As people get older, they have more healthcare needs. Yet are all of the tests and procedures really worth the time and effort to have them done? Are they improving the quality and quantity of life for an elderly loved one or could they be sacrificed without any loss of either?
Healthcare screenings are an important aspect of preventing worst case scenarios in otherwise healthy individuals. By catching diseases in their earlier stages, people can go on to live longer and more active lives, lives unabbreviated by the devastating outcomes of cancers and other healthcare complications.
What, though, if there aren't very many years left? Does an elderly loved one really need all those tests?
Common Health Care Screenings
The most common screenings are aimed at detecting signs of hidden diseases such as cancer, diabetes, heart disease, and other chronic conditions that can shorten a person's life. Screenings that have a high benefit to low risk outcome include routine blood pressure checks, annual lab draws, and hearing and vision screenings.
According to Dr. Howard LeWine, chief medical editor with Harvard Health Publications, screening only makes sense when the process of finding and treating a hidden disease will prevent earlier death or relieve uncomfortable symptoms. What LeWine and other field experts have found is that screening elderly patients who have a life expectancy of 5 or 10 years just doesn't make sense. The quality and length of life usually can't be improved when there aren't very many healthy years left.
Questionable late-in-life screenings could include:
There is no set recommended age to stop receiving health care screenings. Yet medical societies have established guidelines for some of them. Pap smears, for example, can generally be foregone at age 65 when all previous results have been negative. Colonoscopies and mammograms can be foregone around age 75 when the risk is deemed to be average.
Researchers at the University of North Carolina at Chapel Hill's School of Medicine examined data from over 27,000 senior citizens aged 65 and older who participated in the National Health Interview Survey from 2000 to 2010. They discovered that overscreening is common, leading to unnecessary expense and potential harm. The researchers concluded that prostate, colorectal, breast, and cervical cancer screenings were unlikely to provide a benefit to those with limited life expectancies.
Deciding when to stop receiving healthcare screenings for common conditions like cancer is a decision that should be made with a doctor. It is one that family members/caregivers and their loved ones must have an important say in.
"Health screenings can't extend life expectancy to the extent
that living a healthy lifestyle can"
Risks to Routine Screenings
LeWine notes that a fit and healthy 75 year old could benefit from certain more invasive screenings and go on to live longer because of early detection and intervention. A frail 75 year old, however, who might already be struggling with diabetes and heart disease may actually increase the risk of death by having such tests.
Many times when screenings uncover the presence of a mass, surgery is recommended to remove it. There is time spent waiting for the biopsy results and all of the stress that goes along with scheduling, pre-op tests, and yet more waiting. Stress has an adverse impact on overall health, and the risk of complications from the procedure itself are to be considered too. Older people may have a harder time fighting off infection in healthcare settings, and they don't do as well under general anesthesia. They also recover from surgery more slowly than younger people. Some screenings may result in a person being placed on medications that cause even greater risk or have deleterious side effects.
Alzheimer's disease is the sixth leading cause of death in the United States; however, experts are questioning the benefits of screening for the disease. The U.S. Preventive Services Task Force (USPSTF) found that even when screening could identify cognitive impairment associated with the dementias, the medications used to slow down the process of cognitive decline may not be enough to actually enhance patients' ability to function. In fact, more harm may be done in the process. The medications prescribed to slow down the disease carry serious side effects that can dangerously slow the heart rate and increase the risk of falling. Once an elderly person falls the first time, they are at a higher risk for falling again, with all the attendant dangers.
Healthcare screenings are preventive measures, and experts continue to agree that the best preventive measures against disease are exercise and maintaining a healthy body weight. Health screenings can't extend life expectancy to the extent that living a healthy lifestyle can, but even so, life expectancy is difficult to predict. The bottom line is that family members, caregivers, and the elderly person involved should be informed of the risks and benefits of each test so the decision can be made with peace of mind, knowing that quality of years doesn't always equate with more interventions.
LeWine, H. (2014). Many Seniors Get Unnecessary and Potentially Harmful Cancer Tests. Harvard Health Publications. Harvard Medical School. Available at http://www.health.harvard.edu/blog/unnecessary-cancer-screening-tests-201408197371. Last visited June 8, 2016.
Moyer, V. A. (June 3, 2014). Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 160: 791-797. Available at http://annals.org/article.aspx?articleID=1850964. Last Visited June 5, 2016.
Trevor, J. R., Hendrix, L. H., Stokes, W. A., Allen, I. A., Chen, R.C. (2014). Cancer Screening Rates in Individuals with Different Life Expectancies. JAMA Internal Medicine, 174 (10): 1558-1565. Available at http://archinte.jamanetwork.com/article.aspx?articleid=1897549.