If the Doctor Recommends Surgery for Your Elderly Parent, Should They Say Yes?
The Centers for Disease Control and Prevention has estimated that 51.4 surgical procedures were performed in 2010. Of those, over one third (38%) were on patients age 65 or older. As the U.S. population ages, the number of surgeries recommended for older patients will only increase.
Let's say that your elderly family member is of advanced age and perhaps they are already suffering from various health issues. If the doctor recommends surgery, what do you do? The reflexive response may be "yes," since we assume that doctors know best. But, do doctors always consider the unique characteristics of older patients when suggesting invasive procedures?
JAMA’s Surgical Decision-Making Framework for Older Patients
Earlier this year the Journal of the American Medical Association (JAMA) published a helpful surgical decision-making framework targeted at older patients. It is comprised of three basic questions:
Will surgery prolong my life?
How will surgery affect my quality of life?
Will surgery allow me to preserve my independence?
I wish that I had access to this framework before my 83-year old father had aortic valve replacement and coronary bypass surgery. Doctors often classify outcomes as "successful, " if they result in prolonged life for a patient, regardless of the resulting quality of life or impact on independence. Our family's deliberations might have been very different, if we had communicated to doctors that our definition of a "successful outcome" was only possible if we could answer "yes" to all three questions.
The ACS Geriatric Surgery Verification Program
Fortunately, the medical community is beginning to recognize that a surgical procedure that might be "routine" for a healthy person of 40 or 50, may be very different for an older adult. The Coalition for Quality in Geriatric Surgery is a project sponsored by the American College of Surgeons and the John A. Hartford Foundation. The goal is to develop standards and outcome measures which recognize the unique physiological and social needs that aging surgical patients have.
Finalized standards will be released in July 2019 at the ACS Quality and Safety Conference. Looking ahead, hospitals will have the opportunity to participate in a voluntary initiative called the ACS Geriatric Surgery Verification Program.
Tips for Caregivers
Use the JAMA surgical decision-making framework. Before speaking with the medical team, have an honest discussion to clarify what quality of life means for your loved one. In this conversation, you should also explore how important independence is to your loved one. Would they be willing to accept limited independence in exchange for prolonged life? These are tough discussions, but they are one of the only ways to ensure that medical treatment is in alignment with your loved one's wishes.
Communicate with the clinical team about your family member's personal goals. Be prepared to push the doctors for clear information about whether their proposed treatment is consistent with these goals. I've found that the default mindset for many physicians is to treat, no matter what the outcome.
If your family member opts for surgery, look for a hospital that has adopted the ACS Geriatric Surgery Verification Program. Since this initiative is in its early stages, it may be some time before implementation is widespread. However, it's still worth asking your hospital if they are aware of the program.
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