Addie, an 86-year-old woman, was hospitalized with an acute intestinal bleed. Addie had been bedridden for many years, by choice. She preferred to lie in bed and watch TV than do prescribed exercises. She politely refused all efforts to get her to be more active. She was pleasant, even humorous, and insisted on doing things her way.

Within a day of her hospitalization, the young surgical resident advised Addie’s family, who lived at some distance, that “the only option” was to remove her intestines. Addie refused this option, stating that she was ready to die rather than have such surgery. Psychiatric consultants were brought in and they obliging reported that Addie had dementia and was not capable of making her own decisions. The nurse care managers of ElderCare Solutions reviewed Addie’s likelihood of recovering from such a  radical intervention with her son who also held her Power of Attorney for Health Care. Addie’s son made the decision to take a “watchful waiting” approach and decline the recommended immediate surgery. Within a couple of days, Addie’s bleeding stopped and she returned home, intestines intact, to enjoy a hot dog on her birthday a week later. She stayed in her home for another year where she died of an illness, unrelated to her intestinal bleed.

This tale dramatizes the need to slow down the process of medical decision making to take a holistic approach to the question “what are we trying to accomplish?” There is seemingly no end to the number of tests, procedures or medical interventions that can be offered by modern medicine. Such an abundance can be a blessing or a curse. Because an intervention is available begs the question, “should it be done”? These questions deserve discussion in all instances, but are most apt, and even urgent, when the recipient of care is an older adult. The ethical imperative of medicine to “do no harm” has particular meaning when applied in the last years of life.

Slow Medicine offers such a path of care, one that is particularly suited to the needs of older adults.  Most interventions are not of an emergency nature in which rapid decisions need to be made. Most — “should I take this medicine,” “should I have this test” — can be made after discussion of the risks and benefits and consideration of “what are we trying to accomplish?” Such conversations best include a consideration of family and individual values. They provide for a balance between the mind, the heart and the purse. Even though one may feel hurried, health care decisions rarely need to be made in haste and are often best made around a kitchen table rather in the doctor’s office. It is ok for an older adult or a family member to ask for and to take time to deliberate. It is the older adult’s time table that matters most, and decisions can be paced to accommodate the proper processing of information to make the decision that best fits the individual’s circumstances and desires.

Slow medicine is not about “giving up”, but about “letting go.” At the end of life, when “even the gentlest of breezes can knock one off the precipice” there can be a thoughtful and active choice to “go  slow” or even “do nothing.” Slow Medicine is less about medical interventions and more about building relationships that encourage and support the often very hard work older adult’s face of graciously accepting help and care. The Slow Medicine approach is one that communicates, “you will not be abandoned” even if little more is offered. For very often, and in the end, what is needed most is the caring presence of others.