When I told my mom about the next medical procedure I had planned for her, she replied, “Enough with the doctor’s visits.”
She is right. For the previous six months, I had arranged for her to be interviewed and examined by an army of medical professionals, including an audiologist, a geriatrician, a physical therapist, and several specialists at the Aging Brain Center at Montefiore Medical Hospital in Yonkers, New York. She wants these dates to stop.
In my defense, I was hoping for solutions to the age-related problems she suffers from. In her defense, the geriatrician said my mother was relatively healthy for a 90-year-old woman and recommended that she take a daily vitamin containing iron, vitamin D, and calcium.
It was also necessary to get hearing aids. So were further trips to the Center for the Aging Brain. The last doctor to see her at the center gave up medication because the side effects were harmful. He said he believes her lack of hearing contributed to her mild cognitive decline.
This doctor noticed that my mother was shuffling her feet when she walked and recommended that I take her to a physical therapist. The physiotherapist gave her the option to walk alone every day or come to the therapist’s office three times a week and exercise at home daily. My mother chose to walk.
Do you really need a colonoscopy at 80 or 90?
“This isn’t a one-size-fits-all yes or no answer,” says Dr. Suneet Singh, emergency physician, assistant professor at the University of Texas Austin Dell Medical School and medical director at CareHive. “You have to look at your age, your health and your goals in life. You need to talk to your doctor and ask, ‘Why are these tests being ordered?’”
“Do you have a history of cancer?” he continued. “A colonoscopy can look for polyps. Most are benign, but some can eventually become cancerous, and early detection is where cancer treatments work best.”
Like other doctors, Singh discusses the risks and benefits of surgery and other medical procedures with his patients. “I also talk to them about their goals in life,” he says. “If you’re in good health in your ’80s and ’90s and you want to see your granddaughter walking down the aisle, then yeah, maybe you’ll get that colonoscopy.”
look at your age “For example, recent research shows that colonoscopies could prevent death from colon cancer in patients with a life expectancy greater than 10 years,” says Dr. Eric Chyn, geriatrician, assistant professor and director of the geriatric medicine grant program at Rutgers Health New Jersey Medical School and University Health/Outpatient Clinic.
For elderly patients in excellent health who are expected to live 10 years or more, Chyn believes colonoscopy “is likely to do more good than harm.”
If a patient is in good health and expected to live five years, the benefit of colonoscopy is unclear, he says. “That’s why a joint decision is particularly important. If the patient is in poor health and less than five years old, a priority treatment that improves the patient’s quality of life would be of greater benefit than a colonoscopy.”
“However, this is not a blanket statement that colonoscopy is never appropriate for older people in poor health,” he says. “If there is a concern about life-threatening internal bleeding, a colonoscopy would still be offered for the purpose of diagnosis and treatment.”
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Undo or stick with it?
Chyn and Singh point to the US Preventive Services Task Force (USPSTF), which maintains an up-to-date list of recommendations for various medical procedures for people of all ages. For example, the task force recommends biennial mammography screening for women ages 50 to 74. After the age of 75, the USPSTF sees little evidence that women need to have a mammogram.
“We consider patients’ medical comorbidities and prognosis,” says Chyn. “We examine the treatment goals of the patients. We empower patients by explaining the likelihood of benefits and harms in the context of their personalized healthcare profile, so they can make decisions that align with their treatment goals.”
The USPSTF recommends against it PSA (prostate-specific antigen) screening for prostate cancer in men aged 70 and older due to potential harms, such as false positives leading to more testing, overdiagnosis, overtreatment, and treatment effects such as incontinence and erectile dysfunction. “Here again, it’s all about talking to your doctor and making an informed decision,” says Singh.
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Do the positive aspects outweigh the negative?
A good example is a proton pump inhibitor, which is great for heartburn. It’s also associated with an increased risk of weak bones and lung infections. “An elderly patient in excellent health may choose to stop taking proton pump inhibitors to avoid lung infections and weakened bones,” says Chyn. “On the other hand, a nursing home resident in poor health may see heartburn symptom control as a top priority.”
Women 65 and older and men 70 and older should have routine bone density tests for osteoporosis. Symptoms of osteoporosis often go undetected until a bone fracture occurs. According to the American College of Obstetricians and Gynecologists, osteoporosis is five times more common in women than in men.
Men aged 65 to 75 with a history of smoking should schedule screening for abdominal aortic aneurysms. Screening can detect an aneurysm before it ruptures.
See also: Do I have to enroll in Medicare if I’m still working at 65?
Too many medications?
“Many older adults take five or more medications every day,” says Singh. “It’s called a polypharmacy. is it too much Again, you need to weigh the benefits and risks by discussing this with your doctor.”
Chyn asks his patients what bothers them most, then focuses on improving his patients’ quality of life. “After determining if it’s important to my patients, I prescribe it or prescribe it appropriately,” he says. “This is another example of shared decision-making and personalized health profiles as the basis for treatment plans.”
Continue reading: Maybe you’re about to become a family carer and don’t even know it
Keep any doctors you see informed about drug side effects and to find out if your new prescription will interfere with an old one. You can also look at those from the American Geriatrics Society List of beerswhich publishes inappropriate medications for older adults.
This article is reprinted with permission from NextAvenue.org© 2022 Twin Cities Public Television, Inc. All rights reserved.
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https://www.marketwatch.com/story/do-you-really-need-all-those-medications-tests-and-doctor-visits-11659713027?rss=1&siteid=rss Do you really need all those meds, tests, and doctor visits?