Boomer Corner

If not Immortality what about The 120 Club? Planning for the End of Your Life When you need Palliative and Hospice Care in Bali

My good friend Alexander Everett died in 2005 aged 85 on his ranch in Oregon. It wasn’t really a ranch, more like an Ark. Alexander just liked to hang out with animals, certainly not eat them. Hewas an educationalist and an English eccentric much influenced by Rudolf Steiner and Huxley’s Perennial Philosophy, who decamped to Oregon in the 1960s becoming a leading figure in the personal development movement that became popular at that time. As a young man he had been crippled by polio but claimed to have cured himself. He was, he told me a member of the 120 Club, all of whom committed themselves to live to be over 120 years old. Alas, Alexander didn’t make it. He died 35 years short aged 85, which is respectable.

Somewhere around the age of 18 or 19 our bodies cease developing and from that moment on the various body clocks that comprise what is us, start their remoseless countdown to our eventual demise. How long we last from that point on depends on good luck, our genes, our lifestyle and how much money we have. The process doesn’t usually start to manifest visibly until our mid-30s or so and, given good genes, psychologically we don’t usually start to feel old until our early 70s. Here’s what we’re all up against:

Chronic Inflammation

Aging people suffer an epidemic of outward inflammatory diseases such as arthritis, but chronic inflammation also damages brain cells, arterial walls, heart valves and other structures in the body. Heart attack, stroke, heart valve failure, and Alzheimer’s have all been linked to the chronic inflammatory cascade.

Glycosylation

Diabetics age prematurely, but even non-diabetics suffer from this chemical reaction, where protein molecules bind to glucose molecules forming non-functioning structures. Glycosylation is most evident in senile dementia, stiffening of the arteries, and degenerative diseases of the eye.

Methylation Deficit

Our cellular DNA requires constant enzymatic action for maintenance and repair. Aging cripples methylation metabolism causing DNA damage that can manifest as cancer, liver damage and brain cell degeneration.

Mitochondrial Energy Depletion

The cellular energy powerhouse, the mitochondria, requires a complex series of chemicals to maintain critical functions such as transporting nutrients through

Who will end up with your books and your tchotskes,

your gadgets and your garden tools when you change the cell membrane and purging the cell of toxic debris. your cosmic address at the end of your life? Mitochondrial depletion lead to congestive heart failure, muscle weakness, fatigue and neurological disease. It’s probably the easiest and least onerous part of your estate planning to make a list of all your possessions and decide who will get the stuff you have accumulated all these years. Will Junior get your porno movie collection? Your daughter might like some jewellery or family heirlooms; maybe your best friend would appreciate your gadgets or garden tools. You have made your Last Will and Testament? Good. That takes care of your estate, your possessions and financial accounts and settles your preferences. Or does it?

Estate Planning

Planning for the dissolution and distribution of your estate is not that cumbersome but you need to take a few things into account, especially if you have property or a foot in two countries. Besides the bequests and provisions your last will and testament should appoint an executor who will take care of administrative and financial matters such as liquidating bank and investment accounts, your pension or retirement accounts, ensuring your assets go to the proper beneficiaries, paying any debts or taxes. It could also include selling your home or terminating your lease. And with foreign property rights restricted in Indonesia, be sure you don’t leave behind a can of worms your executor will have to deal with. Even if you have little in the way of assets or possessions, you should have a simple will because if you die intestate the legal system in your location will decide who gets your assets, no matter how massive or meager. Things are more complicated if you are the parent or guardian of a minor child, have an informally adopted or sponsored child and there’s no document stating what you want to bequeath them or who will care for them after your demise. By the same token, are you making some provisions for your faithful staff who may lose their jobs and probably have no retirement or financial cushion to fall back on? Another thing to consider is to make sure that your will does not contradict the account beneficiaries named on your retirement accounts, life insurance policies and the like. The person listed as the beneficiary on each of those policies will get the money even if your will says otherwise. Make sure your beneficiary designations are up to date and sync with any other legal provisions you have made. It pays to review the beneficiaries on all your accounts. You may not be ready to die and in fact may yet have a long bout of life ahead of you but remember that things change, people come and go in your life and situations alter. Be sure these changes are updated in your will. Including your will, make a list of critical documents that the will’s executor will need to settle your estate like your insurance policies, bank and investment account statements, credit and debit cards, pension and tax documents and pertinent information like your Social

