- The heart valve replacement that is 92-year-old results in a stroke, hundreds of thousands in medical and care costs, and a horrible end of life.
- The partial knee replacement in a mid 80’s patient where they never wake up.
- The colonoscopy in the mid 80’s patient that perforated the colon resulted in a horrible menagerie of medical procedures, and costs to correct a procedure that was inappropriate in the first place based on her age.
- The endoscopy on the patient who is a well-known comedian in her 80s that she never wakes up from.
- The anesthesia worsens the patient’s dementia for a minor decision.
These scenarios are far more common than many of us realize.
Weighing benefits and risks is essential in any patient, but in the elderly, the risks are higher and the rewards are often lower as we all near the end of our lives.
When considering any medical procedure, it is important to assess if the recommended procedure will be something the patient can recover from or if they are nearing the end of their life. This is an important consideration as in many cases, palliative or comfort assistive care is more appropriate than an intervention that creates pain, turmoil, and stress and ultimately can result in medical costs that have no benefit, but instead cause great harm.
The problem is that we are usually ill-prepared for making these decisions as our medical system does little to counsel and prepare us when the time comes.
If someone has cancer and has been just diagnosed, what patients experience is fear, grief, and many other emotions. Those emotions often lead to a search for an answer.
At the end of life, the answer often is that less is more and when does hospice become appropriate?
Most of us are ill-equipped to make these decisions which are often why a living will is in place. The medical system will not make a decision for you that should be rational, as life and death decisions are rarely rational.
On the other hand, the system will often suggest a potentially life-saving decision that can end horribly, when the best idea was palliative or comfort care. In older patients from the mid 80’s on, less is more, and sometimes, the children must advocate when the parent is incapable of making this decision on their behalf. Unfortunately, children may also fall into the same emotional trap too.
It is important to consult not only with the patient’s geriatrician to discuss the benefits/risks but also with a social worker.
In summation, older patients 85 and above are at very high risk of medical interventions, considering their ultimate life span. Less is more is likely to be your best guide when an older patient is having a health problem that may be requiring a realization that they are nearing life’s end. The right to die with dignity is more important than an intervention that may at high risk extend the quantity of life at the cost of their quality of life.