PUMPING IRONY: Too Old to Operate?

Researchers have developed guidelines to determine whether elderly patients are strong enough to recover from surgery.

surgery-aging

Shortly after her 80th birthday, my mother paid a routine visit to her doctor. She departed with the knowledge that her body had produced a cancerous tumor in the vicinity of her colon. What subsequently transpired was not what I would call optimal.

She underwent surgery to remove the tumor. Chemotherapy soon followed, and we all watched her waste away.

A bit more than two years later, she was dead.

Aging is fraught with emotional, complicated decisions that don’t always favor the aged. In Mom’s case, there were loved ones who were not ready to see her pass into the great beyond without a fight. It became, in a sense, more about them than about her. And because she always angled in the direction of sainthood, she was willing to suffer for their benefit.

As a result, her final years were not as satisfying as they might have been. But that’s just my opinion.

It’s not my intention to replay a debate in which I refused to engage back then (life is complicated enough); I only want to note some recent research that may help other families — and their elderly loved ones — deal with the same conundrum.

Like my mom, most people in their 80s tend to be relatively frail, which can affect how well they recover from surgery. And because more than a third of all surgical procedures are performed on people over the age of 65, a research team from the University of Chicago and the Medical College of Wisconsin (MCW) set out to create a screening process that would help doctors, patients, and their families decide whether surgery is the best option.

“Patients with frail health have less ability to overcome stressors such as illness, falls, and injury, and have a higher risk of adverse effects from medications, procedures, and surgery,” noted study coauthor Angela Beckert, MD, an assistant professor of medicine at MCW. “If a patient is more robust, with better physical performance and vigor — in other words, less frail — then I believe surgical outcomes would be better.”

The study, published in the Annals of Thoracic Surgery, identified five distinct conditions — unintentional weight loss, weakness, exhaustion, low activity level, and slow gait — that define frail or pre-frail people. When researchers used those guidelines to screen 125 elderly surgery candidates at the University of Chicago Thoracic Surgery Clinic, they discovered nearly 70 percent were probably too frail to recover successfully from an operation.

But with no screening protocol in place, many of them would have submitted to the procedures and risked a variety of postsurgical complications, including lengthy hospital stays, prolonged out-of-home rehabilitation, and a lower quality of life.

“This study indicated that a large number of patients who are candidates for major surgery have important risk factors related to frailty,” explained University of Chicago thoracic surgeon Mark Ferguson, MD, a study coauthor. “Knowing what these factors are can help physicians, patients, and the patients’ families better understand the risks and may motivate them to participate in activities that reduce their risks.”

It’s been almost 13 years since Mom died, so there’s no point in second-guessing her decision to go under the knife. But I think she’d be happy to hear that there’s a movement afoot to help others make those decisions more effectively and maybe let a few old folks live out their final years with a little more joy than what she had in hers.

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