime at 6:34 AM on January 17, 2007

Ok, well, I'm a smidgen depressed now...
posted by miss lynnster at 6:56 AM on January 17, 2007

Seconding ALS, although that often strikes persons at younger ages, just as likely it will hit in the later years. And the role of Hospice is pretty limited until very late. But metastatic ovarian cancer is horrible as well. I can't stress enough the value of Hospice care. If you are ever looking for an organization to involve yourself with or support with a donation, look into your local chapter.
posted by docpops at 7:55 AM on January 17, 2007 [1 favorite]

Ookseer describes what my father's last years would have been like. He had started down that road, and it was terrible to see. He'd had a kidney and part of a lung taken out, was undergoing aggressive chemo and radiation, and faced years more of the same.

The last time I saw him in the hospital, I found myself (secretly) wishing he could just go--on top of the pain and constant nausea, he hated being dependent on others, hated being weak.

A few months later, he died from an aortic dissection, no hospitalization, no pain, first symptom to brain death in 2 minutes.

I love my father, and have many happy, treasured memories of him. But I've never regretted my wish.
posted by MrMoonPie at 7:57 AM on January 17, 2007

I don't know whether this is worse than what's already been suggested, but I thought I'd throw it out there since I haven't seen it yet: dying during failed attempts at resuscitation would be pretty awful. Alarms are going off all around you, you may have broken ribs from cpr, your body is convulsed by violent electrical shocks from a defibrillator, you may even have a tube down your trachea for a ventilator (a condition the body finds so instinctively unacceptable the even people in comas manage to tongue them out of their throats)... The body is injured and insulted in myriad ways in hopes of preventing death. There is little dignity and certainly no peace in this procedure. If it works, then obviously it's worth it, but if not...
posted by vytae at 7:59 AM on January 17, 2007 [2 favorites]

COPD. Maybe with CHF.

Imagine never being able to draw a full breath no matter how hard you try. Feeling permanently terrified of suffocating to death -- air hunger is one of the most viscerally terrifying ways to go.

COPD + CHF means being tortured like this for months, maybe years before you finally die.
posted by NucleophilicAttack at 8:13 AM on January 17, 2007

You may be interested in the book How We Die: Reflections on Life's Final Chapter by Sherwin Nuland. I read it almost a decade ago and found it sobering but not really depressing. Of course I and everyone I knew were younger and healthier then.
(By pure coincidence it sits on my shelf right next to Why They Kill.)
posted by Martin E. at 8:21 AM on January 17, 2007

"And if you do have a horrible terminal disease, what are the best ways to ensure you die as happily as possible?"
I'm not sure 'happily' is the right term. The best anyone and any money can provide is 'as comfortable as possible given the circumstances'. That means gentle, wholistic, personal care whether in a hospice or a home starting with assiduously titrated pain relieving medication and on through keeping the tongue and palate moistened and removing sleep from the corners of the eyes, to making sure there's no creases under any part of the body, to repositioning regularly in the least disturbing manner possible, to ensuring that there are sufficient bed covers to make them just warm enough, to preventing the intrusion of bright lights and loud noises to cleaning them or cleaning up after them when necessary ----- all within the limitations that the particular illness confers on the situation. And any other little consideration or action whose sole purpose is to provide just that little bit more comfort.

You want someone around who both really cares and also knows how to do all this gently but efficiently.
posted by peacay at 8:30 AM on January 17, 2007

Coal workers' pneumoconiosis (also known as black lung) is uncurable, and it causes sufferers to slowly suffocate to death. The last few days of black lung are supposed to be absolutely excruciating, because you cannot breathe. Recent regulations have limited miners' exposure to the coal dust particles that cause black lung, but the disease is still very much a concern for miners and their families.
posted by arco at 8:33 AM on January 17, 2007

My father is dying right now of mesothelioma (asbestos-related cancer) aggrevated by congestive heart failure. He can no longer stand on his own. He needs help to do everything - get dressed, wash up, shave, go to the bathroom, everything. Chemotherapy treatments have left him in altered states where he doesn't recognize what's happening, who's talking, or what language they are speaking. He gets out of breath while watching TV. He is constantly in pain and the morphine he takes barely takes the edge off. He regularly defacates and urinates on himself because he can't feel the urge to use the bathroom.

My dad is 64. I think that is the worst part of all.
posted by MeetMegan at 8:53 AM on January 17, 2007

And if you do have a horrible terminal disease, what are the best ways to ensure you die as happily as possible?

If part of your plan involves dying on your own terms, you could move to Oregon.
posted by peep at 10:25 AM on January 17, 2007

My dad's dying of OPCA right now. He probably has "locked-in" syndrome, and is literally a vegetable in a bed. He can't even blink a yes or no coherently any more. He's being pumped full of morphine, and we're taking him off the ventilator by the end of the week.

If I ever get a disease of that nature, I am going to kill myself early on, while I still can under my own power. (Or move to Oregon.) Stringing things along is NOT WORTH IT. You don't want your friends and family to remember you best in a bed for years on end, trust me.

(Yeah, great timing for me to find this thread.)
posted by jenfullmoon at 11:50 AM on January 17, 2007

Depends on what you consider awful.

My grandfather developed Parkinson's. He was mentally alert but slowly lost control over his motor functions. He didn't die in weeks or months, it was nearly a decade of slow decline.

A friend of mine died a few years ago (only aged 42). She developed a brain tumor that consumed her mind in a few months, a comparatively swift death. During the course of the illness she suffered enormous pain until the cancer finally ate away enough of the brain to leave her without pain.

I can't say which is worse.
posted by chairface at 12:01 PM on January 17, 2007

my dad died of bulbar amyotrophic lateral sclerosis.

als comes in two kinds, structural (i.e., lou gehrig) and bulbar (extremities work fine, but speaking and swallowing muscles affected the most). his first symptom, he sounded like he'd consumed a pint of liquor, although completely sober. i thought he'd just had a stroke or transient ischemic attack affecting the area of the brain controlling those muscles. i could have cheerfully dealt with drunk-sounding-dad for another 10-20 years; when the als diagnosis came in i scoffed; he was too old for that.

in his last 24 hours he asked us to give him a gun, but we didn't want to face the inevitable outcome of that; instead, his doctor prescribed a fentanyl patch to calm him down.

fellow mefites, don't ever let somebody apply a fentanyl patch to your body unless you want to die. it will calm you down all right, way down.
posted by bruce at 1:21 PM on January 17, 2007

I think dying while on a transplant list would be not only painful from your disease, but painful in realising that people die every day and their organs just go into the ground and rot when living people could use them.

I'm terrified of dying.
posted by loiseau at 8:10 PM on January 17, 2007

I think that NucleophilicAttack has nailed it. The ambulance company I work for part time does a lot of inter-facility transports, and we see a lot of COPD/CHF patients.

Otherwise, the worst way to die when you're old?

Alone.
posted by drstein at 9:25 PM on January 17, 2007

i only read the first few ans, and from my experience i disagree with them. i think dementia isnt a bad way for someone to die, because they generally dont feel any pain of it. also, physical pain can be dealt with - we get used to it - for example soldiers do. torture is only physical pain. i think the worst way to die is when you watch loved ones die, and cant do anything about it, and know that you are going as well. like if you are in a sinking boat.
posted by edtut at 12:25 AM on January 18, 2007