As we grow older and enter into our twilight years Security or National Insurance numbers and make sure you we will be faced, perhaps inevitably, with the spectre tell your family or carers where to find them. This includes of palliative, hospice or home based health care. passwords so your online accounts can be accessed. Other If we are lucky enough to live to a ripe old age without practical directives should address the paying of any taxes major health concerns, all we need is home care due, utility bills, recurring payments or donations. Any time and that is relatively straightforward and fairly a major change occurs in your life, make sure your will and uncomplicated. It suffices to have a trusted, responsible last directives reflect it.

and capable caregiver to help us with mobility issues, bathing, food preparation and the various tasks we have difficulty performing. And lucky you, in Bali, this type of care is still very affordable. Combined with regular medical checkups or home visits by a health care team, you can thank your lucky stars you don’t need more focused attention.

It’s a totally different matter if you suffer a medical condition that needs constant attention and professional intervention. Then you need palliative care and your options are either daily at-home visiting nurses if your condition is manageable by that or institutionalised treatment. Just to be clear on the difference between palliative care and hospice care: palliative care is targeted medical treatment if you have a diagnosed serious condition that can be treated though not necessarily healed. Hospice care takes over when treatment is no longer effective and is stopped as it is determined that the patient is not going to survive the illness. Hospice care is mainly about pain management and making your last moments as comfortable as possible. Bali does have these services but not in the ways of our western world. As previous Boomer Corner articles have pointed out, at this time there is only one full-fledged private medical assistance facility in Bali that provides palliative and hospice care and that is SadaJiwa in Sembung village, Mengwi. A few of the area’s hospitals provide palliative care but the services are limited. Sanglah Hospital has a Palliative Care Unit and Home Care services but no inpatient hospice care. Prima Medika only provides palliative care for oncology patients. Home nursing care services exist but if you google the providers you will find out there is not an abundance of them. Regardless of all the talk and hoopla by the Ministry of Tourism about making Bali the Mecca of retirees by promoting senior living programmes, very little actually exists in the matter of providing services and infrastructure when those retirees, after a number of healthy and active years, become dependent upon medical care and assistance. Real estate developers who promote the so-called retirement villages that are sprouting like mushrooms after a big rain just offer blocks of villas or apartments designed for the still active and healthy retired set. There are no medical clinics or nursing services on the premises. Resident Care - SadaJiwa’s founder and director is Dr. Gede Patra - who is also the president of the Bali Hospital Association - and he kindly explained that SadaJiwa currently has 2 resident programmes. One is a plan for healthy people who do not need medical treatment other than occasional checks and vital sign monitoring. The other plan is for people requiring focused medical care. SadaJiwa looks like a model retirement village with attractive villas set in lush gardens and a quiet environment but it has an onsite medical clinic staffed by doctors, nurses and therapists, therapeutic facilities, an ambulance and links to BROS hospital in Denpasar. It is home to a number of Indonesian and expat patients with medical conditions such as Alzheimer’s, cancer, stroke and cardiac disease who are undergoing treatment and are cared for by attentive staff and nurses. Some of the nurses have been trained abroad in palliative and hospice care. SadaJiwa’s programme is holistic in that it incorporates care for the physical, social, mental and spiritual needs of the members of its community. Whatever your creed, belief system or level of physical and mental condition, the mission of SadaJiwa is to provide an environment conducive to retaining the quality of life for older or ailing people. Check it out at www.sadajiwabali.com. Home-based Care - Dr. Patra is fully aware of the dilemmas faced by the aging expat population in Bali and he has devised another programme to cater to the medical needs of visiting or resident expats. A mobile team consisting of a doctor and a nurse visit patients at participating hotels, resorts and private villas to perform checkups, monitor vital signs, consult on dietary needs and personalised exercise routines. At this time several hotels in Ubud, Bedugul and some beach areas are part of the project which is expanding at a rapid pace and is also being promoted to the existing traditional tourist villages (Desa Wisata) that are dotted all around Bali. Obviously this concept would be ideal for the retirement villages and communities, especially in the more remote areas or places where medical attention is not around the corner. This home care programme is also available upon individual request on a daily, weekly or occasional schedule. More information can be requested from Dr. Patra by calling 0812 3951 364 or email gede_patra@ yahoo.com. Another exciting development is the acquisition of a remote telemedicine diagnostic system which allows realtime clinical analysis and performs up to 11 different medical and diagnostic tests like measuring body temperature, height and weight, blood pressure check, blood tests, urinalysis, oxygenation, electrocardiogram, heart monitoring, etc. The system is essentially a sophisticated portable machine - operated by a nurse or clinical assistant - that can be deployed at remote locations, even in the privacy of your own home. The results of the tests are sent online to a remote physician for diagnosis and a treatment plan can be developed if necessary. This is ideally suited to serve patients in offsite or remote areas and should be available soon as Dr. Patra is already in the testing phase of the project. Plan and Check - It is obvious that geriatric care in Bali is still wobbling in infant shoes. It is not a glamorous or popular specialisation and there are only 5 geriatric specialists in Bali at this time. Coupled to the scarcity of adequate care facilities for older and sick people, this picture is not very encouraging for expats with serious chronic and end-of-life conditions. So it behoves us doubly to plan and prepare for this eventuality, especially since health insurance plans do not always cover palliative, hospice or home health care. Best check your policy now. If you are a veteran, check those benefits too. Let’s hope geriatric care will get better in time and we can all enjoy Bali to the very end of our lives.

