Tuesday, November 25, 2008

Treating Elderly with Chronic Diseases - Adding Life?

Rosemary Flanigan, PhD
November 25, 2008

Two events this past week seemed to coalesce: Dr. Rob Martensen came from the National Institutes of Health to talk about his new book, A Life Worth Living: A Doctor’s Reflections on Illness in a High-Tech Era and TIME magazine’s cover story was “The Sorry State of American Health.”

Rob spoke about healthcare for the elderly suffering from chronic diseases which too often offers to treat when there is little advantage to the treatment and side-effects that, though mentioned as they must be, are often not explored with the patient who might reject the treatment if he/she knew more.

Then along comes TIME, reporting that the U.S. spends16% of GDP on healthcare, the highest than any other nation. (“One benefit of all that spending is that the U.S. leads the world in medical innovation. Hospital care remains the largest expense, driven by demand from an aging population.” The healthcare dollar is spent as follows here: $ .32, hospital care; $ .21, physician and clinical services; $ .10, prescription drugs; $ .09, nursing-home care; $ .07, administrative costs; $ .04, dental care; $ .04, equipment; $ .02, research; $ .12, all other)

The U.S. ranks just 34th in the world in life expectancy, at 77.9 years. Rob told us that in the 1980’s a Swiss demographer, Arthur Imhof, published a series of papers that looked at human life and medical progress through the lens of four hundred years: life expectancy has barely changed in those four hundred years!

“Despite the ingenuity of medicine’s panoply of late-life interventions, and putting aside their huge cost, inconvenience, and the suffering associated with using some of them, technologically advanced interventions appear to add little additional life for those in their ninth and tenth decades.”

Sobering thoughts. There will never be a dearth of possibilities for ethics committees to intervene in end-of-life care. What other domains we may enter, end-of-life will offer us ready opportunities for reflection and counsel.

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