Are Doctors Neglecting Their Older Patients?

Leigh Page

Disclosures

February 19, 2015

In This Article

Negative Stereotypes of Older People?

Physicians are often accused of providing too much care to elderly patients at the end of life, but there's evidence that these patients also get far too little care before reaching that point. Years of skimpy treatment for elderly patients in their 70s and beyond impedes their health and may well hasten their death.

Providing care to older patients seems to be a hot-button issue for the medical profession. Medscape's recent 2014 Ethics Survey showed that physicians were divided on whether older patients deserve as much care as younger ones. Whereas about one quarter approved of diverting scarce or costly resources away from older people, many more disagreed.

Meanwhile, Ezekiel Emanuel, MD, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, set off a firestorm of debate on this topic in an essay he wrote in the October issue of The Atlantic, in which he stated that he would decline medical treatment after age 75.[1]

It's well established that elderly patients already get less medical treatment. A 2004 study[2] found that they were less likely than younger patients to get life-extending care, such as surgery and dialysis, even after patients who refused that care were excluded. In a 2001 study,[3] use of chemotherapy for older patients with breast cancer plummeted from almost one half of eligible patients aged 65 to 69 years to 1 in 10 among those aged 80 years or older.

This low use of invasive treatments is not based on poor survival rates. Recent studies show promising survival for elderly patients after chemotherapy[4] and hip replacement.[5] In addition to these expensive treatments, withheld care involves even simple prevention, such as exercise, smoking cessation, home safety, and proper use of medications and alcohol, according to Ronald D. Adelman, MD, co-chief of the Division of Geriatrics and Palliative Medicine at Cornell University's Weill Medical College and New York-Presbyterian Hospital.

"Many physicians don't recommend preventive measures for their older patients," Dr Adelman said. Dan Perry, executivedirector of the Alliance for Aging Research in Washington, DC, put it more bluntly. "The healthcare system fails older people," he said. "Many doctors base their treatment decisions on uninformed stereotypes of older people."

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