Hormone Imbalance

Trillions of cells in the human body are synchronised to function by chemical signals called hormones. Aging creates hormonal imbalance that can lead to depression, End-of-life preferences osteoporosis, coronary heart disease and loss of libido.

Now that the estate portion of your bounty is settled, have Excess Calcification you given a thought to the other end-of-life decisions you need to make while still, as they say, of sound and competent Calcium ions are transported into and out of cells through mind? What about drawing up a Living Will that will instruct calcium channels into the membrane. Aging disrupts this your nearest and dearest how you want to be cared for process and the result is excess calcium in the cells of the when you are no longer in a position to verbalise coherent brain, heart valves and arterial walls that can lead to thoughts? Remember there are very important instructions arteriosclerosis and Alzheimer’s. in regards to your end of life preferences that simply do not belong in a Last Will and Testament since that document will not be read until after your death.

The western way to do that is to draw up an Advance

Directive, a legal and binding document that outlines your wishes if you become incapacitated due to illness or injury.

It sets forth the specific life- supporting or prolonging measures you would like applied -or not- like resuscitation or CPR, or whether to end all life-saving measures. Your wishes should be written down and the document given to the people most likely to be close at the time of your demise.

You should not leave these agonizing decisions to others.

These instructions should include the type of care you wish to have, the medical team and the hospital you want to end up in. If you wish to be an organ donor here in Indonesia you can register with Komite Transplantasi National (the

National Transplant Committee) or the Eye Bank (Bank

Mata Indonesia) ahead of time and stipulate that in your directive.

Fatty Acid Imbalance

The body requires essential fatty acids to maintain cell energy output. Aging causes alterations in the enzymes required to convert dietary fats into specific fatty acids the body requires. The effect of fatty acid imbalance manifests as irregular heartbeat, joint degeneration, low energy, hyper-coagulation, dry skin and a host of other conditions.

DNA Mutation

Numerous synthetic and natural compounds mutate cellular DNA and cause cancer cells to form. Aging cells lose their DNA gene repair mechanisms and the result is DNA genetic damage causes cells to proliferate out of control, i.e., turn into cancer cells.

Immune Dysfunction

For a variety of reasons, the aging immune system loses its ability to attack bacteria, viruses and cancer cells. In aging humans, excessive levels of dangerous cytokines are produced that cause the immune system to turn on its host and create auto-immune diseases,, such as allergies, lupus, anemia, rheumatoid heart disease and arthritis.

