Aging is not a disease. It is the achievement of a long life and an accomplishment that can be appreciated and enjoyed. Older people may have more medical conditions than people who have not lived as long, but most can continue to live active and productive lives.
As doctors, we are highly trained to diagnose disease and to treat it. This is a strength of our health care system, but it also may cause problems. Treatments are not without risks. Drugs have side effects, and use of multiple medications has the additional risk of interactions among them. Since older people generally take more medications than younger people, the problem is magnified.
Technology relating to laboratory studies and imaging studies has moved ahead at a rapid rate. It is becoming possible to identify conditions earlier and earlier. Prompt treatment may be beneficial for some conditions, but premature treatment of something that may not become a problem for years, if at all, may subject a patient to the risk of adverse effects. Both drugs and surgery entail risks. Medication risks increase the longer drugs are taken and the more that are taken. Watchful waiting may be a valid option in some situations.
When I am teaching doctors in training, I suggest going gently with diagnosis and treatment for older people. That is, to avoid excessive or premature screening tests in the absence of illness or symptoms and to avoid aggressive treatment when possible. I feel that this becomes progressively more important later in life.
Our bodies and body composition change as we age. Not all of the changes are harmful to health. For decades menopause was thought of as a disease and treated with hormones. Subsequent research demonstrated that such treatment, when prolonged, was causing more problems than it was helping.
Some physiologic changes in aging may be beneficial, or at least not as harmful as they have seemed. There is growing evidence that some of the commonly observed changes in aging may actually be protective.
It is OK to ask questions about suggested tests and proposed treatment. A strong principle of biomedical ethics is “respect for autonomy,” which translates to a doctor respecting the preferences of his or her patients regarding testing and treatment and informing them of benefits and risks of the recommendation. This does not mean that the patient should take over the process, but it does suggest shared decision making between doctor and patient, especially in prescribing when a test is only mildly off the “desired” level and where treatment may have significant side effects.
* Hear more of Dr. Tager’s health advice on Thursday, June 16th!
Robert Tager, M.D. is a neurologist and Clinical Professor of Family Medicine and Gerontology at the Keck School of Medicine of U.S.C. and U.S.C. Davis School of Gerontology. He teaches Ethical Issues in Geriatric Health Care and Introduction to Clinical Geriatrics at the Gerontology School and is active in the Program of Medical Humanities, Arts and Ethics at the Medical School.
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