There’s a concerning trend regarding the elderly and the medical industry. Evidently, doctors and surgeons often fail to convey to their older patients (and their families) what risks their future surgery might pose. Moreover, they rarely participate in consulting the patient and everyone involved in everything related to the surgery. This involves what the patient wishes, what life will be like for them after the operation, and what the optimal course of action is for them.
The problem is compounded by the fact that the elderly frequently want different things from their health than others. According to Clifford Ko, UCLA’s David Geffen School of Medicine professor of surgery, they usually have different goals in mind. It’s not uncommon that their priority is being healthy enough to spend time with their loved ones. They also prefer that their health provide a degree of independence for them. This stands in contrast to what younger people normally seek, that being longevity.
But the American College of Surgeons is on its way to rectifying this issue. The college has issued a standard called the Geriatric Surgery Verification Program. This program aims to allow more involvement from senior patients into their own medical procedures. Patients will have more opportunities to discuss what they want from the surgeries. More effort will also go into explaining to them how their life will be after the surgery as well as how the recovery stage will unfold.
Some changes on the horizon will improve the experience of elderly patients. One of these will be naming people who decide on matters in the patient’s stead in medical records. In case of intensive care, medical professionals will have to detail what interventions await the patients (resuscitation, dialysis, feeding tubes, etc.).
The Current Methodology
All of this stands in stark contrast to the medical methodology in place now. Surgeons and doctors normally explain the illness and how the upcoming surgery should alleviate it. They’re also required to inform their patients of the possible complications that could happen during or after surgery.
Ronnie Rosenthal, Coalition for Quality in Geriatric Surgery Project co-leader and surgery and geriatrics professor at Yale School of Medicine, agrees that the current way of things is not sufficiently patient-centric. In her opinion, too often do doctors not take the time to ask their patients what their priorities are.
She recounts a patient of hers that had suffered from rectal cancer. He was eighty-two years old and had undergone a stroke some eighteen months beforehand. As a result, walking and even swallowing was a challenge for him. His wife, meanwhile, had been thrice hospitalized on account of pneumonia, in addition to having congestive heart failure.
Rosenthal made clear to the man that, should she operate on the tumor, he will wind up in intensive care with a breathing apparatus. More likely than not, he would soon afterward need to transfer to a rehabilitation center. He said that he would rather be at his wife’s side than under the knife. He lived for another two years, while his wife passed away six months before he did.
Guidelines for Informing Patients
Harvard Medical School associate professor Zara Cooper claims that only five questions are enough to provide guidance for senior patients. These are:
- What effect on your daily routine does your health have?
- What about your health do you consider the most important?
- What expectations do you have from the operation?
- What worries you the most about the treatment or your health?
- Without which abilities can’t you live?
Zara also has a story similar to Rosenthal’s. Some years ago, an eighty-eight-year-old patient of hers had endured a car crash and ended up in the ER. She and other medical staff told his family that he would become extremely dependent on his family for the most basic of daily tasks. The family replied that this would be terrible for him, especially given his passion for skiing. They decided that he should not undergo the treatment, and he soon died.
Medical Recommendations and Patient Wishes
UCLA professor of medicine Clarence Braddock says that patients’ desires often don’t align with medical recommendations. In fact, her research in 2012 has concluded that well over 90 percent of focus-group seniors would rather that their doctor ask for their opinion and give them choices. However, another study of hers found that orthopedic surgeon would only ask for their patients’ input in regards to decision-making in around 15 percent of cases. And only 12 percent of the time would they make efforts to gauge the patients’ understanding of the operations and its consequences.
Margaret Schwarze, associate professor of vascular surgery at Madison’s University of Wisconsin, devised a method that would better inform patients. The idea is to elaborate to them what the worst and best outcomes of an operation are. This should be explained in simple-to-understand terms. They need to know if there would be pain, if they would require professional care, if they could return home and in what state, and the like. When doing so, the patient will be capable of making more informed decisions about what they wish to do.