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100 Years Old and Still Tickin': The Rise in Medical Interventions for the "Older Elderly"

By July 18, 2008

An article published today in The New York Times tells the story of Hazel Homer, a beautiful and youthful looking 104 year old. When Hazel was 99 years old, several doctors told her there wasn't much they could do about her heart failure. Then she found a doctor who implanted a specialized pacemaker-defibrillator combo that synchronizes her heart and can deliver a life saving shock if needed. It's a device that could keep her ticker ticking for some time.

This type of aggressive treatment isn't uncommon any more for the "older elderly" - those approaching or surpassing the century mark. Knee and hip replacements, cardiac bypass, heart valve replacements, and cataract surgeries used be reserved for the younger geriatric crowd and not often recommended for those in their 90's. That's no longer the case.

Our relentless search for the fountain of youth and our increased focus on health has contributed to a healthier elderly population. Many of these spunky elderly folks aren't content to sit around and wait for the grim reaper to come knocking. The medical technology is there and they want to take advantage of it.

The debate is sparked when you begin to look at quality of life vs quantity of life. Are these medical interventions really prolonging life or are they putting an elderly person at greater risk of death? Will the intervention improve their quality of life or will the effects of the intervention actually decrease it?

It looks like there is no right answer across the board. Hazel has done pretty well for herself. She still takes pleasure in dressing up in a skirt and blouse everyday and matching her earings to her outfit. She states that the best part of life right now is that she is alive.

Hazel's choice isn't right for everyone, however. Take a 92 year old woman with dementia and heart failure who's family is considering an implantable defibrillator device. What's the better way for this woman to die - a slow decline with progressive disability, weight loss, malnutrition, and inability to recognize family? Or a sudden heart attack? Most people I talk to say they would like to pass away peacefully in their sleep. A defibrillator device could prevent that scenario from ever happening.

As with any medical decision, when deciding whether to pursue aggressive medical treatment, it's important to weigh the pros and cons and always take your personal and family goals into account. For more information on making difficult health care decisions, see Introduction to Difficult Decisions: Identifying Goals of Care.

I'd love to hear what you think. Would you make the same choice as Hazel?

July 21, 2008 at 4:44 pm
(1) Wendy B says:

I see two contrasting populations of “old” people. The first population I work with at a skilled care home – people who have lost their ability to care for themselves, sometimes at shockingly young ages.

The other population are my walking friends, some of whom I’ve known since they were newly retired. Now, 20+ years later, some have departed but others are still tackling 3-6 mile walks for recreation and fun each weekend. My friend Boyd Decker is now 90 this spring was still greeting me at walks, dressed head to toe in fluorescent pink, the “Pink Panther,” ready with a sly comment and insisting on getting a hug. I have other walking friends who completed a their first full marathon (26 miles) in their 80′s. These people transform what it is to be “old.” They haven’t stopped living.

An arbitrary age limit is silly. I know 40 year-olds who have basically stopped living, unable to walk or hold a job due to weight or other infirmity. I want to be like the Pink Panther. Only – no pink, I’m allergic to pink.

July 21, 2008 at 4:55 pm
(2) Mike B says:

I see more and more people living healthy and productive lives well into their 90′s. My mother lived in New York City and owned her own business until 85. She walked two miles everyday to work and then back. She had season tickets to the ballet and opera, and went out with her friends (all in their 80s) 3-4 times a week.

July 21, 2008 at 5:08 pm
(3) Pam says:

I want to be a Hazel. But I’m not sure if I would want heart surgery at her age, unless I’d taken good care of my body and thought I could recover from the procedure. However, if a person is dealing with advanced dementia, or other very limiting conditions, it seems like protecting and prolonging life would be a difficult choice.

July 21, 2008 at 5:08 pm
(4) Trisha says:

Thought provoking, isn’t it?

My 82-year-old Dad just spent 10 days visiting us from 1600 miles away, and he’s living exactly what this story is about. He’s a 22-year cancer survivor and still exercises daily and religiously eats his blueberries and tomatoes (for their lycopene.)

My mom, on the other hand, is in her 9th year of Alzheimer’s disease, living in a memory center, completely unresponsive, and we have to wonder whether she is happy or content or ?? We don’t know.

One parent is in a position to advocate for himself. The other is not.

Someday we’ll all be there….

July 21, 2008 at 6:30 pm
(5) Myrrh says:

I want to meet the Pink Panther!

I think that the decision about whether to treat health problems agressively depends on the individual. For me, I want to live as long as possible, IF my mental faculties are firmly in place. Quality of life is very important to me.

I’ve met older folks who are in wonderful health, and they have so much to offer those of us who are still relatively young.

July 22, 2008 at 12:00 pm
(6) Barbara says:

My mother got a defibrillator at the age of 76. She resisted the procedure for a long time because of her fears of how it would look cosmetically. In fact, she wanted to be the one to choose the model, as if she was choosing a piece of jewelry! The procedure was no big deal and the recovery was even easier. And, she was pleased that she can still comfortably wear a bathing suit. Her story shows that it is more important for doctors to be aware of patient’s individual issues, rather than making decisions made on arbitrary issues such as age.

July 22, 2008 at 12:50 pm
(7) Lynne says:

Hearing about Hazel inspired me to now take my run that I was delaying this morning!

I think we definitely need to look at the individual rather than chronological age. I know 30 year olds that are much less active, and seem to enjoy life less than my grandparents in their 90′s.

I think your entry presents an action point for those of us that are younger. We can stand up and be advocates for our older friends and family and encourage them (work with their health care providers) to be treated more aggressively if they are young at heart. For example, with lung cancer, only 10% of those participating in clinical trials are over the age of 70. I am sure there are many over-70′s that act and feel younger than the under 70 crowd.

July 23, 2008 at 12:31 pm
(8) Ginny says:

I do NOT agree with aggressive medical interventions for the “oldest old” or even the very old. The odds of possessing mental faculties firmly in place past the age of around 85 or even 100 years of age is highly unlikely, with most people past the age of 90 statistically having a very low quality of life due to multiple medical issues including dementia. I work in a nursing home. Eldery people develop heart failure as natural part of dying; however, some people find this fact of biology unacceptable. The problem I see with pacemaker implantation in very old but relatively cognitively inact patients is that while these patients keep living with the aid of their pacemakers almost all go on to eventually develop dementia which robs them of all traces of dignity and causes unbelievable suffering both emotional and financial for their families as well. The heart just keeps on beating while the rest of the body including the brain is shutting down. These patients are denied a dignified death due to heart failure and instead linger on in a kind of living death complete with uninary and fecal incontinence, the inability to recognize their own children or other family members, in some cases screaming and cursing at times, or just existing in a continuous drooling stupor. No one wants to die but there are fates worse than death and I have seen them firsthand. Young at heart is good but in the end you can’t really cheat death.

January 5, 2009 at 5:45 am
(9) great9124 says:

I know 40 year-olds who have basically stopped living, unable to walk or hold a job due to weight or other infirmity

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