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Warning against surgery age limits

Thousands of older patients are needlessly dying because they are being denied treatment on the grounds of their age, a report has found.

Surgical treatments, which can prolong life and improve living standards for older patients, have been shown to steadily decline as patients get older, the research suggests.

But as the population ages and people are living longer lives, doctors have a “moral duty” to properly care for older patients, according to the Royal College of Surgeons.

They said that surgeons should no longer look at a patient’s age to assume whether they are suitable for surgery, instead their overall health should be taken into consideration, according to the report written by the RCS, Age UK and MHP Health Mandate.

The report found that surgery rates decline for people as they grow older for a number of treatments including breast cancer operations, joint replacements, prostate cancer treatments and hernias.

While the incidence of breast cancer peaks in patients aged 85 and older, surgery rates decline sharply from the age of 70, the figures indicate.

Pensioners are the main group to receive hip and knee replacements but the rates of surgery in England dropped sharply in patients over the age of 70, according to the data which examines the number of operations between 2008 and 2011.

The research also found the number of patients who receive treatment for prostate cancer plummets after after patients reach the age of 70.

Michelle Mitchell, charity director general of Age UK, said “When it comes to peoples’ health, their date of birth actually tells you very little.

“A healthy living 80-year-old could run rings round someone many years younger who does not share the same good health. Yet in the past, too many medical decisions we believe have been made on age alone with informal cut-offs imposed so that people over a certain age were denied treatment.

“This report shows the large gap between the number of people living with a condition or health need and the surgery rates to treat older people.

“We would like surgeons and other health professionals to read this report carefully and examine what they can do to ensure that age discrimination is eradicated from the NHS, as legislation now demands.”

The authors of the report said there are a number of possible explanations as to why older people are not getting life-saving treatment.

Doctors are looking at people’s age to assess whether they are suitable for treatment, instead of their overall wellbeing and fitness, they said.

Discussions with patients about possible treatments could be “limited or ineffective”, they add.

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 RCS said.

Clinical factors could mean that the risks of treatment outweigh the benefits or patients could decide themselves to opt out of treatments, the report states.

Professor Norman Williams, president of the RCS, said: “This isn’t about surgeons slamming the theatre door on older people.

“In fact it is alarming to think that the treatment a patient receives may be influenced by their age. There are multiple factors that affect treatment decisions and often valid explanations as to why older people either opt out of surgery - or are recommended non-surgical treatment alternatives.

“The key is that it is a decision based on the patient rather than how old they are that matters.” The authors have made a series of recommendations to ensure that older people have fair access to surgery, including ensuring there are no age “cut offs” which would see older patients denied treatment.

Multidisciplinary teams, including specialists from geriatrics and other hospital departments, should make joint decisions about treatment, they said.

Junior doctors should receive dedicated training for the care of elderly patients and communication with patients to discuss the risks and benefits of surgery must also improve, the authors said.

They also suggest that disease awareness campaigns should be created to make older people mindful about illnesses. For instance, there should be a new campaign to raise awareness about breast cancer in older women.

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.

NHS Confederation chief executive Mike Farrar said: “Age discrimination is not only illegal but goes against all the principles and values of the NHS. Access to NHS services should always be based first and foremost on clinical need, not on age.

“This report presents some worrying figures. We need to look at them carefully to examine whether they are the result of arbitrary decisions taken solely on the basis of age, or because some non-surgical treatments could offer greater benefit, or a patient chooses not to undergo surgery.

“We know that prejudicial attitudes against older people still pervade through society but the NHS and its staff should close the door to such unacceptable behaviour.”

Health Minister Dr Dan Poulter said: “There should be absolutely no place in the NHS for assumptions about entitlement to treatments that are based on age or any other form of unjustified discrimination.

“All patients should be treated as individuals, with dignity and respect, and receive care that meets their healthcare needs - irrespective of their age.

Readers' comments (6)

  • Not where I work, we perform interventions on anyone who will benefit from it - 80's, 90's, we've had patients who are over 100.

    It's about quality of life but obviously everyone needs to be aware of the complications and the after-care that may be needed. People have to respect the concerns of the surgeon and the anaethetist.

    The only people I have seen not want the surgery are the patients themselves. They are the ones who say " I don't want an operation at my age" - the only people I've seen putting pressure on them to have treatment are the relatives.

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  • One can really ask the age old philosophical question 'what is the purpose of life' if it is only to end up dying at the hands of government and NHS rationing and negligent "care"? How often is this put down as the cause of death on the certificates?

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  • I can't say I am fully surprised by this, though it is disheartening. I don't have a lot of experience of surgery, so can't specifically comment. I always consider my experience as a Cardiology Nurse and I remember some years ago we had a patient who was 114 but was as fit as an 80 year old, if not even younger. The doctors looked at this patient's quality of life and then proceeded to implant a new pacemaker in him! To this day, I still can't quite believe it, even though i looked after the patient but, his age was not even considered at all...the doctors merely asked "Would the Pacemaker improve quality of life?". This is a perfect example of quality of life over age

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  • doctors are under so much pressure now to treat everyone, I don't envy them. Whatever they do they get criticised, we as nurses just take the flak.

    why can't anyone just die of old age anymore?

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  • Anonymous | 16-Oct-2012 5:54 pm

    I'm not sure what your definition of dying of 'old age' is?
    "The report found that surgery rates decline for people as they grow older for a number of treatments including breast cancer operations, joint replacements, prostate cancer treatments and hernias."
    I don't consider witholding treatments for these conditions is allowing the patient to die of old age. However, I do believe that some patients may undergo futile treatment, not necessariiy surgery, that prolongs/or creates a poor quality of life without the patient's full understanding of the outcome. That can include some invasive treatments for advanced cancers, where the treatment makes their end of life battling with side effects. Therefore, I do agree with you that sometimes people should be allowed to die of 'old age' with dignity.

    Anonymous | 16-Oct-2012 12:30 pm
    I do get your point, 'what is the purpose of life' when we are expected to keep as healthy as we can, which inevitably leads to an increase in the elderly population, only to be discriminated against when we do become ill. Probably another ploy to save paying out pensions.

    I do find the messages out there are confusing for healthcare professionals, let alone the public

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  • I wonder how long we can keep going with replacement bits, when I am 90 and my heart slows down a bit will I have to have a pacemaker to speed it up and keep me going for another 20 years?

    My heart will slow down because it's been beating for 90 years, naturally at some point it will stop.

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