I accompany many of my clients to their medical appointments and I am often surprised at the number of tests that are suggested despite the person’s advanced age and poor health. Many times, I speak up on my client’s behalf to better understand the risks and benefits of those tests.
I was recently asked to assist a 90-year-old gentleman who had significant weight loss, abdominal pain, and loss of appetite. He was living in a personal care home and was finding it difficult to leave his room or even his recliner. He ultimately ended up in the hospital and his physician recommended a colonoscopy.
Fortunately, I’d already had a discussion with him and his son prior to this recommendation and it was decided that this procedure and the preparation for the test was not worth the risk. He chose instead to elect non-invasive comfort measures and was discharged under the care of hospice.
There is little evidence that screening tests in people over the age of 70 are beneficial. Many of the routine cancer screenings—such as mammograms, PSA test for prostate cancer, pap smears, and colonoscopies—can carry considerable risks particularly for those with other serious health problems such as heart disease and dementia. If routine pap smears have been negative in the past, you should consider only scheduling one if a problem is suspected after the age of 65. The same goes for mammograms and colonoscopies after the age of 75, and PSA screenings for men at average risk—independent of age.
In just a single year, research studies found that 25 to 42% of Medicare patients received at at least one of 26 useless (and potentially harmful) tests. Receiving these tests can actually do more harm than good.
As a consumer of healthcare, we need to become more educated. One resource that will help with decision making is the Choosing Wisely initiative. Patient-Friendly materials were developed by Consumer Reports in partnership with medical specialty professional organizations. For more advice, visit: www.choosingwisely.org/patient-resources, or contact Severino Health Advisors.