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More seniors opting out of invasive tests
By MEG HECKMAN
Each decade of Gert Hochgraf's life has brought a new batch of medical tests. She's obediently endured cholesterol checks, mammograms and Pap smears. But she made a decision recently: Her next colonoscopy will be her last.
"I'm 83. Something's got to get you sometime," said Hochgraf, who lives in Concord. "I'm going to put my foot down."
Doctors often hear similar sentiments when patients in their 80s and 90s realize they've outlived the risk of dying from many diseases. Old age will most likely kill them before cancer, heart disease or other illnesses, so invasive tests no longer seem worth the time, money and possible discomfort.
Medical experts recently determined that women over 65 can forgo Pap smears if they've had normal results for most of their lives, but when it comes to other tests there are few clear guidelines. As a result, physicians must balance patient needs, personal experience and fast-developing research about treating the elderly.
"At some point we orientate towards quality of life rather than quantity, and then the patient calls the shots," said Dr. B.J. Entwisle, a gerontologist at the Family Health Center in Concord. "It's a moving target."
Sometimes, it's a question of math: If colon cancer takes a decade to progress, then it might be okay to give up colonoscopies at 80 or 90. In other instances, discomfort becomes a factor. For example, a nursing home resident might have to endure an ambulance ride for a CAT scan. And then there are the people who defy all medical logic, living well into their ninth or 10th decade despite clogged arteries. Do they really need to get their cholesterol checked each year?
Dr. Rick Pollak, who works at Concord Family Medicine, isn't sure.
"Many of the studies that have been done didn't include the elderly and especially not those older than 75," he said. "If you're dealing with someone who is older than 75, you look at their overall health and what their life expectancy is."
Doctors caution that there are some things patients should continue to do no matter how old they are, like getting flu shots, checking for skin cancer and exercising. And they expect firmer guidelines for other procedures as more Americans reach old age.
The job of setting those guidelines falls to the U.S. Preventative Services Task Force, a group of physicians who determine the most effective methods to prevent or diminish the severity of diseases. Recently, they started looking specifically at elderly patients.
"We were scratching our heads and saying, 'Gosh, people have not dealt with this issue very well in the past,'" said Dr. Diana Petitti, the vice chairman of the group and a physician in southern California. "Where do we start?"
Setting a starting age for screening tests is easier, because there's plenty of data on people between 40 and 60. But researchers often have a hard time compiling information on the oldest patients because their conditions are complicated and their mortality is high. This makes doctors loath to cut off tests at a certain age.
"There is a huge ethical issue in withholding services simply because a person is old," Petitti said.
Most doctors agree that, when it comes to the elderly, broad recommendations are more useful than strict rules. And, in many cases, the patient has the final word.
"We've done a very good job of teaching patients that they need things," said Dr. Richard Friedman, who practices at the senior health center at Elliot Hospital. When he suggests older women stop getting Pap smears, some women refuse. "They want to keep having exams because they feel safer that way."
Source: Concord Monitor
Senior Citizen Aticles | Senior Medical Tests
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