Age: Sometimes a Good Reason to Discriminate

Cheryl Clark, for HealthLeaders Media , August 14, 2014

As evidence grows that the risks of harm outweigh the chance of benefit for some procedures on older patients, thoughtful providers are putting the brakes on overly aggressive care for their senior patients.

Three months before my 92-year-old father died, his family doctor diagnosed an occluded popliteal artery in his leg. Dad was cachectic and skeletally thin, barely spoke, and was too weak to move without help.

On top of congestive heart failure and dementia. He also seemed so very, very sad.

Though it wasn't in his best interest, I watched medicine's referral network take over his care. He should see a surgeon, his doctor said. An operation could restore blood flow to his leg and foot. His hopeful wife got dad dressed, maneuvered him gingerly into the car and into the surgeon's office—a very difficult undertaking—one very slow and scary step at a time.

Just say yes, and surgery would be done, they were told. Another perilous trip to the cardiologist to make sure his heart was strong enough. He'd need expensive drugs that promised to rekindle his desire for food. $100 each for tiny tubes of silver medicine for the pressure sores on his feet.

None of it worked.

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6 comments on "Age: Sometimes a Good Reason to Discriminate"

Ira Stamm (9/3/2014 at 9:34 PM)
My paternal grandmother was 101 when she was diagnosed with breast cancer. The surgeons at a prominent academic medical center were prepared to do a mastectomy when my father and his siblings intervened on her behalf. They said No! to the surgery. My grandmother lived to 103 and died from other causes not related to her breast cancer. A good example of academic zeal almost overshadowing common sense.

Steve Pew, Ph.D. (9/3/2014 at 2:56 PM)
While the article points out some good considerations about when to be discerning about treatment it metaphorically throws out the baby with the bathwater by suggesting absolutes. Each patient is different as to how they respond or need different treatments and to suggest that abstinence if good for all is good for one obviates the issue. One example is the hysterical overgeneralization about the use of benzodiazapines. The true harm may be in not using them, carefully monitored. Rather than suggesting that if you are old not to use them at all or categorically rarely one might suggest that the be used when/where needed. There are very simple tests for fine and gross motor coordination and for mental cognition such as the Stroop test to determine whether there are side effects that would impair any one individual. As long as benzos allow the person to get a good nights sleep but do not impair daytime motor or cognitive functions then they should be used. The harm of sleep deprivation may far exceed the diligence to balance medication use. To suggest that their use results in falls and car accidents is careless caution and no evidence to support that on a case by case, individual basis. If you've seen one patient you've seen one patient (not all)

John C (9/3/2014 at 2:15 PM)
How about the flip side? I have a mother who is 94 years old and her mother lived to be 104. My mother suffers from A-Fib. I believe that she would be a great candidate for ablation therapy; but, the physicians say it is too risky for someone her age. So she suffers from shortness of breath and fatigue and can no longer bowl or work in the garden as she loved to do until just a few short years ago. It brings to mind the orthopod that didn't want to replace my grandmother's hip at 72 years old because " much use is she going to get out of it." At the age of 96, she needed another because that one had worn out and she lived her last 8 years with that hip pain. Sometimes, the reward DOES justify the risk.




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