July 6, 2016

Elderly Patient Care: Deciding on Treatment Options

Last week, my friend Brian sent me a link to a blog post, Yes or No to Treatment: The Conundrum of Decision-Making When Elderly.

The blog – Gap Year After Sixty -- belongs to another friend, Sam Harrington, who stepped away from his medical practice to spend some time in Maine, writing. There’s a book in the works, perhaps titled “A Better Death” or perhaps "The Boomer's Guide to the Last Trip." 

Sam’s blog post is about the difficult subject of what to do when an elderly patient is offered a new treatment. Sam includes some technical concepts, like relative benefits vs. absolute benefits, and the number of patients needed to treat vs. the number of patients needed to harm. I found some of those explanations hard to follow. 

But the post also includes a good list of questions to ask the physician of an elderly patient. Sam explains:
Don’t allow your doctors to limit their consultation to the relative merits of their treatment plan. Instead, ask them the following questions:
  • If I were your mother or father, would you put me through it?
  • If I live longer because of the treatment, will the quality of my life be reduced?
  • If I choose the treatment path, am I more or less likely to lose control?
  • Am I more or less likely to end up in an ICU?
  • Am I more or less likely to be in pain?
  • Is doing nothing reasonable?
Focusing only on the positive outcomes of a therapy versus no therapy limits one’s understanding of end-of-life issues to relative comparisons but ignores the absolute bigger picture of success without treatment, failures with treatment, and the inevitability of death coming for all.
 All good questions.

This issue – pros and cons of treatment for elderly people – has been a frequent theme on my own blog. And now that I’ve passed my 87th birthday, it’s more and more an issue for me… and for my family, my doctors, and my medical power of attorney.

Here are just a few of my posts on the subject over the past few years:

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