Is it worth torturing sick old people if the treatment is more bitter than the disease?

According to Associate Professor Bruce J. Naughton from the University of Buffalo, who works primarily with aging problems, in order to provide optimal medical care to hospitalized elderly patients, the medical community should overestimate the need and expediency of using high-tech methods of treatment.

The problem is that the dependence of medicine on overly aggressive high-tech procedures, often prescribed to elderly patients with bouquets of diseases, eventually often results in poor quality of treatment results, that is, in contrast to what attending physicians should strive for.

For example, the results of many studies indicate that staying in the intensive care unit is often associated with a low level of satisfaction of both elderly patients with several diseases and their loved ones.

Published data obtained in medical institutions across the United States also demonstrate that a number of indicators of poor care, such as late placement in a hospice and transfer from one institution to another within three days before death, are associated with the use of high-tech methods of treating elderly patients with serious illnesses.

Naughton explains that we have an aging society, access to high technology and very high expectations from the capabilities of the healthcare system, as well as a culture that denies the fact that we cannot live forever. However, it turns out that more effort and more technology does not necessarily provide better care.

He also notes that for doctors and relatives of elderly patients, abandoning aggressive therapeutic procedures can be a difficult decision, even if such a procedure seriously worsens the patient's quality of life in the short term and, under many circumstances, cannot certainly have a long-term positive effect.

Doctors often consider it their duty to carry out all possible interventions, but they need to realize that non–beneficial procedures are a waste of time and that in reality their task is to provide optimal medical care, which does not always consist in the use of high-tech procedures.

Naughton recommends that relatives of elderly patients who are prescribed procedures associated with a certain risk adhere to the following rules:

• ask the attending physician to discuss the patient's life expectancy, including its quality;
• to clarify whether there are alternatives to the procedure under consideration? What will happen if it is refused?
• in any case, get the opinion of a third-party specialist;
• make an appointment with a specialist in geriatrics or symptomatic therapy as soon as possible. In some cases, when the patient and his family are fully aware of the risks associated with the procedure, they may refuse it, based on the fact that, despite the increase in life expectancy, it can significantly worsen its quality;
• if possible, conduct short-term testing of the procedure (for example, dialysis) to assess its potential benefits.

Doctors are rarely criticized for deciding to perform any procedures, such as surgery, while the refusal of the procedure often causes criticism. However, the purpose of medical care is to help patients achieve their goals, which in most cases are to maintain the ability to serve themselves in everyday life and not be a burden to their family. Unfortunately, too active interventions often do not bring relief to a person, but, on the contrary, increase his suffering, therefore, each patient should be approached individually, while the attending physician should always think about how not to harm him.

Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru based on Medical Xpress materials:
Better care for some elderly patients means less intervention, says geriatrics specialist.

17.04.2012