Biggest risk elderly patients face when confronted with an illness is over-treatment

A close friend was struggling with medical decisions regarding his elderly parents. One of them was diagnosed with an unlikely condition, and enthusiastic medics and some family members were gunning for a truckload of interventions. As the human body ages, many organ systems slow down. Aches and pains are common, and so is the propensity to certain illnesses. Some conditions will require an adjustment to lifestyles, and can just be watched without undue interventions.

Other conditions will inevitably worsen with time, but not necessarily to fatal stages. What is required is not a knee-jerk reaction to any symptoms that afflict the elderly, but a balanced response to maintain quality of life. Studies have shown a growing tendency to intervene unnecessarily when the elderly become unwell. The pressure to do something comes from many avenues, not least from family members and friends, but from doctors too. But medical interventions can be harmful too, sometimes making an otherwise stable condition worse. Or inadvertently accelerating death.

The biggest risk the elderly face when confronted with an illness is what is referred to as over-treatment. Some will be harmed by the medications that get prescribed. Others will suffer avoidable hospital acquired infections after a brief hospitalisation. Still, others will suffer avoidable surgical complications, following ambitious surgical procedures that were ill-advised. And a good number will end up dead as a direct result of treatments that may have been over-played. What is required is an objective critique of any proposed medical interventions in the elderly.

A team of specialists should usually be involved, led by a geriatrics physician. A critical balance of benefits and harms of any treatments should be evaluated. 
The anticipated life expectancy should always be part of the equation. Doing nothing may appear incomprehensible, but it is sometimes the better way out, allowing the elderly to live the rest of their days free from avoidable medical misadventures.

I don’t mean that the elderly folk should be left alone to suffer when illness strikes. What is required is restraint from the emotional tendency to push for ungainly treatments. 
And most elderly people can make decisions for themselves, nobody has a right to coerce them into medical interventions that they themselves want to avoid. A clinically stable state is sometimes better than an intervention that has no clear end point. Restraint with the elderly avoids inadvertent harm.  

Dr Alfred Murage is a Consultant Gynaecologist and Fertility Specialist. [email protected]