How does age effect treatments

MaryCatherine

I will start by saying that I am in my final months of being 69.  When I read the stories people share, their diagnoses and subsequent treatments I wonder how much age plays a part in testing and treatments.  I am a retired nurse and also had the opportunity to be educated in all levels of Palliative Care courses available at that time, including CAPCE. But that was many moons ago, so things change. I have to say that the education in Palliative Care focuses primarily on cancer, although ALS did get mentioned, but that’s a whole different ballgame. I do remember  attending a large conference, and asking the question “ how much does age effect the spending of health care dollars?”  It was a bit un-nerving to ask a large room of doctors that question, but basically the answer was…same treatment and effort for everyone.  At the time I wondered how true that was. By the end of my career as a Community nurse, patients with life- limiting diseases, age did not seem to be a factor….but life extending treatments were not use liberally, except for ‘comfort measures’. Yes, certainly, some diseases are incurable, but I personally feel that testing, scans, and other means of ‘condition update’ are offered very hesitantly and guarded. The other thing I have personally experienced, that when I was admitted to the hospital, I was asked about my DNR wishes were. The first time I was hospitalized I was asked 3 times, my answer was always the same, but the fact they asked three times, I felt I did not not give them the answer they wanted. They were very nice about it, but I felt if I had a heart attack I would want some intervention.  My thoughts were, I’m going thru chemo, and battling unpleasant side effects, should my life be expendable, if yes, then what’s the point. I understand the DNR covers all scenarios, including, happening upon a person who has stopped breathing for an unknown amount of time.  But, should a person present to a hospital with symptoms of a heart attack, and stop breathing, what do they do when a DNR was established the last time. DNR’ s can be changed in a moments notice.  I hope you see the point I am trying to make here, and I would love to hear your thoughts on this

Strongwoman

@MaryCatherine
  I am hoping that from your post I am answering it correctly but if I am off track, apologies and let me know if there is something I can be more specific on.
  Is your concern how age affects treatment and what treatment protocols are presented to oneself in general? OR Is it that the concern is that when "palliative" that treatments are more streamlined/limited due to the classification one is put in?
  Here is what I know in my own case.
I am 51 and have been deemed Palliative. I have been asked numerous times about DNR's when entering the hospital for my surgery and/or hospital stays as well as what my wishes are as this disease progresses.  My initial answer when I was faced with surgery was a DNR.  I changed my mind that day before I had my surgery through many anxious tears.  My surgeon said "Good as you are far too young and your condition at this point would not warrant not trying to resuscitate you."  From here on out, my wishes are currently no DNR.  If at such time it is evident to myself that my organs are failing me and my disease is progressing there will be a point where I will re-instate a DNR.  I am not currently ready for that.
  As for treatment and palliation, I believe that my team works with my wishes and concerns. I feel that we have a good understanding of one another and they all "know" me well enough now to have established a good relationship.  I like being 'armed' with all of the facts good and bad before I make a decision.  I like to 'sit in' the information and decide for myself what type of quality of life any treatment or medication will provide for myself.  I don't believe they omit anything or treat me any differently based on what we currently know re: my prognosis.  They support me along the way and I am honest with them and my symptoms.  One thing I do know for sure, is there are some things I don't want my family to endure and have let my Palliative Doctor know my wishes.  This is very important to me in case I can't speak and then they will know my directives.  We do revisit this situation a lot as we go along.  It seems redundant in some ways but in other ways it is not.  When being admitted to the hospital, I remember being asked the DNR question down in Emerg, again once I get to a floor/bed and again when the doctors come in.  I do believe it is their protocols they must follow and although repetitive is necessary on their end and I really don't think much about it.
  As for your last comment, I don't know the answer.  My thoughts are this, if your team knows they will follow your wishes. Some people have paper documentation for their DNR's and it MUST be present in order for them to not try reviving you to my knowledge in an Emergency situation.  
  Age is a factor in medicine and treatment for many reasons and I would say if you have concerns that way, discuss them with your team and don't be afraid to ask the question "why" or "what if".  I also ask best and worst case scenarios as well as the "do nothing" category as well.  The question you pose is so hard to answer as everyone is an individual and even with the same diagnosis can have so many other variables that can affect outcomes and treatment protocols.  So I feel that age is a factor but not as a negative only to be able to decide what the best treatment options are for you.
  Not sure if this has helped or not but hope it has.

MaryCatherine

I guess my questions are because I’m unsure why my oncologist has not ever offered any scans to see how I am progressing. The only thing I could think of is that because I am “older”, maybe expensive testing is not encouraged. Also, the fact that my oncologist seems very busy and doesn’t take much time to talk to me. On more than one occasion he just stands in the doorway and doesn’t come in. That is not conducive to a conversation with concerns. Ever time I ask him a question, I feel like I’m bothering him and perhaps taking him away from a younger patient, whom he is more concerned. This has even been said to us. My husband accompanies me to my appt and is with me the entire time. HE doesn’t want me to start a conversation with the doc in case it has an unpleasant outcome. I’m not interested in crying and baring my soul to the doc, he is a gyn/onc and I would like to maintain a professional but compassionate relationship with him guiding my care. I’m afraid to tell him my GP is ordering a complete scan, for himself and the Internist orders. I should not have go feel so apprehensive talking to him about this or anything else related to my condition. The DNR is another matter. I want to be resuscitated as well, so I should be prepared with my decision should I end up needing a hospital admission or surgery. I think the fact that we are all trying to survive and willing to take the unpleasant side effects of our treatment, is a good indication we want to live. Thanks for listening 

HoldingOn

Hello @ MaryCatherine,
when I was recently referred to the local public health palliative services team, I too had a vague sense of being pressured to sign off on DNR despite plans for ongoing active treatment. As I’m scheduled for a surgery soon, I said no; should things go sideways under anaesthesia I DO want to be revived. I’m not ready to give up, not after making it through so many chemo treatments for recurrences. 

And yes, I share the sense that my age (69, the same as you) and disease stage might play a role. My surgery (related to a problem caused by the original debulking surgery and now causing pain and anorexia) was rescheduled three times because “patients with cancer” were considered more urgent. No other details were offered by way of explanation so I really had to give my head a shake at that one.  With the last cancellation I had a long hard think about how we are triaged in a social-medicine society where resources are now limited and need since Covid has increased. 

Are seniors or those of us in end-stage disease considered less important than younger healthier people who still actively contribute to society by way of working and paying taxes?  My experience suggests perhaps yes, although one would be hard pressed in finding a doctor who would openly agree with that. 

Having said all this, you have a legitimate right to ask your oncologist questions about your treatment plans. I believe it’s the norm for patients with OC to get regularly scheduled CT scans and blood tests. How often is something that needs to be discussed with your oncologist. If that’s not something happening you need to be informed of the rationale.  

Prepare for all your appointment with a list of questions (and if your husband accompanies you, ask him to take notes; sometimes there’s so much information it’s hard to remember everything).  On occasion I have asked my oncologist to sit down during an appointment, signalling that our meeting is important to me. Do keep your oncologist informed about any tests or treatments ordered by other doctors; this is information he needs to aware of. I doubt he would question another doctor’s actions. 

When I spoke to my family doctor and oncologist about the ongoing delays with my surgery they both advocated for me by contacting the surgeon. Perhaps your GP could speak with your oncologist to get some clarity regarding his treatment plans?

This is your body and your life; don’t let feeling intimidated frustrate you. You already have enough to deal with, and having some answers might ease some of the worry. 

Let us know how it goes. Take care