Over treatment is a persistent problem among the aging population. Elderly people commonly have multiple medical issues and therefore are more likely to have more than one doctor involved in their medical care. Research shows that the more doctors an individual has, the more likely they are to be prescribed conflicting medications and undergo unnecessary procedures. The problem is that, for elderly people, unnecessary tests and surgeries can have dire consequences.
Common Types of Overtreatment in the Elderly
In an effort to encourage honest, informed communication between doctors and their patients, the American Board of Internal Medicine (ABIM) created “Choosing Wisely,” a campaign that enables different medical societies to create lists of “Things Physicians and Patients Should Question.” The initiative contains information and recommendations from about 50 different national medical organizations, including the American Geriatrics Society (AGS) and the American Medical Directors Association (AMDA).
The following five treatments and tests are common recommendations for aging adults, but the “Choosing Wisely” campaign cautions physicians, seniors and their family caregivers to carefully consider the benefits and drawbacks of each before making a decision. Keep in mind that each patient is different. While these interventions do come with risks, they may be necessary for some seniors.
Anti-Psychotic Medications
Both the AGS and the AMDA advise that antipsychotic medications, such as quetiapine (Seroquel), risperidone (Risperdal) and olanzapine (Zyprexa), should not be given to people with dementia unless other nonpharmacologic methods of managing anxiety and dementia-related behaviors have already been attempted. “Antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm,” says the AGS in a statement. The effectiveness of these prescriptions vary, depending on the individual and the type of dementia they have. Medical professionals and elder care experts have hotly debated the effectiveness of these drugs, trying to tease out the specific benefits for people with dementia and weigh them against the side effects, which can include confusion, incontinence, dizziness and even an increased risk of sudden death.
Cholesterol-Lowering Drugs
While undoubtedly beneficial for middle-aged individuals and those with certain heart conditions, cholesterol-lowering medications called statins may not help those in their 70s, 80s and 90s, according to the AMDA. As with all drugs, statins carry certain risks, including muscle damage and weakness, neuropathy, increased risk of falling, and cognitive impairment. The likelihood that a person will experience these side effects tends to increase with age. Research also indicates that low cholesterol may actually be detrimental for some older adults.
Colorectal Cancer Screenings
Regular colon cancer screening is recommended for most people age 50 and older. Those with irritable bowel syndrome (IBS) or a family history of colon cancer are urged to start testing sooner. However, experts are questioning the value of these invasive exams for older adults, especially since the risk of complications from colonoscopies increases with age. The American College of Surgeons (ACS) suggests that each person’s situation be evaluated on an individual basis to determine whether a colonoscopy would be beneficial. For those with no family history of colon cancer and who have a life expectancy of less than a decade, the risks of undergoing a screening may outweigh the benefits.
Feeding Tubes
For people with severe dementia who can no longer eat on their own, percutaneous feeding tubes are sometimes recommended to ensure adequate nutrition and avoid aspiration. However, the AGS, the AMDA and the American Academy of Hospice and Palliative Medicine (AAHPM) all caution against the insertion of feeding tubes for patients in the later stages of dementia. Instead, they suggest oral assisted feedings as the preferable option. “Contrary to what many people think, tube feeding does not ensure the patient’s comfort or reduce suffering; it may cause fluid overload, diarrhea, abdominal pain, local complications, less human interaction and may increase the risk of aspiration,” according to the AMDA.
Benzodiazepines
Often prescribed for anxiety and insomnia, benzodiazepines, such as alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan) and other sedative-hypnotic medications, can have a profoundly negative impact on an older individual’s health and safety, cautions the AGS. The negative side effects of these drugs are enhanced in elders, putting them at greater risk for falls, being hospitalized and getting into an automobile accident. The AGS recommends exhausting all other options for treating chronic sleeplessness and agitation before turning to these types of prescriptions for relief.
Communication Is Key When Making Healthcare Decisions
Making medical decisions is a difficult process that involves a meticulous assessment of risks and benefits. Luckily, informed consent policies require health care professionals to make sure that their patients (or those who are acting on their behalf, such as a medical power of attorney) are comfortable with the suggested course of care. However, it often falls to patients and their caregivers to ask questions and gain a thorough understanding of their medical options.
Doctors may not always provide complete information about a treatment plan voluntarily, and they may not be aware of what each patient’s goals and concerns are. Fostering open communication with medical professionals is crucial for avoiding unnecessary health care and costs. The following questions can help patients decide whether a particular test, procedure or medication is necessary.
- Why is this necessary? It’s important to understand the reason why a physician has ordered a certain test, procedure or drug. Getting a doctor to describe the logic behind their decision will either put your mind at ease or raise red flags about the validity of their suggestion.
- What other options are there? Sometimes there is more than one way to conduct a diagnostic test, perform a surgery or treat an ailment. Asking about all the possibilities will allow patients and caregivers to make more informed decisions.
- What’s next? Understanding the follow-up care for a particular test or procedure can help you decide if it’s worth going through with it. For example, deciding whether to subject a senior to cancer screenings like colonoscopies and mammograms is a dilemma for many family caregivers. Some choose not to pursue testing for their loved ones because even if they received a diagnosis, they would be too frail to benefit from harsh treatments like chemotherapy, radiation therapy or surgery or would refuse them altogether. In these cases, such testing would cause unnecessary discomfort and added expense.
- What are the risks of following this treatment plan? Every medical procedure, no matter how innocuous, comes with risks. Understanding possible complications, their likelihood and their effect on a senior’s health is essential to making an informed decision about a test or procedure.
- What are the risks of not pursuing this treatment plan? Sometimes playing the devil’s advocate can be useful. Ask the doctor what could happen over both the short and long term if a certain test or procedure is not performed.
The best way to prevent a loved one (or yourself) from receiving unnecessary medical treatments is to have an honest dialogue with the doctor. Above all, don’t be afraid to ask questions about a physician’s recommendations or seek a second opinion.