Medicine for older people: treat the person, not just the body

23 Jan 2017




While this is admittedly a bleak, generalised view of modern medicine and some specialities such as general practice, geriatrics and palliative medicine do transcend this model, my experiences of hospital-based medicine give me reason to examine its effects.

I have always assumed older people were just like me, except older. As time goes on, fewer are older and more are younger. We all want the same things. Long productive lives, fulfilling relationships and to be able to do things. It is only as we age that we begin to understand the value of independence. It is invisible to the well and young.

Palliative medicine has shown me that people value their independence more than their lives. While discussions about death are often met with stoic indifference, rarely do people facing loss of independence remain unmoved.

Medical intervention in older people has the same aims as that in younger people. To cure, maintain or comfort. Being older just means you are more likely to have diseases already. Unfortunately, one of these diseases is frailty. Frailty is becoming increasingly recognised as its own entity. Currently there is no cure for frailty and ageing, as its cause cannot be prevented.

To be frail means you are much more likely to need help to do things. You are more likely to have a chronic disease and you are less likely to survive a serious disease. It also means the part about cure “at any cost” can have quite a cost. The burden of the treatment can outweigh the benefit, the risks of death or disability loom.

The adage of ‘curing at any cost’ can have a significant cost in older patients. Screenshot, Youtube

An ethical approach to medicine requires we obtain consent for interventions we propose. Informed consent implies that accurate information about prognosis can be communicated to the patient. This has proved elusive even for blunt measures, such as whether or not someone will live.

When it comes to the likely effect on independence, estimating the risk of functional decline for an older individual facing a serious event becomes an inexact science.

The difficulties become more apparent when viewed within the idea of the body as machine and doctor as mechanic. Seeing only the body and not the person leaves me with inexact probabilities as guides.

Cure at any cost means I am unable within my own mind to comprehend the effect on the person. The frenetic pace of the hospital environment denies me the time. Lack of life experience for a younger doctor makes many considerations invisible. Death aversion within medical culture colours consultations.

My work in a busy emergency department has taught me older people are indeed like the rest of us. They want to be seen, recognised as people and treated as adults. It’s easy to find out something about the person. They don’t want superhuman medicos. They want us to be honest and to be able to express uncertainty.

A greater part of the satisfaction I find in my work comes from helping older people confront what is in front of them, and helping them make decisions in the context of them as a person, not just the failing lumber of the body.

Read other articles in the series here.

The Conversation

Bill Lukin, Consultant Emergency Physician and Palliative Medicine Trainee Physician, Clinical Associate Lecturer at the School of Medicine, The University of Queensland
