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Oldest patients get ‘less treatment after surgery’


Patients aged 80 and over are significantly less likely to be investigated or aggressively treated after surgery than those in younger age groups, according to an audit of hospital deaths in Australia.

This is in spite of the fact that the oldest patients have higher rates of trauma and multiple underlying conditions on admission, noted researchers in the online journal BMJ Open.

“There may be a culture of less intensive investigation, monitoring and possible failure to intervene in the elderly group”

Study authors

The researchers assessed data from a national audit of deaths after surgical procedures in every specialty carried out from 2009-12 in 111 public and 61 private hospitals across Australia.

Over 11,000 patients were included in the final analysis. This group was divided into three age bands: 17-64, 65-79 and those aged 80 and above. The average age of those who died soon after a surgical procedure was 78.

Of those who died in hospital, most had been admitted as emergencies (83.4%). Nearly half (45%) had an incapacitating and life threatening disease on admission.

The oldest old had higher rates of admission as a result of trauma or other emergency than either of the two other age groups. But they were treated differently, receiving lower levels of aggressive and expensive treatment, said the study authors.

They had around half the rate (11%) of unplanned returns to theatre of those aged 65-79 (20%). They were also less likely to have unplanned admissions to intensive care (16% versus 24%) and less likely to be treated in intensive care (60% versus 77%).

Surgical care for older patients tends to be complex, which is likely to influence decisions about their hospital care, noted the researchers.

Nonetheless, they said the oldest old had the lowest rate of diagnosed post-operative complications, despite virtually all of them having multiple underlying conditions that are usually associated with a higher risk of problems arising after surgery.

The study authors said: “Our data suggest that there may be a culture of less intensive investigation, monitoring and possible failure to intervene in the elderly group.”


Readers' comments (6)

  • It's sad that we look at the age of a person as opposed to the actual person. I have nursed some of the most fabulous 80-90 year olds, all in excellent health and many coming in for routine mionor ops. How sad they fall into an age bracket that deems them not worthy of further investigation and aggressive treatment.

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  • older people need more after care than other groups and should have what they need

    totally agree with the comment above mine and they are often far more resilient, stoic, less complaining and more appreciative and more rewarding to look after than many younger patients.

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  • Totally disagree with this study. In my experience in Critical Care this group of patients receive the same access to my service because they are deemed to have a reversible component. The majority of these patients have co- morbidities which will potentially make their recovery more tricky post acute event and will mean that they do not return to their pre admission level of health which is unavoidable.

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  • Penny pinchers flying desks is the issue. If I was supported and permitted to use my judgment If I think a patient would do better with more aggressive or expensive treatment then why not? To quote Orwell "I am not a number" and I expect the same treatment for my patients that I would want.

    I bet it'll be different when those making the rules are 80 and come back from major surgery.

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  • Why is it that some people feel they are actually growing younger rather than growing older. Fact is, every person that I know is growing older, not a single one of them is growing younger. Look after your future and the future of each member of your family and friends. Doesn't matter how hard you try, you are simply growing older, guaranteed.
    Set the standard of care now and you won't have to worry about the care you and yours receive in the future.

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  • The sad reality is that we are an ageist society and this is just a mirror on that fact.

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