A stroll through the halls of the Kendal at Hanover retirement community reveals residents working in hobby shops or checking out books from the library, signs that its residents are dedicated to preserving their mental and physical health for as long as possible. Approximately 75 percent of Kendal residents, all of whom are 65 and older, are completely self-sufficient, according to Kendal nurse practitioner Joanne Sandberg-Cook.
With the aim of protecting the quality of life of elderly patients, Dennis McCullough, a member of the Dartmouth Medical School faculty and former Kendal medical director, developed the idea of "slow medicine" -- a slower, more deliberate and critical approach to medical treatment for the elderly.
Many physicians automatically advocate aggressive treatment for all patients' diseases, but the idea of slow medicine suggests that such treatment is not always best for elderly patients.
"Very technically-oriented care has come to dominate the health-care system" McCullough said. "Slow medicine is a way to slow down decision-making to allow for thinking and reflection and avoid quick decisions without more clarity about why things are being done, what the pros and cons are."
Kendal's staff focuses on maintaining patients' quality of life, rather than trying to cure illnesses at all costs, according to Sandberg-Cook and Brenda Jordan, another Kendal nurse practitioner.
"Medical care got to the point where there was a prolonged period of disability at the end of life," Sandberg-Cook said. "Our job now is to try and compress that period of disability to a short period just before death.
Sandberg-Cook may not even recommend that patients test for diseases if they would not want to undergo treatment. Most physicians, for example, would advise female patients to have yearly mammograms, but Sandberg-Cook might not suggest such a course of action for a 90-year-old woman who would not want to treat cancer even if it were discovered.
"We're not just going to do tests unless we know what happens when we know the result," Sandberg-Cook said.
Patients also differ in their choice of treatment, Jordan said, with some residents selecting the most strenuous treatment, which for cancer can include radiation and chemotherapy, while others opt for hormone therapy or no treatment at all.
Jordan and Sandberg-Cook do not exclude aggressive forms of treatment as a possibility, but inform patients about the potential results of both aggressive and non-aggressive options, so that "people go to the emergency room knowing exactly what to expect."
"We do not hesitate to send people for a hip replacement," Sandberg-Cook said. "We send people for heart bypass surgeries but not without very careful discussion ... This is really intensified medicine."
Family involvement in the decision-making process is another important component of slow medicine, according to McCullough.
"Younger people have to reach out to understand what it's like to be older," he said. "And older people have to extend back and welcome involvement of their children and grandchildren in their care because eventually most older people will find themselves dependent on their children and grandchildren."
Sandberg-Cook and Jordan especially stressed grandchildren's involvement in medical discussions.
"Grandchildren can be much more influential than [the residents'] own children," Sandberg-Cook said.
Close patient-doctor and patient-nurse relationships are another part of slow medicine. Kendal's staff members have a closer relationship with their patients and understand their medical needs more completely because they are general practitioners rather than specialists, Jordan said.
"We have to reorient people to the idea of a general practitioner," she said, adding that many of Kendal's new residents are surprised that the staff can meet most of their medical needs. "We're there to reorient them to the idea that we can treat 80 to 90 percent of their problems."
Kendal's medical clinic is run by the Dartmouth-Hitchcock Medical Center and DMS students perform research and do residencies there.
