Medical treatments don’t always reflect the wishes or goals of older seniors, and some procedures aren’t a good idea at older ages, according to a new study from the Dartmouth Atlas Project, part of the Dartmouth Institute for Health Policy & Clinical Practice.
The report, “Our Parents, Ourselves: Health Care for an Aging Population,” identified five types of care that either aren’t recommended for older adults or aren’t always what seniors wish for their own care. Two are screening tests, embraced as important preventive procedures for younger people but often viewed as more risk than they’re worth for frail elderly.
Even the U.S. Preventive Services Task Force, the nation’s leading body for screening recommendations, has urged seniors to refrain from PSA tests and mammograms, saying the former isn’t necessarily beneficial and the latter may be risky for those age 74 and above. New balance needs to be established between preventive tests and the risks and advantages they have across ages: “An aging population will also create new opportunities for organizations to align care with patient preferences and refocus attention on quality improvement programs that follow age-specific guidelines for treatment and screening,” the report states.
The other three treatments identified by the report involve end-of-life care. HHospice care services are being accessed too late, with 17 percent of Medicare beneficiaries dying just three days after entering hospice, the report found. Since Medicare covers hospice benefits for those who are expected to live six months or less, many people are waiting far too long to make use of hospice care, undermining the benefits of end-of-life care versus life-prolonging care.
Conversely, more older adults are spending their last weeks in an intensive care unit, a rising trend, the report noted. Some blame the medical community for the failure to communicate the inevitable progression of a disease, allowing the families to pursue life-prolonging treatments instead. “If you unleash an oncologist who does not know how to say, ‘Your cancer has progressed,’ but they know how to say, ‘I know what we can try,’ that’s why people end up in the ICU with feeding tubes,” Diane Meier, MD, director of the Center to Advance Palliative Care, told Kaiser Health News.
Finally, the report concludes, too many people with dementia are being given feeding tubes, which carry high infection risks and may not be what the patient would want. Worse, the feeding tube does nothing to improve the patient’s condition: For those in the latter stages of dementia, the lack of interest in food and difficulty in eating is a natural part of the disease progression.
Read the entire Dartmouth report here.