Be the master of your own mor­tal­ity dur­ing fi­nal days

China Daily (Hong Kong) - - COMMENT -

Ear­lier, there was a fam­ily tragedy in Yiu Tung Es­tate, Shau Kei Wan. An 80-year-old man could not tol­er­ate his wife’s be­hav­ior fol­low­ing a stroke and stran­gled her. The me­dia cited the in­for­ma­tion from the So­cial Wel­fare Depart­ment which in­di­cated the fe­male de­ceased had been al­lo­cated a sub­si­dized place in a day-care cen­ter but she de­clined.

The Econ­o­mist and Kaiser Fam­ily Foun­da­tion, a US think tank, car­ried out a study in an ef­fort to find out where peo­ple want to spend the last days of their lives. The sur­vey in­ter­viewed more than 4,000 peo­ple from Ja­pan, the United States, Brazil and Italy. De­spite dif­fer­ent back­grounds and cul­ture, more than half the re­spon­dents wanted to spend their last days at home.

What about Hong Kong? The me­dia quoted 70-year-old Dr Yeoh Eng-kiong, for­mer sec­re­tary for health, wel­fare and food: “When I pass away, I want to be at home... you know how crowded a hospi­tal is...” We all share the same thoughts.

How­ever, to pass away at home in Hong Kong ac­tu­ally poses many prob­lems. Pro­fes­sor Joseph Lee Kok-long, mem­ber of the Leg­isla­tive Coun­cil rep­re­sent­ing the health-ser­vice sec­tor, pointed out that less than 3 per­cent of the pa­tients par­tic­i­pated in the Home End-ofLife Care Pro­gramme; the orig­i­nal idea had been to en­able el­derly pa­tients suf­fer­ing from chronic dis­eases to choose to stay at home and en­joy a peace­ful time dur­ing the last days of their lives. The rea­son is that many peo­ple “wor­ried about han­dling death them­selves” if death had not oc­curred in a hospi­tal. In ad­di­tion, peo­ple may worry that the spirit of the dead would at­tach to the home, turn­ing the prop­erty into a “haunted house” and thus af­fect­ing the price of the prop­erty.

On the other hand, with an ag­ing pop­u­la­tion, chronic dis­eases such as de­men­tia are be­com­ing in­creas­ingly com­mon in Hong Kong. Ac­cord­ing to govern­ment in­for­ma­tion, Hong Kong’s ma­jor causes of death, such as cere­brovas­cu­lar dis­ease and chronic lower re­s­pi­ra­tory dis­ease, de­clined from 2001 to last year, whereas de­men­tia in­creased from 2.6 per 100,000 peo­ple to al­most five times that level today. De­men­tia could last for 10 to 15 years and would there­fore put a heavy bur­den on care­givers.

In the US, as many as one-quar­ter of peo­ple die at home be­cause of the huge cost of hos­pi­tal­iza­tion. Ac­cord­ing to Medi­care, the US govern­ment’s med­i­cal in­sur­ance, US cit­i­zens spent a quar­ter of their to­tal med­i­cal ex­penses in their fi­nal year. How­ever, lo­cal re­search also said that the an­nual op­por­tu­nity cost of the US home care­givers was as high as $522 bil- The author is an honorary pro­fes­sor at the Depart­ment of Com­puter Sci­ence in the Univer­sity of Hong Kong.

lion. One rea­son is that a lot of peo­ple gave up their work to take care of the pa­tient at home. The sec­ond rea­son is tak­ing care of the pa­tient of­ten ex­tends to day and night. In Hong Kong, ac­cord­ing to a sur­vey by the Depart­ment of So­cial Sci­ence of the Univer­sity of Hong Kong and the Hong Kong Coun­cil of So­cial Ser­vice, within the fi­nal six months be­fore pass­ing away, el­derly peo­ple on av­er­age are ad­mit­ted to hospi­tal three times for a cu­mu­la­tive 28 days. You can imag­ine how hec­tic the care­givers can be. As such, they are prone to suf­fer from care­giver syn­drome.

A Stan­ford Univer­sity study found care­givers suf­fer from great men­tal stress, ir­ri­tabil­ity, guilt, and so on — they are more likely to have de­pres­sion and suf­fer from ill­ness. As a re­sult, they may die ear­lier than the pa­tient — this is the case for 4 per­cent of de­men­tia care­givers.

In the 2015 Qual­ity of Death In­dex pub­lished by The Econ­o­mist, Hong Kong ranked 22nd among 80 coun­tries and re­gions in the world. It is not pro­por­tional to our high per capita in­come — which is four times higher than the global av­er­age. Tai­wan ranked sixth glob­ally and first in Asia in the In­dex; Hong Kong needs to catch up, whether in reg­u­la­tions, hos­pice care, ad­vance di­rec­tives or life and death ed­u­ca­tion.

On the other hand, in­for­ma­tion tech­nol­ogy may help — tele­health can re­duce the fa­tigue of both pa­tients and care­givers, big data anal­y­sis helps pre­dict devel­op­ment of dis­ease. A sen­sor net­work at home can safe­guard the pa­tient — in case no mo­tion is de­tected in the bath­room or kitchen for say half an hour, a sig­nal would be sent out to alert the rel­e­vant par­ties. More­over, a part­ner­ship among the pub­lic (the govern­ment), the pri­vate (cor­po­ra­tions and civic as­so­ci­a­tions) and the peo­ple (friends and rel­a­tives) or “4P” could be formed to help im­prove the liv­ing qual­ity of pa­tients and care­givers.

When fac­ing our own mor­tal­ity, ev­ery­one is a novice, so we need to take ex­tra care of it. We came to this world sur­rounded by love, we want to pass away with dig­nity and peace. This is the essence of a peo­ple-ori­ented smart city.

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