Do I want heavy treatment in the intensive care unit if I become very ill due to the corona virus? This question concerns many people, who are vulnerable to major decline in their health. The Ministry of Health will make 10,000 Treatment Passports available to doctors and other healthcare providers. It is a tool for recording treatment wishes, which can also be used in the case of corona disease.
The Treatment Passport was written by Ester Bertholet. As a geriatric specialist, Bertholet knows everything about vulnerability and vitality in aging people. She has a practice in Velp, near Arnhem, in the same building as a general practitioner. She is referred daily to people who have become ‘vulnerable’ and helps them to regain strength. She also starts the conversation – what do you want if something goes wrong with your health and you can do less? A question that is now on many people’s minds, because they run an extra risk of becoming seriously ill due to the corona virus due to weaker health. What do I want in that case? Do I want to go to the hospital to be on a ventilator? Research has shown that intensive care has a serious impact on your health and vitality.
will
There are advance directives in which you can record these kinds of things, but Bertholet noticed in her practice that people did not find them practical. She therefore published this booklet herself – the ‘Treatment Passport’. Here people can write down their treatment wishes. The elderly unions, doctors’ associations and the ministry have shown interest in the Treatment Passport. Bertholet hopes it will be made available free of charge to all elderly people, not just the frail elderly. “It’s better not to think about this until you’re at your most vulnerable, but much earlier. For example, if you are sixty and still vital – do I want treatment in the ICU and be resuscitated? The earlier you ask yourself this question, the better it will become a bit more common to think about these wishes.’
Vulnerable
Because when are you a ‘vulnerable elder’? Bertholet: ‘Physicians’ guidelines state that if people have multiple disorders and can no longer take care of themselves properly, there is vulnerability. They can no longer shower or dress themselves. Or they can no longer climb stairs. You can also explain it this way: you are vulnerable if you have various conditions that affect the condition of the entire body. This is often the case with a more serious heart or lung disease, diabetes or an autoimmune disease.’
GPs and practice nurses see what can go wrong. A complex patient gets something ‘small’ such as a bladder infection. He unexpectedly deteriorates and he ends up in the nursing home, while he never wanted to. Couldn’t that have been prevented? In fact, you should think much sooner about what you do and don’t want, says Bertholet. ‘I discuss the question with all my patients: what is important to you, what do you no longer want and what do you especially want? This sometimes scares people, but in the end they really enjoy talking about it and clarifying their wishes.’
Not to the hospital
What kind of wishes do you have to think about? An example. ‘People with lung emphysema get short of breath at night and go to the hospital. There they are admitted and treated. But they don’t sleep well there and they lose a lot of weight. They often also get delirium in the hospital, because that happens much faster if you are not at home. I then ask why did you go to the hospital? People then react very surprised – can you also stay at home? Yes, you can also be treated at home. Not as fast as in the hospital and there is no oxygen in the middle of the night at home. But we could have tried with medication that would have made you less anxious. Even if the risk of death had been greater, people would prefer to be treated at home. You really do get older by being hospitalized, hardly anyone realizes that.’
Never wanted
Some people want to use less medication, others don’t go to the cardiologist every year for a check-up. They can write down these kinds of things and discuss them with their doctor and relatives. ‘It is also useful to write down who should be called if you become seriously ill,’ says Bertholet. ‘People need to realize what can happen. If you talk about your wishes, you run less risk of things happening that you never wanted.’
In June’s Plus Magazine there will be an article about vulnerability with Ester Bertholet.
Also see this broadcast of Eenvandag and this one broadcast of Op1 (from minute 29) about the Treatment Passport. And this article in ANBO magazine.