Your instructions should also indicate your wishes for preferred last rites, burial, cremation or repatriation preferences, appoint a funeral service and a trusted relative or friend who agrees to take care of all that. Also don’t forget to leave behind a list of family and friends you want notified. ‘Next of kin’ may not be near if you have Non-Digestive Enzyme Imbalance family in another country. Indonesian Immigration and Internal cellular functions depend on multiple enzymatic your consulate also need to be informed. reactions occurring with precise timing. Aging causes enzyme disturbances in the brain and liver, which result in And now for the big caveat: Remember that every country severe neurological diseases such as Parkinson’s or has its own norms and regulations when it comes to persistent memory loss. Impaired liver function results in durable health care and appointing a health care proxy. If toxic damage to every cell in the body. you plan to die in Indonesia you are well advised to inform yourself of the practices here. In fact, a quick survey Digestive Enzyme Deficit among a few Bali lawyers reveals that unfortunately, the

Indonesian law system does not recognise a Living Will. The aging pancreas often fails to secrete enough digestive However, you can draw up a private statement letter enzymes, while the aging liver does not secrete enough regarding your medical directives and wishes on how bile acids. The results are the chronic digestive problems medical personnel should treat you in case of a lethal many face as they age. condition. This statement letter only indicates your wishes and does not have the strong enforcement capacity like a

Excitotoxicity will. It behoves you to discuss these matters with your private physician now and see where you stand. The aging brain loses control of its release of neurotransmitters such as glutamate and dopamine, and this results In the end it doesn’t really matter - or does it to you? in devastating brain cell damage and destruction. Statistics claim that nearly half of people age 55 and older don’t have a will. I bet the percentage is even higher for

Circulatory Deficit not having a Living Will. Yet it is important to document your end-of-life preferences and communicate those to

Microcapillary flow of blood to the brain, your family and/or the people that are likely to be near you eye and skin is impaired as a part of at that crucial time. Putting a plan in place for things like normal aging. The result is that disorders medical care and funeral arrangements helps ensure that of the eye (such as cataract, macular upon your death, your wishes are carried out and that degeneration, glaucoma) are the No.1 family squabbles are avoided over your dead body. In age-related degenerative disease. Major terms of funeral arrangements, you can leave the and mini-strokes are common problems arrangements to a competent service like Antara Bangsa associated with circulatory deficit to the Funeral Services. Expats in Bali concur they are very brain. good and take care of the details. Oxidative Stress Don’t wait to put your affairs in order. Now, while you are Free radicals are unstable molecules that have been implicated in most diseases associated with aging. Antioxidants have become popular supplements to still hale and healthy and still have control of your belongings and the execution of your last wishes, is the best time to put some order in your end of life preferences. protect against free-radical-induced cell damage, but few Don’t wait until life’s inevitable loops throw you a curve and people take the proper combination of antioxidant beat you to it. supplements needed to do any good.

By Adrian By Shari By Ines Wynn By Shari By Ines Wynn

The Boomer Corner is a column dedicated to people over 60 living in Bali. Its mandate is to cover topics, practicalities, activities, issues, concerns and events related to senior life in Bali. We welcome suggestions from readers. E-mail us at : Baliboomers@gmail.com The Boomer Corner is a column dedicated to people over 60 living in Bali. Its mandate is to cover topics, practicalities, activities, issues, concerns and events related to senior life in Bali. We welcome suggestions from readers. E-mail us at : Baliboomers@gmail.com The Boomer Corner is a column dedicated to people over 60 living in Bali. Its mandate is to cover topics, practicalities, activities, issues, concerns and events related to senior life in Bali. We welcome suggestions from readers. E-mail us at : Baliboomers@gmail.com The Boomer Corner is a column dedicated to people over 60 living in Bali. Its mandate is to cover topics, practicalities, activities, issues, concerns and events related to senior life in Bali. We welcome suggestions from readers. E-mail us at : Baliboomers@gmail.com The Boomer Corner is a column dedicated to people over 60 living in Bali. Its mandate is to cover topics, practicalities, activities, issues, concerns and events related to senior life in Bali. We welcome suggestions from readers. E-mail us at : Baliboomers@gmail.com Copyright © 2019 Boomer Corner You can read all past articles of Boomer Corner at www.BaliAdvertiser.biz Copyright © 2019 Boomer Corner You can read all past articles of Boomer Corner at www.BaliAdvertiser.biz Copyright © 2020 Boomer Corner You can read all past articles of Boomer Corner at www.BaliAdvertiser.biz Copyright © 2019 Boomer Corner You can read all past articles of Boomer Corner at www.BaliAdvertiser.biz

Copyright © 2019 Boomer Corner You can read all past articles of Boomer Corner at www.BaliAdvertiser.biz