The New York Times ran a story about "slow medicine," the practice of medicine focused on comfort rather than a cure. In this case, reporter Jane Gross focused on seniors who decided resuscitation, surgery and other drastic measures were not worth the pain and discomfort at the end of their life.

The term slow medicine was coined by Dr. Dennis McCullough, a Dartmouth geriatrician, Kendal’s founding medical director and author of “My Mother, Your Mother: Embracing Slow Medicine, the Compassionate Approach to Caring for Your Aging Loved One.”

Among the hard truths, he said, is that 9 of 10 people who live into their 80s will wind up unable to take care of themselves, either because of frailty or dementia. “Everyone thinks they’ll be the lucky one, but we can’t go along with that myth,” Dr. McCullough said.

Ms. Sandberg-Cook agrees. “If you’re never again going to live independently or face an indeterminate period in a disabled state, you may have to reorganize your thinking,” she said. “You need to understand what you face, what you most want to avoid and what you most want to happen.”

Kendal begins by asking newcomers whether they want to be resuscitated or go to the hospital and under what circumstances. “They give me an amazingly puzzled look, like ‘Why wouldn’t I?’ “ said Brenda Jordan, Kendal’s second nurse practitioner.

She replies with CPR survival statistics: A 2002 study, published in the journal Heart, found that fewer than 2 percent of people in their 80s and 90s who had been resuscitated for cardiac arrest at home lived for one month. “They about fall out of their chairs when they find out the extent to which we’ll go to let people choose,” Ms. Jordan said.

Of course, the decision to seek or decline care is a personal one. But it is something we will all have to face at some point -- not just the elderly. (Don't forget to write your wills!)

But as the article pointed out, there is a quiet etiquette being broken in even talking about it. Doctors are supposed to do everything possible to save a patient whether they are 10 or 100. But oftentimes, patients are never told of the actual physical discomforts and financial costs in receiving surgery, for example, near the end of life. What do you think? Should more doctors broach this sensitive topic?

This is an ongoing theme close to my heart as my parents care for my grandmother who has Alzheimer's and it will be only a matter of time before my husband and I are in the same position. There also seems to be an affordable caregiving shortage in this country, as situations like this one of a Berkeley Parents Network writer are all too common:

I am wondering if anyone can suggest resources to help me figure a course of action for my mother who has dementia. She has been diagnosed with dementia in the last few years and the facility threatens to kick her out when she doesn't cooperate as they like. Our understanding when she bought into the facilty and they assessed her finances was that they would care for her for the rest of her life. Since she has been moved to assisted living several years ago her money has been spent more rapidly and she has about a year and a half left of funds. Can anyone recommend a lawyer (specializing in this sort of law) or some other resources to help me figure out if the facility has the right to evict her - they do not have a dementia ward and how we can care for her when her money is gone. I feel quite panic struck by what will happen when her money runs out.
Living with us in our 1000 sq ft house with 2 small children is not an option.
anon

Whew. I feel for this family. Right now my parents share a house with my grandmother and her sister who live upstairs. My grandmother's mental health is declining quite rapidly. While she is home alone during the day -- my parents work -- she can't cook nor can she go outside without getting lost. The other day, my mom dropped her off at a TJ Maxx while she went to the dentist and when she got back she found the store manager with a bewildered Latina customer who was translating what my confused grandmother was saying. My grandmother wanted to go home but did not know her own address. What a mess.

I will be seeing my family in a couple weeks, BTW. They are flying out from New Hampshire for Eli's birthday party, a welcome event especially for my parents.

A recent story in Newsweek highlighted an unfortunate -- but predictable -- side effect of China's draconian one child policy: Many elderly people are alone and they have no one to care for them.

Family is the bedrock of Chinese society, at least in theory. But three decades of gut-wrenching change are testing those old bonds. More kids than ever are leaving their hometowns—even the country—in search of jobs. This generation is the first to grow up under the one-child policy, rolled out in 1979. They are "more likely to be spoiled and self-centered," says demographics expert Cai Feng. "As adults, children of this generation lack the inclination to support their parents." Forty-two percent of Chinese families in 2005 consisted of an old couple living alone, according to the National Bureau of Statistics.

That's causing even young parents to rethink the meaning of family in China. For centuries a healthy brood of boys was considered the best form of social security. That's still generally true in the countryside; farmers prefer sons who can work in the fields over a daughter whose earning potential—if any—is transferred to her husband's family. But in China's cities, many young couples now say they prize daughters over sons for their loyalty. "Urban couples all think girls are much better than boys. Girls are more thoughtful, especially towards their parents," says Feng Xiaotian, a sociology professor at Nanjing University who has conducted surveys of Chinese families. In a recent China Youth Daily poll, respondents who preferred a daughter (29 percent) edged out those who wanted a son (28.4 percent).

