A surgery that improves a younger person’s quality of life could easily do the opposite for an elderly patient. Nevertheless, almost a third of Medicare patients undergo surgery in the year before their passing.
An article from Kaiser Health News describes the story of an 87-year-old woman with a “do not resuscitate” directive who received a defibrillator she didn’t want. Government statistics peg the cost of the procedure around $60,000. Medicare paid for it, and the patient went to another cardiologist for a second opinion. That cardiologist, Rita Redberg, M.D., disabled the device and discharged the patient with a home hospice service.
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“We have a culture that believes in very aggressive care,” Redberg told KHN. She also points out the likelihood that an elderly patient may not see the same benefit from an operation, especially if the procedure requires a long period of recovery.
In fact, a 2016 paper (PDF) published in the Annals of Surgery suggests such procedures rarely improve the length or quality of a frail, elderly patient’s life. Amber Barnato, M.D., who teaches at the Dartmouth Institute for Health Policy and Clinical Practice, told KHN that the cost of such surgeries can easily compound, as older patients who undergo an operation within a year of death spend an average of 50% more time in the hospital and nearly double the amount of time in intensive care as others.
As part of the effort to bend the cost curve in healthcare more generally, studies have uncovered substantial numbers of unnecessary or overused procedures. When it comes to the elderly, the procedures also may end up being unwanted and potentially detrimental to a patient’s quality of life. Experts in palliative care stress the importance of talking to patients about their care goals to be sure treatments align appropriately with the patient’s wishes.
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Ultimately, patients need to understand the most likely outcomes of surgery and make an informed decision, according to Margaret Schwarze, M.D., a surgeon and associate professor at the University of Wisconsin School of Medicine and Public Health, who co-authored a 2017 paper on the subject.
“If someone says they can’t tolerate the best-case scenario—which involves them being in a nursing home—then maybe we shouldn’t be doing this,” she told KHN.