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Thread: Adults over 70

  1. #1
    Join Date
    Mar 2004

    Adults over 70


    I came across this article recently and it might be of interest to some:

    If you are past 70, think twice before submitting to optional surgery. At that
    age there's a kind of double jeopardy.

    First, do no harm


    This ancient medical motto needs repeating in an age where the urge to do something, anything, often overpowers prudence. Sometimes doing nothing is the best a doctor can do. True, medicine increasingly offers studies that weigh the benefits of drugs and surgery against hidden risks. Surgeons read us our chances of survival from statistical tables, such as the one on
    this page. What they often omit to say, however, is that surgery can
    derange the mind. Life should be measured by more than duration.

    A 73-year-old Toronto woman recently broke her hip and, rather than resort to a cane, consented to the implantation of an artificial hip. The operation was a success, she healed well and then she suddenly stopped speaking or showing any interest in her surroundings. Weeks later she recovered her mental equilibrium, but it wasn't quite the equilibrium she'd had before.

    A Boston man, 79 years old, whose family had noticed only the beginnings of senility, underwent a total hip replacement. He descended into full-blown dementia afterward. Months later he was better—living at home—but still not well enough to live on his own. He may spend his last days in a nursing home.

    Howard Spiro, a gastroenterologist who heads the program for humanities in medicine at Yale Medical School, has witnessed this phenomenon firsthand, although he concedes that it is hard to quantify or even to prove. "I'm 72, and I see that some of my friends who've had surgery aren't what they used to be," he says. "The [surgeons] will say, 'The patient looks good to me,' but then they don't see what goes on in the home."

    What's the matter? Some doctors put much of the blame on anesthesia and postsurgical painkillers. Another theory holds that clots, which are released into the bloodstream during surgery and the convalescence that follows, block blood vessels in the brain, causing tiny strokes. Old people are particularly vulnerable because their arteries are often partly blocked and they may already have had a number of ministrokes.

    Some surgeons, such as Andrew Warshaw, chief of general surgery at
    Massachusetts General Hospital, argue that some candidates for surgery
    are very sick and that sickness predisposes them to mental problems. "I'll
    expose my bias," he says. "Telling a candidate for prostate surgery,
    'would you rather get up three times at night or risk losing your brainpower'—man, that's really loading the argument. Until we have more reliable data, I would be very wary of frightening people."

    But most geriatricians agree with Spiro in putting the blame on the surgery and anesthesia. "There are patients with absolutely no [mental] impairment, and after their bypass they have it," says Robert Butler, director of the International Longevity Center at New York's Mount Sinai Medical School.

    "I would not recommend casually to patients over 70 that they go for
    surgery," Butler says. "There might be occasions when the discomfort
    from a hip problem might be only minimal, and you don't need a replacement. That's also true of lower-back pain. It's horrible the way some orthopedists rush in to treat with surgery."

    Why don't more doctors warn their older patients of the risk? In good part
    because they simply aren't aware of the extent of the problem. In an
    article in Science & Medicine, Yale's Spiro wrote: "If we think about such
    matters, we may be reassured by studies showing impairment to be only
    temporary, as judged by psychological tests. [However,] no one studies
    amusement, empathy, association, recall of minor events, poetic ability or
    the quirks and delights that account for personality."
    Spiro continues: "Questionnaires and answers from the patients themselves will cast little light, for how do you know when part of yourself is no longer with you?" His advice: If in doubt about elective surgery, don't get it.

    Surgical risk

    Do you really need a new knee? Coronary bypass, Coronary angioplasty
    Hernia repair, Spinal fusion, Hip replacement, Prostate removal,
    Hysterectomy, Disc removal, Knee replacement
    Source: Medicare.

  2. #2
    Join Date
    Sep 2003
    Northern California

    I would hope that everyone, not just those over 70, give very serious consideration to the potential complications, especially when we're talking about elective surgery. I don't know about every surgeon, but I've been with several elderly people when they've discussed scoliosis surgery with their surgeons. One very recently. They were all told that the risk of complications is very high. (The most recent was told she stood about a 50% chance of having a major complication.)

    I always encourage patients to try to get a copy of the disclosure form that lists the potential complications, prior to surgery so they have time to weigh the risks v. the benefits.


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