To avoid loneliness, or even worse, a nursing home -- still considered shameful in Chinese society -- many elderly Chinese are "adopting" adult women as their daughters. Young, wealthy urbanites are breaking the one-child policy by having more children and paying a fine. They are also having more children through loopholes in the policy such as bearing children in another country or saying that their older children are handicapped. In the most extreme cases, men are having children by different women.

The Chinese government has no safety net for so many elderly people so it is encouraging youth to take care of their parents. "The Education Ministry has supported a resurgence of Confucian studies, which promote respect for elders," the Newsweek article stated.

This topic resonates with me as I have always been conflicted by culture clash; the American ideal of rugged individualism and the more communal attitude I was raised with by a Latino family. Like the Chinese, there are deep cultural biases against nursing homes among Latinos. My grandmother, whose mental capacities worsen by the day due to Alzheimer's, lives with my parents.

But what do you do if you live far from your family? How should the Chinese deal with this aging crisis?

Update on my grandmother: I did call her yesterday and she sounded happy to hear from me. It's as if our previous conversation never happened. (Whew!)

She is depressed as she experiences highs and lows. Let me assure you, she is taking medication and speaking with a therapist who is constantly reminding her that she needs "to do her part" in her living arrangement with my parents. (I said the same thing.)

But many of you made good suggestions, including making sure that her doctor had a specialty in geriatrics. I will suggest that to my parents. Thank you all!

What is up with you?

I had an unfortunate phone conversation with my grandmother whose mental health is quickly detereorating. Just a refresher -- she and her sister share a duplex with my parents who are overwhelmed with their care.

Recently, my 80-something-year-old grandmother had a pacemaker put in so I called her. I was shocked by her animosity towards my parents. She called them bandidos -- thieves – and told me they wanted to help themselves to inheritance; that they would not leave a dime to my uncle who is having some money woes and has called her for cash. (A real problem for my parents who say he got her "all excited.")

“They (your parents) always tell me what to do. Don’t you think I am the mother and they should listen to me?” she asked.

Me: “Actually, you are under their care. They are paying your bills. No one else is helping them.”

My grandmother: “Well. If you feel the way they do, then you can go to hell!" Vete par’ carajo!

My grandmother has never spoken to me this way, and I am trying to put things into perspective. She is old and senile. She feels paranoid as she requires a lot of help from my parents. My parents are the ones who drive her to her doctors’ appointments -- too numerous to count -- and the supermarket and sometimes cook for her. They are the ones who pay her bills, although I told them this was silly since my grandmother has money from her house, which they sold. But they do not want to be accused of stealing, which my grandmother does regularly. This is all further complicated by the fact we are Latinos, which means two things: a.) Children are seen and not heard and b.) Children never put their parents in an “old folks’ home.” But my parents have been pushed to the point they are considering it.

My father called me the next day and told me she complained about the way I “treated” her over the phone. This is not the way I would characterize this conversation. I spent most of the time on the line silent, letting her vent.

But he told me not to worry. “I know the truth,” he said. “I know how she is.” He sounded so tired -- and frustrated.

Here is a quirky cultural story out of Japan: There is a company named Japan Efficiency Headquarters that actually allows people to rent out actors to stand in for them during family events.

Let’s say your children have no grandparents. No problem. Just rent out an elderly couple for a playdate! Can’t visit mom in the hospital because of work? Simply hire an actor in your place.

The company was created in response to Japan’s workaholic culture, according to the trade publication Quality Digest Magazine.

Because of the overemphasis on the work quadrant in Japan, a firm called Japan Efficiency Headquarters rents out actors to visit the parents and children of people who are too busy with their careers to do it personally. The Tokyo-based organization charges $385 for a five-hour visit by one person, $769 for a couple, and $1,155 if the client also wants to rent a baby or child. For example, a 35-year-old Tokyo computer salesman sent a couple to visit his 64-year-old father who lived ten minutes away from him. "Our purpose is to fill a hole in the heart," says company president Satsuki Oiwa.

The International Herald Tribune weighed in with anecdotes of its own:

"I wanted to touch the skin of a baby once again," said a 75-year-old grandmother. "My own grandchildren have already grown up." So she and her 79-year-old husband rented a couple and a child for an afternoon. "I had no feeling they were strangers," she said.

A couple in their mid-20s with a two-year-old son rented an older pair of stand-ins to play their child's grandparents, who live far away and are too old and feeble to visit.

I wasn’t surprised by this trend story. The Japanese don’t seem bothered to have robots, for example, take the place of human caretakers. Some years ago, I remember writing about Wakamaru, a robot that would take care of the aging Japanese. Because young people are not having children, there is a healthcare crisis in Japan in that there aren’t enough caretakers for the elderly.

Back then I was creeped out by the notion of robots taking the place of people. But one of Wakamaru’s creators had some harsh words for me:

"Obviously, if this completely replaces human companionship, that would be sad," Tilton added. "But maybe that is a step up from television that keeps a lot of Americans company."

Ooh, ouch! We are an isolated culture and I know we live to work, too. But I hope we never get to the point of having to rely on these services.