An Australian doctor believes the country needs to re-think how it treats sick elderly patients in hospital. He calls for more discussion of the issue.
The
outgoing director of an Intensive Care Unit in a Sydney hospital, who pioneered
intensive care medicine, thinks keeping elderly patients alive in hospital – at
the end of their life – may be overtreating them. Older patients are being
treated more intensively and expensively than ever before and “sometimes you
wonder whether it’s the right thing,” Bob Wright, AM, said (Canberra Times,
April 22, 2014). He has worked in intensive care since it was introduced in the
1960s and 70s – for 43 years.
Wright
said that there were elderly people who led an active life and were healthy
that could benefit from intensive care, but there was a “spectrum” of doctors,
patients, and families who preferred to prolong “vigorous” treatment at the end
of a person’s life, even when the patient was “irretrievable.”
Some
questions are: do we save as many lives as we can for as long as we can, even
if it means over-medicating and over-treating people? Is there such as thing as
over-treatment? Does extending their time extend their wellbeing? How do you draw the line between "retrievable" and irretrievable"?
People
over 65 years in Australia are the most expensive age group to treat in intensive
care, in terms of time, energy, and money. The New South Wales Department of
Health has conducted a preliminary analysis that indicates that it costs about
$202 per hour per person over 65 years in the Intensive Care Unit (ICU) – 71%
more than the cost of young babies in neonatal care.
According
to the Australian Institute of Health and Welfare, the number of people over 85
years admitted to hospital increased by 9% a year in the years from 2006/07 to
2011/12. And in another state, Victoria, intensive care specialist Graeme Duke
at Box Hill Hospital in Melbourne analysed data on more than 108,000 elderly
patients and found ICU admissions for those over 80 years of age rose by more
than 3% over 12 years.
But
while the number of patients over 85 years admitted to the ICU is increasing,
the number of admissions of over 65 year olds is decreasing, according to Duke
(from his paper published in the Medical
Journal of Australia). He thinks the reason for the decrease may be because
people from 65-80 years are getting better medical and health advice.
What
are the alternatives?
Duke
thinks perhaps better primary healthcare is preferred over vigorous treatment. Ken
Hillman, professor of intensive care at the University of New South Wales
believes the issue is not about cutting costs, but something needs to change.
“The baby boomers need to change dying and death like they did with birth,” Hillman
said. Baby boomers are those born post war, from 1946 to 1964 – a “bulge” of
births – whose generation introduced family planning and contraception, and are
currently moving (almost en masse) into
their retirement years.
Ben
White, the director of the Health Law Research Centre at the Queensland
University of Technology said some doctors were hampered by legal concerns, and
therefore their only option was to continue treatment for even the most
“irretrievable.” The government in some states have introduced an online
“advanced care plan” which provides information on how to plan medical care for
elderly patients and the Australian Medical Association president, Steve
Hambleton, said better end-of-life planning is required – for the whole
population – with an emphasis on quality of life.
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