We live in an age in which health care spending has come under close scrutiny, and rightfully so. But how will we decide such issues when dealing with the elderly. What I would NOT want to see are decisions based on age alone. There are protocols being generated by large groups of advisers suggesting that colonoscopies should not be performed on patients over the age of 75.
I fear that such arbitrary declarations fail to consider the mental and physical status of any particular patient. Patients vary enormously as they age. Some are mentally and physically quite vibrant and functional well into their nineties. Others suffer from such debilitating cardiovascular/pulmonary or cognitive disabilities in their forties or fifties that a colonoscopy would be inappropriate.
Allow me to offer one particular example which illustrates my point. An 87 year old woman literally bounded into my office requesting a colonoscopy. “My primary doctor detected an iron deficiency anemia in me and I believe I probably have colon cancer. I need a colonoscopy”. I was a bit taken aback by her forthright approach and obvious excellent physical and mental state of being. “Besides, my sister had colon cancer.” I performed the procedure and did, indeed, find a colon cancer. A CT scan did not reveal evidence of metastases and we discussed a surgical option. “I’m all for it”, she said “let’s go for it!”
I referred her to a local colo-rectal surgical group and spoke to the surgeon before her visit. I alerted him to the fact that she was 87 but asked him to evaluate her on the basis of how she seemed to him. He agreed and soon scheduled her for surgery. She did great and was out of the hospital in about four days. There was no requirement for chemotherapy in her case.
So here was an individual patient who was clearly of such physical and cognitive functionality that her life expectancy might easily allow her to reach 100 with exceptional quality of life. A colonoscopy in her made perfect sense and she has every expectation to life many more years as a result of what transpired subsequently.
So, while motivated by a desire to reduce health care expenditures, let us be cognizant of the unique nature of each individual and avoid placing artificial limitations on testing based on age alone.
That would be age discrimination at its worst.