Our Rising Life Spans
Lawrence H. Knott, MD, FACS
“Surgeons and referring physicians need to be more aggressive about elective surgery in these elderly patients.”
The average life span in this country has risen by 25 years in the last half century, according to statistics presented at the ACS annual meeting. The average life span the age to which 50% of the population lives - has risen from 50 years in 1947 to 75 in the 1990’s reported Dr. Ronnie A. Rosenthal, who is completing a geriatric surgery textbook. Approximately 12.5% of the population is now over age 65, she said. By the year 2050, she added, this age group is projected to be about 20% of the total U.S. population. “ The most rapidly growing portion of that population, she said, are persons over the age of 85, whose numbers are expected to increase form 3 million now to 19 million by 2050.”
On average, a 65 year old will live an additional 15 years, a 75 year old will live an additional 10 years, and an 80 year old an additional 7 years. Acknowledgment of these figures has altered therapeutic decisions in surgical practices. We have moved from an era where old age was a contraindication to surgery to a time when it is no longer acceptable to deny surgical treatment based on age alone.
Interestingly enough, research over the past several decades suggests that advanced age itself only minimally increase the operative risk. More important is the presence of underlying chronic conditions more prevalent in the elderly. These comorbid conditions impact surgical outcomes much more than age.
The aging process affects all organ systems in ways that can negatively impact the elderly patient’s response to surgery and illness. Physiologic changes in the heart, lungs, kidneys and gastrointestinal tract in the elderly contribute cumulatively to a diminished reserve capacity when faced with surgical stress.
Nevertheless, surgeons and referring physicians need to be more aggressive about elective surgery in these elderly patients. Mortality rates in elderly patients are much higher after emergency surgery than after elective surgery. Multiple organ failure often occurs following major emergency surgery and represents the most common cause of death.
Recent studies have shown that octogenarians tolerated elective repair of abdominal aortic aneurysm as well as younger patients. There remains however a hesitancy to refer the septuagenarian or octogenarian for elective repair though the results with rupture and operative intervention are dismal. In addition colorectal surgery for carcinomas has been looked at in the elderly with similar survival rates for patients older and younger that 80 years of age. Likewise, elective surgical treatment of biliary tract disease in the elderly has been shown to result in improved morbidity and mortality rates as opposed to emergency surgery for complications of cholecystitis.
In summary, most elderly patients benefit from carefully selected procedures designed to solve specific problems. The goal should be to perform elective surgical procedures and avoid emergency surgery as much as possible.
Goals of Medical and Surgical Care For the Elderly Patient:
1. Maximize or maintain potential life span
2. Maintain dignity of life, maximize self-esteem
3. Maximize independent function, minimize dependence
4. Relieve suffering, with particular attention to pain
5. Although cure might not be possible, palliation and comfort are just as important. |
