Dear Carol: My mom is 78 and she’s thrilled because her doctor told her that since she’s over 75, she’s done with taking colonoscopies and “a bunch of other tests.” I was alarmed, but she said that there’s not a lot of good to be gotten from the tests at her age, and there are risks in having them.
Mom is healthy and I want to keep her that way. What if she develops colon cancer? Granted, she has no sign of any problem with her test last year, but the possibility still worries me. Is this policy just to save the health insurance companies money or is this ageism because older people aren’t valued? As you can tell, I’m upset and even angry with my mother for accepting this idea without a fight. — KO.
Dear KO: I can understand your alarm and would be as angry as you are if I felt this was simply a cost-saving step, or worse, active ageism. However, this has been the prevailing policy for many thoughtful clinicians over the last few years and is, in fact, one that I like.
Let's look at colonoscopies since you specifically mentioned them. Apparently, your mother’s had colonoscopies regularly with negative results. What they are considering here is her age and her history of negative test results balanced with the risks of the tests. In other words, given her history, her risk of creating a problem such as a perforated bowel or a reaction to the anesthetic is likely higher than her risk of developing symptoms from colon cancer over the next 10 years. Obviously, your mom could live well beyond the next 10 years, but 10 years is what's used as a guide.
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It’s important to understand that your mom not having colonoscopies does not mean that nothing is done. The doctor will likely order periodic stool tests to detect possible problems. Should a stool test show cause for concern, the doctor would discuss with your mother the risks and benefits of a colonoscopy. The big question will be whether or not she is healthy enough at that time to withstand treatment such as surgery and chemotherapy and/or radiation if cancer is found.
To aggressively treat cancer symptoms with treatments that will lower quality of life over the short term should be an individual choice at any age. For older adults who have a limited life expectancy due to accumulated years, this is a major point to consider.
We all must remember that medical tests can be of enormous value, but few are risk-free. Also, of course, they are expensive, and it’s not discrimination to consider health costs in general. As long as there are older people who want every test available when it comes to their health, they should have choices. However, part of choosing should be the freedom to say no.
Your mom needs to maintain open communication with her physician. If she has any doubts about age discrimination, she should obtain a second opinion.
Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at www.mindingourelders.com. She can be reached through the contact form on her website.