Monday, June 04, 2012

How old is too old?

How old is too old?

It seems like at least half of our population in the ER these days is over 80, many into their 90's and even 100. Yup, grandma and grandpa are living a lot longer these days. With age, comes inevitable medical problems. Like heart attacks, strokes.

Its a wondrous medical world these days with sophisticated medication and technology available to extend or save your life. They are expensive too, of course and risky. It forces the question: Should the very elderly be kept alive with technology? Should a 90 year old be intubated? Should a 92 year old get TPA? Should a 89 year old have a AAA repair?

These type of procedures are being done on the very elderly every day. There are times when I am the nurse for a patient who is in their mid 90's and I know that they won't survive, but we go ahead anyway and do all of these interventions. I can't believe what we do sometimes.

Should we be doing it? Is it ethical? Are we willing to pay for expensive interventions for the very elderly as their numbers explode? Get ready for a tax rate of about 50% if it continues as it is now.

We don't deal with death very well in this country. We want to live forever, so as a rule, we don't think about these kinds of situations. We have a hard time even allowing end of life care to be talked about, worrying that their will be "death panels".

We have to decide: Do you or your mom or dad want to be kept alive by machines? Do you or your mom or dad want interventions that are very risky and could lead to worse complications? Those kind of decisions are coming sooner, rather than later.


Frootytooty said...

Very valid point. The population is definitely getting older, which would be fine if they were also getting chronic diseases later, but of course they're not... sigh.

I guess it's different in ED where you have to do everything to save the patient, but in hospitals here there's definitely a cut-off point for age for certain procedures.

Anonymous said...

Thank you for voicing this. It is obvious to many that this type of 'care' cannot continue. We certainly need to be thinking and talking about this before change can be made.

Phiddy said...

As a retired ICU nurse I saw this day in and day out. It was sad because most of my elderly patients never made it out of the ICU. Their families could not say no to whatever intervention was being touted by the doctors. These elderly folk never thought to make a living will themselves. So others made their decisions for them and these most always went against what the patient wanted.
Why can we not let go of those older members of our families whom we love, and let them die a completely natural death? Who knows????

Nurse K said...

Living wills are the biggest joke ever. Even if the patient signs one saying they're DNR/DNI and don't want heroic measures taken for them, the family can just revoke that at any time. It's more like a suggestion versus a document that anyone has to follow. People revoke these all the time in the ER.

Christie said...

Oh, this is such a tough one for me. My grandpa is 92, and hospice for FTT. Extremely forgetful, but alert and knows family.
Obviously he's a DNR--he is hospice. However, when the assisted living facility called saying he had a GI bleed, and I raced over to check him out in time for him to vagal on the toilet as he passed quite a bit of blood, I knew I couldn't let him die like that.
Off to the ER we went. 1 unit PRBC and FFP, fluids, overnight observation stay, and back to the assisted living facility he went. Our family understands completely that this was only a bandaid to what could be a much larger problem, but no regrets. Hospital staff was made aware that we didn't need any testing (so no scopes, CTs, etc) as we wouldn't treat CA. He stayed a DNR, and we did not want pressors or intubation or CPR.

I always thought it would be much more black and white than the decision making process was, though. Knowing what I know as a nurse, I still was unable to NOT treat this GI bleed. Who knows what it was--diverticulum, perfed polyp, huge ruptured hemorrhoid, or cancer. He's been back to himself the last 4 weeks though, and I'm grateful for that.

Unknown said...

My grandpa was cared for at home and had a living will just in case the time came when he needed care by professionals. Our family in it's entirety was present when he had it written and notarized and we all were willing to follow his direction. He died peacefully in his sleep a few weeks later.

These decisions are very hard for families but they MUST be made. There was an article in last week's Time magazine Titled "How to Die" it was a good article. I suggest that everyone read it. It outlined how one family walked through the aging and death of parents in a very gracefully way.

Anonymous said...

Who makes the decision that someone is "too old" to receive "expensive interventions"? Who decides that a patient is too old to survive an intervention?

My mother in her early 80's was rushed to the ER and diagnosed with a bowel perf. The ER physician stated, "If you were younger we would do surgery. Because of your age, we will try to make you as comfortable as possible."

Many years earlier, my mother and I had serious talks regarding quality vs quantity of life. I knew this was something that could potentially be "fixed" without compromising her quality of life and demanded a surgical consult.

In the ER, you only have a short time to interact with the patients and their families. You do not know the patient prior to this "crisis". How can you judge that they are "too old" to receive "expensive intervention"? Remember, age is but a number. Hopefully you will live to be "old" one day. When you do, I hope that your healthcare provider considers all the facts and not just your age.

(BTW - mom had successful surgery and lived many more quality years.)