Debate Continues Over Surgery For Elderly

Doctors, once hesitant to perform major surgery on patients older than 80, are starting to revise the standard of care.

More patients inching toward the century mark undergo cancer operations, open-heart surgery and joint replacements at an age they once might have been told to let nature take its course.

Credit improvements in medical technology, coupled with a growing aging population skewing healthier than previous generations. But advances are not free of controversy.

Much of the concern deals with bioethics, such as quality versus quantity of life and the growing monetary burden on Medicare. There also is the specter of ageism, which suggests doctors put a shelf life on procedures based on a patient's chronological age.

A recent British Journal of Urology International study showed as much as a 52-months-of-life benefit for many elderly who had surgery, provided they did not die from an unrelated disease. However, the overall survival rate for all octogenarian bladder cancer patients differed only slightly (18 months to 15 months) for those who had surgery compared with radiotherapy.

For heart patients, surgery to replace valves or perform angioplasty no longer is rare, says Dr. Robert Kincade, cardiac surgeon with the Sutter Heart & Vascular Institute in Sacramento, Calif.

And patients often receive a mixed message, says Ralph deVere White, a University of California, Davis, urologist. Among elderly men seen by urologists, prostate cancer is even more common than bladder cancer. The latest treatment philosophy for prostate cancer is that early detection in the elderly should not result in surgery. The thinking: Elderly patients will die of something else before the prostate becomes an issue.

So, just because you can prolong an elderly patient's life, should you?

A longtime advocate of rationing health care for the elderly is Dr. Daniel Callahan, co-founder of the Hastings Center, a bioethics think tank in New York. He suggested that, to save Medicare, patients over 80 should not have invasive surgeries.

But the Census Bureau reports that 85-plus is the fastest-growing age demographic in the United States.

The Sacramento (Calif.) Bee