Doctors Don’t Act Aggressively to Sustain Elderly, Report Says
Doctors have a bias against taking aggressive action to keep alive an elderly patient who is severely ill, according to a government report issued Friday on life-extending technologies.
“There’s an awful lot of ignorance and prejudice ruling decision-making,” said Sen. John Heinz (R-Pa.), who said a doctor stopped providing tube-supplied nutrition for a seriously ill relative without getting the family’s permission.
“We can make modern miracles,” Heinz told a news conference, where a report on life-sustaining technologies and the elderly was released by the congressional Office of Technology Assessment. Too often, however, doctors believe the age of a patient determines his ability to survive a major illness, Heinz said.
Clear Guidelines Needed
Heinz said hospitals should prepare clear guidelines on when to use special technology such as mechanical ventilators, resuscitation and feeding by tube.
The elderly are “just as likely to live after costly illnesses as they are to die,” Heinz said, calling for better consultation among patients, families and doctors.
A patient’s age is a bad basis on which to decide whether someone should be “resuscitated, dialyzed or fed,” said Dr. John Rowe, chairman of an advisory panel to the Office of Technology Assessment.
Rowe posed the hypothetical case of a 70-year-old man suffering from diabetes who had also experienced a heart attack and had had a cancer removed. “You can’t tell me if that man is frail, disabled in a nursing home or sitting on the Supreme Court,” said Rowe, chief of the gerontology division at Harvard Medical School.
Doctors often give their older patients “less aggressive diagnostic care and therapeutic care,” Rowe said. “There is an innate bias against doing too much for older people.”
Many Patients Thrive
Many “individual elderly patients survive and thrive after treatment with a life-sustaining technology,” said the Office of Technology Assessment report.
The elderly as a group have lower survival rates and more medical complications when they are treated with life-sustaining technologies, the report said. However, that may be partly the fault of the medical profession, resulting from “inadequate expertise regarding aging and geriatric care.”
If a doctor believes “an elderly person should not receive aggressive life-sustaining treatment ‘because he won’t do well,’ he is almost certain to not do well,” the report said.
More important than age in determining if a person will survive is the patient’s previous health status and the severity of the illness.
