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Stop treating 90-year-olds as you would 70-year-olds

September 22, 2017

There are five subgroups for adults. But all Americans 65 and older — including the two fastest-growing segments of our population, the 80- to 90-year-olds and those over 100 — are lumped in a single group, as if bodies and behaviors don’t change over the last half-century of life.


Just as we don’t confuse toddlers with teenagers, or young adults with their middle-age parents, so, too, are we able to distinguish 70-year-olds from the nonagenarians a generation ahead of them. Those two groups — the “young old” and the “old old” — don’t just differ in how they look and spend their days; they also differ biologically.


Studies have shown that procedures used to treat common urological conditions not only had no efficacy in frail older men but also caused permanent functional decline and death. Older patients with acute myeloid leukemia have also been found to benefit less from treatment. And changes in the kidneys, heart, skin and other organs steadily decrease older people’s ability to tolerate chemotherapy and radiation. There are simply different risk-benefit ratios for older adults; the frailest and oldest often incur all the immediate harms of treatments, from prevention to intensive care, without seeing the benefits.


The sad fact is that we frequently don’t know how to best care for the old. Treatments rarely target older adults’ particular physiology, and the old are typically excluded from clinical studies. Sometimes they are kept out based on age alone, but more often it’s because they have one of the diseases that typically accompany old age. And yet we still end up basing older people’s treatment on this research, because too often it is all we have.


Equally troublesome is the failure of studies to measure outcomes that reflect older people’s priorities. Most would rather live comfortably and independently for a shorter time than live for a slightly longer time confined to a bed or nursing home.


Life is a three-act play. It’s time our medical system reflected that truth

Images Courtesy PIXABAY


The column was originally published in The New York Times Opinion section

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