My daughter’s favourite board game at the moment is ‘The Game of Life’. I’ve lost count how many times we’ve played it. The idea of the game is to make decisions about how you live your life based on a variety of choices. These start with deciding to get a job or going to college and progresses (in order) through marriage, having kids and then retiring.
You have ‘won’ if you’ve made more money than everyone else. I’m not exactly keen on this being the take home message to be honest however I have to admit it is fun. I usually end up choosing a career as an astronaut and living in a beach front apartment. Amazing!
I was talking about the game with friend and colleague Emma Vardy (@emmavardy) this weekend. We got to talking about a different version of the game that would reflect more realistic choices to be made in later life. For example when choosing a house it could include things like does it have any adaptations? Does it have ground level entry? The family section could include discussions about power of attorney and living wills.
While this may seem a tad facetious I do think there is a conversation to be had about our life choices as we age. I think it is something that very few people have – usually it comes late and at a time of crisis.
My on call last week reinforced this assumption. I assessed several frail people who had had no prior discussions about treatment escalation plans. Unfortunately all of them were so ill they could not participate in any of the discussions. I had to speak to families that were already very distressed at seeing their loved one so unwell.
These conversations can be hard and time consuming. While I feel it is important to have them and do them with sensitivity, I do feel that I overload people with information. It’s a lot to process.
The new DNACPR guidelines have been released along with new forms. The main difference is the documentation of decisions and how they are communicated to the person and their families. 
Resuscitation is without doubt the extreme end of the treatment spectrum but what about antibiotics, fluids, nasogastric feeding or operations for example? In 2013 it is thought 1 in 14 people over the age of 65yrs has dementia. This is projected to increase by ~40% by 2025  We should be having these conversations much earlier. If we truly are in control of our lives or certainly our health then surely we would want a say in what happens to us later in life? What about when we no longer are able to process that information and our families are asked to help inform/guide/shape treatment plans in the middle of the night?
If these are conversations that seem ‘too serious’ or perhaps the response from parents is ‘och, I’m too young for that!’ then why not try playing ‘The Game of Life’. When you get to the finish line of retirement instead of counting your money go to http://www.mypowerofattorney.org.uk and have a real conversation about your future.
Even astronauts living in beach huts will eventually need to do that….