If you have elderly parents who may be frail, the idea of a complex surgery should have you concerned. While surgeons often suggest that a surgery may be needed to prolong the life of an older person, most of these surgeries result in poor outcomes, and worse, unneeded suffering for both the person who had the procedures and their families.
For too long, our health system has emphasized the quantity of life over the quality of life. Too many of our elderly are also passed from doctor to doctor and are taking medications that often result in other iatrogenic problems that could have been avoided.
When considering any surgery, a doctor, the patient and their families must evaluate weather the benefit outweighs the risks. In older patients who have illnesses or problems in organ systems, having a surgery can shorten their lifespan and may result in medical complications requiring more procedures, more costs with little or no benefit. While it is true that there may be a medical indication for a surgery, it is also true that the procedure may not be curative and may become a costly boondoggle for the patient, Medicare and offer a poor quality of life.
The argument for end of life counseling when considering a complex surgery on the elderly should always be part of the discussion. The truth is, if a patient was offered this and from a statistical perspective, Medicare would not pay for the procedure or its follow-up hospitalization, would a patient still opt for the surgery? This is an ethical and moral question because many of these surgeries do more harm than good, and many of these patients spend the rest of their lives in pain or under nursing care when the other option may have been palliative.
It is also true that older patients often experience dementia or worsening dementia after anesthesia, which is another reason to question the appropriateness of a complex surgery.
I have seen these side effects first hand with my Dad who had a partial hip replacement after falling at the age of 89 who in recovery experienced a loss of memory and had permanent cognitive impairments. When he was at the end of life and we were told that he had a flailed heart valve, advancing dementia and difficulty breathing, we were offered either hospice or a palliative (non curative) procedure to fix the flailed valve to make him more comfortable. In the end, it extended his life for a couple of months, and he never fully recovered from the procedure. He had the procedure because Medicare paid for it, and it just prolonged his and his families suffering. The surgery and hospitalization cost was absurd with no benefit to the patient.
There are other stories such as the one where a patients mother opted to repair a heart valve at the age of 89 with an open procedure. She spent the next year and a half suffering along with her family. Many of our readers no doubt have similar stories and it is well known that statistically, more people die from hospital procedures than from anything else, which should have us questioning why we allow this as a society.
A surgeons group believes they can change these outcomes with improved hospital standards according to the NY Times. Statistically, 40 percent of the surgeries in hospitals according to the NY Times are performed on people 65 an older. Studies also show that mortalities from surgeries increase markedly after the age of 80. My mom’s friend is a good example of this since who died while having a partial knee at the age of 82 even though she was otherwise healthy.
Better screening procedures for people when they are younger by chiropractors and other complementary types of providers may help older patients who are developing problems function better and as a result, they may never need a knee or hip replacement or even a walker. My dad only needed a walker after his hip was replaced at the age of 89. Too often, these types of providers are under utilized and the limited reimbursement for chiropractors needs to be changed to reduce the cost of visiting these highly effective providers of care. Too few physicians refer these patients as well, increasing the cost of care for all of us who pay into Medicare.
It is important to improve the standards in care for the elderly who are contemplating surgery. It is also important for us as a society when faced with the high cost of care when a procedure can go wrong from risk consider the statistical appropriateness of the care and whether insurance systems should pay for them.