Ethics and economic realities: goals and strategies for care toward the end of life

Article Abstract:

In the 1990s and the future, elderly patients with chronic diseases will be the recipients of a large proportion of the medical services in the United States. Health care professionals and planners, as well as economists, are unable to control the rising costs of medical care. In addition, ethical, medical, and economic issues have prompted a need to analyze the goals of medicine. Some important issues include: the quality and quantity of medical care; the type of persons provided with health care; and the necessity of various medical tests and procedures. Studies show that medical expenses are highest in the last year of a patient's life and are due primarily to the costs of maintaining care for very elderly patients with chronic diseases. In addition, the high medical costs of patients who die constitute a major portion of the age-related rise in Medicare costs. Chronically ill and frail patients often require frequent readmissions to the hospital, physician's visits, and skilled nursing facility care. Health care costs appear to vary with cause of death, with cancer incurring higher costs than heart attack or old age. Various recommendations are made for societal programs that would ensure equitable access to adequate health care. Strategies to improve relations between physicians and elderly patients are also discussed. They include: the use of hospices; care coordination; the development of standards for defining life-sustaining therapy; standards for effective care and use of resources; and improvement of prognostic skills. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physicians, Medical professions, Ethical aspects

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Societal effects and other factors affecting health care for the elderly: report of the Council on Scientific Affairs

Article Abstract:

The increasing life expectancy in America has produced a growing population of elderly. The aging of the population is such that a student in medical school today may expect to spend half his time in the treatment of elderly patients, yet few show an interest in geriatric medicine. In traditional societies, the elderly hold power and are regarded as wise. But in technological societies such as our own, the power of the elderly is whittled away, and youthfulness is revered. An especially noteworthy attitude which seems to be developing is that the elderly should receive only necessary medical care. This attitude is a predictable response to the escalation of health care costs, and the belief that limited resources might be better spent on the young, who have more potential to benefit. But while the young are more likely to be productive members of the work force, it is not clear that elderly patients are necessarily contributing less to society than the young. The Council rejects any allocation of medical resources which is based on the perceived value of an individual to society because of age. The Council also applauds the increase in awareness of preventive medicine which seems to be taking place in the United States, and recommends that greater attention be paid both to the role of preventive medicine in the care of the elderly, and to the needs, feelings, and medical requirements of the elderly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aging, Economic aspects, Medical care, Longevity, Life expectancy

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The influence of patient age on the diagnosis and treatment of lung and colorectal cancer

Article Abstract:

Recent studies of women with breast cancer suggest that older patients were less likely to receive appropriate care than younger patients. Some health care providers may associate old age with poor outcome, impaired mental function, and limited life expectancy and subsequently withhold effective treatment. It is not clear whether this attitude is also applied to the medical care of patients with common cancers. The relation between age and medical care was assessed in patients with non-small-cell lung cancer and colorectal cancer. Age was unrelated to the diagnostic tests performed on a patient. Lung cancer patients older than 74 years underwent surgical treatment less often than younger patients. Approximately 91 percent of patients with colorectal cancer underwent surgical treatment at any age. Among patients with colorectal cancer confined to a specific region, radiation therapy to the abdomen was administered less often to patients who were older than 74 years as compared to younger patients. These results are consistent with prior studies suggesting that older patients receive different types of medical care as compared to younger patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Colorectal cancer, Hospitalization, Lung cancer, Hospital care

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