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Is there an "informal" age limit on surgical interventions?

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29 October, 2012

Is there an “informal” age limit on surgical interventions?

Thousands of older patients are dying because they are being denied treatment on the grounds of their age, according to a report by the Royal College of Surgeons, Age UK and MHP Health Mandate.

The authors of the report suggests doctors are looking at people’s age to assess whether they are suitable for treatment, instead of their overall wellbeing and fitness.

The RCS suggested the NHS £20bn efficiency drive also puts older patients at a “heightened risk” of age discrimination because restrictions may be imposed when healthcare workers balance the cost of treatment against the patient’s life expectancy.

The report comes after new legislation prevents age discrimination within the health service.

If a patient is denied drugs or treatment on the grounds of age they can now take legal action against healthcare providers.

Readers' comments (11)

  • I have come across many older people who do not want surgery due to their age. I've heard may people say "I can't go through all that".

    I hope this report does not make older people feel obliged to undergo operations.

    Is it also unlawful for doctors to deny treatments to smokers, alcohol and drug users, overweight patients on the grounds of discrimination.

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  • Surely its all about risk/ benefit? As for the comment that Drs should look at a persons prior health and wellbeing as indicators for surgery, well, you can be the fittest 90 year old on the planet but it won't ( and don't!) take much insult to swiftly change that!
    Perhaps it is because we are in a more secular world then we used to, but people seem to be far more scared about the prospect of death then was perhaps the case even a generation or two ago. Has this now lead to us keeping people alive at any cost no matter what their physical or mental state, or is it purely down to the threat of litigation? For example, I have yet to meet another nurse ( or layman for that matter) who would want to be resuscitated if they developed dementia, yet almost daily now I see patients with cognitive difficulties ( as well as a myriad of comorbidities) such as dementia remain on active resuscitation orders when earlier they ( and their families) wouldn't have been subjected to this.
    Whilst we do want to do the very best by our patients, having very elderly people undergoing surgery/ resus etc doesn't always necessarily mean that we are doing the best thing for them.
    I suppose this will all come to the head when we have fully privatised medicine in this country. I don't realy know how it works in America, but having dealt with insurers here about leaky roofs, shunts in the car etc, can anyone see the actuaries sanctioning a CABG for a 95 year old? They'll be thinking why waste the money on someone who is statistically likely to die very shortly, that'll be better spent on a 40 year old who needs the same op.

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  • anyone who wants an op who will benefit from it and have an improved quality of life should be offered the opportunity. there are young people who would not benefit from an op, there are old people who would not benefit. medical/surgical intervention is their to help people, it is not there to stop people trying to sue.

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  • tinkerbell

    We once tried and i mean tried to resus a 97 year old because there was no DNR in her notes. As i was doing the compressions and feeling every bone breaking beneath the palms of my hands i asked 'surely we shouldn't be doing this?'. My manager insisted that we had to go on because there was no DNR.

    When the paramedics arrived and made their attempts too without success and it was called after about half an hour they said they did think it a bit strange to be called to resus a 97 year old on a dementia ward.

    If this is not about being sued then i don't know what is.

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  • Anon 12.18pm
    So you would give a 90 year old a heart/ lung/liver/ kidney transplant, after all they are human beings and would benefit from it and have an improved quality of life, and just as deserving as a 30 year old. Sometimes, sadly and ever more prevailing, we need to think about the quantity of life as well as the quality
    Orthopedic surgery, yes, palliative operations, yes, new heart valves, on occasion yes. Anything else needs a very, very long look at.
    Tinkerbell, that is probably the most distressing thing I have ever read by another commentator on here. Your manager needs to be taken out against the wall and shot along with those paramedics. Resus for over half an hour, absolutely vile to do that to a 97 year old, what are you going to be left with even if you are successful after that? Flayed chest, hypoxic brain injury. Next time, if they insist, do 1 cycle of CPR and then walk away...

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  • tinkerbell

    redpaddys12 | 5-Nov-2012 0:03 am

    Yes, I'm glad you think so and can see the 'horror of it, cos others not involved didn't appear to, it left me in a state of shock for sometime afterwards and the lesson i learned from it was to ensure that all the patients on my unit were reviewed for their DNR status pronto cos i never wanted to have to go through that tick box exercise again, thank you very much. I walked around for days telling me colleagues ' that was f**king awful' but nobody seemed that concerned maybe because they weren't the ones involved, or if they were concerned they never mentioned it, but it doesn't take much of an imagination does it to see how awful that was for those involved. Quite frankly that incident should have involved some kind of debriefing and the management should have implemented changes to how we process DNR on our units, but nothing was done except for the actions i took to ensure after that incident that all current patients on my unit were properly reviewed and all new admissions as soon after admission as possible were reviewed. Even though i spoke to every named nurse after the incident i still had to ensure this was actioned myself.
    Talk about practitioners in their own right.

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  • Tinkerbell
    Terrible, terrible experience for you, something that will never leave you. I have had quiet words with a few people, Drs and Nurses, for being a bit overzealous with the chest compressions on the elderly. The ladies especially can sometimes be as delicate as birds, and when you have someone treating them as if they were a 16 stone prop forward it can be so upsetting, there is absolutely no dignity in it at all. The pressure needed may not be much more than what you would need to perform compressions on a child. Instead, presuming that on the slim chance you rescue them, they have fractured or dislocated their sternum or their costal bones, they get a roaring hospital aquired pneumonia and instead of passing away serenely have 2 weeks of getting frailer and frailer before dying.
    Death is the last journey that we all must go on; and whilst it is right to postpone that journey for some, for others it is cruel to stop them taking those final steps. Death can be a monster that has to be slayedor it can be our salvation, a guardian angel to deliver us from further insult.

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  • tinkerbell

    redpaddys12 | 5-Nov-2012 1:29 pm

    thank you for your understanding. In a novel i'm reading, latest by Lee Child, there is a sentence that says 'an old man once said 'the meaning of life is that it comes to an end'. It struck a chord with me because i think it is the space in between that counts, it is not quantity but quality, i would rather have a good life than a long life in misery.

    Of course if someones life can be improved by a surgical intervention, regardless of age then they should have it, but to keep trying to prolong life at any cost regardless of outcome and continued suffering can't be.

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  • Having worked in orthopaedic trauma throughout my career age is the one factor which does not restrict surgery proceeding. The oldest patient I have ever known go through repair of their neck of femur was 102 and she went back to her care home relatively well-a remarkable lady who told us 'I have lived through much worse things dear!'

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  • there are plenty of elderly who recover well after surgery and can return, within their own limits to an active and productive life. without it their outlook could be very poor and they may continue to live for a long time. obviously surgery and any treatment must be based on clinical need and the fitness and wishes of the patient. there is also little point in putting a patient through the misery of endless diagnostic tests if they are not going to survive anaesthesia and invasive surgery unless there is a vital need where the risks and alternatives have to be weighed up.

    having seen some of the poor results of resus. I would not recommend it or want it in advanced old age.

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  • I also meant to say in my comment just above this that as far as health care is concerned isn't biological age a greater determinant than chronological age in deciding what treatment is required? It seems that the latter is just a convenient but rather meaningless and very inhumane cut off point to suit any current situation and the economy and used to deny people their rights to treatment or on the other side of the coin having some treatments or screening almost forced upon them. Some people, especially the elderly, will accept this trustingly without knowing or understanding their rights.

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