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Planning for end-of-life care

My Care My Plan will host sessions on advance directives and medical power of attorney on Friday in Sonoma and April 17 in Santa Rosa. For information, go to www.mycaremyplansonoma.org

Alzheimer’s disease is now the third leading cause of death in our community. That is one startling finding of a recently released survey of mortality data in Sonoma County In fact, the Department Health Services’ report cites a “significant increase” over the past eight years in mortality due to Alzheimer’s disease.

What does that mean for you and me? Well, perhaps we should all take a fervent interest in preventive measures — exercising, eating well and staying mentally and socially engaged.

And we need to face reality about preparing for our future.

With any serious illness, such as heart disease or cancer — the top two causes of death in Sonoma County — there is a good probability that someone other than the patient will need to make key decisions about medical treatment as the illness advances and end of life nears.

People with Alzheimer’s, and with other diseases that cause cognitive impairment, typically decline slowly over many years. Someone may need to make health care decisions for the afflicted person for up to a decade or more.

How can one prepare? A key step for each of us is completing an advance health care directive. One function of your directive is to name one or more individuals as your power of attorney for health; that is, the person who is legally entitled to make decisions for you should you become unable.

But simply naming someone to handle decision making doesn’t adequately prepare him or her for this role. A community initiative, My Care, My Plan: Speak Up Sonoma County, is hosting free presentations in April to support residents in advance care planning, including how to select an agent, what to talk with them about and how much leeway can be given to them. April 15-21 is National Healthcare Decisions Week, an annual national observance to encourage all of us to consider these and other issues.

Keeping in mind the potential for Alzheimer’s or dementia that comes with advancing age, it is crucial to have “the conversation” with your agent and loved ones early and, if possible, more than once. Too often, by the time a diagnosis is made, the window for abstract thinking and reasoned decision-making has largely closed.

Perhaps you have an agent, but have you considered how well your agent knows you? Does this person understand your values and priorities? Have you revealed what is most important to you concerning your quality of life and what you most fear? Have you considered that your preferences and choices might shift over time? Or through early-, mid- and late-stage dementia? Where would you prefer to live? Under whose care?

Consider as well: Has someone named you as his or her power of attorney for health care? Perhaps you have discussed issues such as quantity vs. quality of life and you feel confident in knowing when to say “no” to CPR or life support. But are you ready for more nuanced decision-making?

And if you are among the many residents who have no family member or friend to take on power of attorney for health on your behalf, these questions still apply. Think them through, and write out how you would answer for yourself as guidance for medical decision-makers. Talk about your preferences with your primary care physician. Attach this written document to your advance health care directive.

Come join us to learn more. Registration is open now for upcoming no-cost events, Friday in Sonoma with Dr. Steven Pantilat, director of the UCSF Palliative Care Program, and April 17 in Santa Rosa with Dr. Gary Johanson, medical director at Memorial Hospice & Home Health. For more information and to register, go to “events” at www.MyCareMyPlanSonoma.org.

Dorothy M. Foster is a psychotherapist in private practice in Santa Rosa and co-chair of My Care, My Plan: Speak Up Sonoma County.

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