Bias towards elderly who will not go quietly

[Anonymous]

Anonymous wrote:I'm a nurse. There is a lack of understanding of what recovery from major surgery can look like for the elderly. It's complicated by the fact that it can be unpredictable who will do well and who will have complications.

I'm not sure that lack of understanding can be remedied because people prefer optimistic innocence.

In my experience dealing with elderly parent with many co-morbidities, the doctors are extremely indirect. I would much prefer it if they were honest about my parent's situation. Instead we made it all the way to a final pre-op with the surgeon, who took a look at my parent and canceled surgery.

For those who think that healthcare is not being rationed, the surgeon's reasoning was that it would be a waste of resources to take a bet on my parent, instead of providing this surgery to a person who is younger, in better shape and could make a full recovery.

[Anonymous]

I went to the doctor this week and had an RN who was still working in her 80's.

[Anonymous]

Anonymous wrote:I went to the doctor this week and had an RN who was still working in her 80's.

So? I'm pretty sure you would have run out of the office if faced with my grandmother who had dementia at 72. I refused to have my blood drawn by a shakey 70 something year old with someone else's blood all over her lab coat. A head of practice pediatrician in his mid 70s covering at the weekend gave my young kid an antibiotic that could have caused his yet to emerge adult teeth to be discolored for life. After talking to my dentist friend, I had to Google our usual pediatrician to find his home phone number and get him to correct this mistake.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have one employee that is age 70 and working full time.

My parents, at 70, were running a business full-time and traveling the world. Sold the business when they were 78 and now are in their 80s happily traveling between their full-time home, their second home, and their kids' homes as well as taking other trips for reunions or to visit friends. Are they going quietly into the night? Ha. They're more active than many 65 year olds. They're kicking a$$ and taking names, and we fully support it.

Do you ever help them with anything? Or are they 100% independent?

[Anonymous]

Anonymous wrote:I'm a nurse. There is a lack of understanding of what recovery from major surgery can look like for the elderly. It's complicated by the fact that it can be unpredictable who will do well and who will have complications.

I'm not sure that lack of understanding can be remedied because people prefer optimistic innocence.

This is why anyone over 80 should be advised against any major medical intervention. There probably are exceptions but that should be the guideline.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm a nurse. There is a lack of understanding of what recovery from major surgery can look like for the elderly. It's complicated by the fact that it can be unpredictable who will do well and who will have complications.

I'm not sure that lack of understanding can be remedied because people prefer optimistic innocence.

In my experience dealing with elderly parent with many co-morbidities, the doctors are extremely indirect. I would much prefer it if they were honest about my parent's situation. Instead we made it all the way to a final pre-op with the surgeon, who took a look at my parent and canceled surgery.

For those who think that healthcare is not being rationed, the surgeon's reasoning was that it would be a waste of resources to take a bet on my parent, instead of providing this surgery to a person who is younger, in better shape and could make a full recovery.

The surgeon thought your parent would die on the table or be worse off for having had the surgery. That isn’t rationing, it’s ethics.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Absolutely terrible thread title, BTW.

Agreed, it is a disgusting title.

I am an attorney who changed careers and have been working in mostly hospice care for the last near decade. The majority of my patients have been elderly, but some were DNR based on chronic degenerative conditions at younger ages.

I’ve noticed that the majority of doctors are just as uncomfortable as the average person with having conversations about death. They may be more matter of fact about it in their own thinking, but they don’t really want to talk about it with patients. There is a lot of avoidance of spelling things out plainly to people who are avoiding accepting it themselves. Even some doctors and nurses who work in HOSPICE, whose jobs are all about helping dying patients die, sometimes push too far to keep people on the alive side of things even if it means prolonging discomfort.

I can’t agree with your OP at all, not the ugly thread title. The truth is that the situation in American medicine is overwhelmingly the flip side of the coin - we spend astronomically to keep people alive in the final years or months, and often causing much anguish in the process for patients and families alike. All because we can’t talk about death in this country and most folks are terrified of it.

As to your parents OP - this is a well tread area of medical ethics and not some ageism bias of the doctors. When patients are in their 80s and beyond, they are statistically much less likely to fully recover from many procedures and treatments - exponentially less likely than a patient in their 50s, 60s, or even 70s. Same with their statistical likelihood of experiencing complications which hasten greater disability and/or death.

This factors into the physician’s determination of what is in the best interests of the patient, and no doctor is required to perform a surgery or treatment on a patient if they feel it is going against their best interests. Some doctors are skilled at explaining this and others just hem and haw and avoid flat out saying how things are. It has nothing to do with a lack of caring about your loved one. I would argue that there is more caring on offer from someone who nudges you in the direction of recognizing your impending mortality than in steering you toward further denial.

The patient alone determines what is best for them. Physicians may be learned intermediaries but they have no right to decide whether a patient gets treatment or not. They have a duty to explain all options and the likely results of each. If they can’t do that, they should switch to pathology.

Not everyone who resists being “nudged” toward the beyond is in denial. Some just have more hope than the people doing the nudging.

No, patients don’t dictate their care. You can’t just order a doctor to do this or that, if it’s not medically indicated. No wonder so many people are leaving the medical field. You think you can boss them around like they’re your nanny.

While medical arrogance may know no boundaries, it is the physician’s duty to explain options and associated prognoses. Failure to do so is prima facie negligence. What is “medically indicated” is a matter of opinion, and patients have a right to have that opinion and the grounds for it made clear. Hiring a physician to provide services does not create a custodial relationship where the physician holds the power of life and death to be exercised at his or her caprice. Oh, and I don’t “think” I can boss the Great Exalted around, I know I can, and I do.

What is medically indicated is not a matter of opinion. It is evidence based most of the time. You’re going to have a really hard time convincing someone to give you a treatment that isn’t proven to work (ie chemo for specific cancers). You think you can bully you way to a specific treatment, but you can’t. A physician will dismiss you as a patient before they do something that goes against established standards of care.

But you keep on keepin’ on with your big bad self.

[Anonymous]

My experience with my own parents is Dr.s are too afraid to seem ageist and discuss the risks of things like anesthesia with dementia. They seem to walk on eggshells and be extra careful likely because we live in such a hostile and litigious society.

I think we really to take an ethical look at how we advise families of elderly, but sadly the families can be insane like mine and can demand all sorts of life saving procedures for a person living as a vegetable who has already had close to 90 years of a very full life until the last 5.

We had to talk certain family members out of suing when the hospital was clearly in the right for finally sending in hospice and doing what was right.