7 ms·

The way we care for the elderly in hospitals is not working and cannot continue as the population ages. Issues like the one raised are just the surface. We are

The way we care for the elderly in hospitals is not working and cannot continue as the population ages. Issues like the one raised are just the surface. We are spending an ever increasing fortune to keep elderly patients alive for just weeks or months, often with poor quality of life. What this and the article is pointing towards, is that we need to get better at assessing when it's time to move from curative medicine to palliative care. This is not just about advancing medicine, but about our culture and attitude towards the (current) inevitability of death.

randycupertino 7y ago
I did a rotation at a wealthy Bay Area hospital where they routinely put stents in patients in their 80s. Thought of reporting them to medicaid for overbilling but most of the pts were private pay. Hospital has over $4 million dollars worth of art on the walls and a $500k koi pond in the lobby.
- cameronh90 7y ago
  I live in the UK, so my experience is in NHS hospitals, which are rather more frugal in their decor.... however over-treating patients in their 80s is little different on this side of the Atlantic. It's not done for a profit motive in general here, but more that nobody loses their medical license, and no NHS trusts get smeared in the gutter press, for trying to "save" a life against all hope (see the controversy surrounding the Liverpool Care Pathway). The lack of any legal route to assisted dying is also a problem. Even if that was introduced here, it would probably only cover people with a specific terminal diagnosis, not the more common scenario in the elderly of repeat curable problems.
  - hydrox24 7y ago
    > The lack of any legal route to assisted dying is also a problem. Euthenasia is a contentious topic, rightly so in my opinion, and is a seperate issue to regaining a balanced view of how and if we should treat the seriously ill when the treatment may harm them as much as the illness.
    - onion2k 7y ago
      I think there needs to be an acceptable palliative care option rather than attempting to extend the life of someone in their 80s. That's not really euthanasia. Accepting death is inevitable and making the last days of life comfortable seems like a better use of money than an operation that will give the patient a few more years of frailty at best.
      - michaelmrose 7y ago
        I would want to live another few years even being frail in fact most people would.
        onion2k 7y ago
        most people would You're wrong. There are many factors in play (family, friends, isolation, stress, money, pain, etc) around the individual's choice, but studies often find that the majority of older people would prefer a palliative approach to end of life. For example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821585/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821585/ Sadly there aren't many studies around this topic. It's important, especially when so many people assume that older people just want to 'not die' rather than listen to what they actually want.
        wongarsu 7y ago
        I personally knew a guy who was diagnosed with cancer and instead of treatment chose to spend his last few months with his family and then just die. This was in Germany, so all healthcare would have been payed for. A major reason was minimizing suffering for his family, having a good conclusion instead of prolonged suffering with unclear end date.
        chewz 7y ago
        My uncle got diagnosed with cancer at 93 and his initial choice was similiar (I have to die of something in the end). But the family convinced him to try the therapy and it worked. He is still after two years alive and relatively well.
- billforsternz 7y ago
  Counterpoint: Bernie Sanders is just 2 years short of 80. He seems to be a vigorous man who had a temporary medical setback, then was restored to full health by stent insertion.
  - melling 7y ago
    Jimmy Carter was treated for brain cancer in his early 90’s. https://www.cancerresearch.org/join-the-cause/cancer-immunotherapy-month/30-facts/20 https://www.cancerresearch.org/join-the-cause/cancer-immunot... He’s still alive 4 years later.
    - nosianu 7y ago
      So we are using extremely carefully selected individual examples now to come up with policies for everyone? Right then. And no, just because something works to "save (or extend) one life" does not mean it should be tried for everybody, because "hope". If you read the article - which says nothing surprising anyway - you balance your very few successes with lots and lots of bad cases. For some few to live longer a lot of people have to suffer more. Completely orthogonal, but since the path this thread took shows people care a lot (too much) about individual examples, I saw this more than once in my own family. My 94 year old grandmother broke here hip, surgery was ruled too dangerous, so she was driven back to her retirement home - where she only spent her last year, when care became too difficult at home - and spent the rest of her days just lying in her bad waiting to die. There was no good option left. That's just how it is near the end. I'm just saying this to show that I'm not talking about something that I only know from discussions such as this one. Also, both my grandmothers (who both made it into their nineties) had surgery in their 80s and both suffered significantly. Their brains were not the same afterwards. Anesthesia is not easy on the brain, even on top of any stress of the surgery itself on the body. There was a significant difference in mental abilities in both my grandmothers when comparing how they were before and after their surgeries (both had them for broken bones that occurred due to age related osteoporosis). And they both had pretty good starting points, others are much more frail at those ages.
      - 7y ago
- jmkd 7y ago
  You mention the art on the walls and the koi pond as if they are spurious examples of unnecessary spending, when many studies point to the great value in such environmental factors in healing.
  - fiblye 7y ago
    If you’re spending millions on art, you’re a museum, you’re being swindled, or you’re trying to find a clever way to shift your cash around. And I doubt hospitals are debuting rediscovered Van Gogh works. Buying affordable works from local artists can fill a massive hospital for well under a million.
    - larnmar 7y ago
      Or Van Gogh prints, for that matter.
  - Ididntdothis 7y ago
    I guess there are cheaper ways to achieve that. I think they are more to impress people.
    - jmkd 7y ago
      The responses here decrying the cost of the artwork and suggesting replacement with prints denies any and all value to artworks as profound objects, and could easily be as mis-applied to museums themselves. For those lacking understanding of the value of art in this context here is a good recent piece of research with many useful references: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328392/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328392/
  - Broken_Hippo 7y ago
    I think the real issue is that these folks are profiting so much as to afford the art while folks have trouble paying for hospital stays. There are so many ways to get original artwork on the walls for a much cheaper price tag, after all - and things get even cheaper if one looks into prints.
- Ididntdothis 7y ago
  "Hospital has over $4 million dollars worth of art on the walls and a $500k koi pond in the lobby." That's one thing I ave noticed in a lot of US hospitals and doctor offices. Everything is very shiny and new and costs a lot of money.
  - vkou 7y ago
    It's the invisible hand of the market at work. Obviously, patients are preferring to pay premium for treatment hospitals with expensive art and swanky facilities.
    - Ididntdothis 7y ago
      I wonder if they preferred it less if they had a way to find out how much the hospital costs before treatment.
      - kube-system 7y ago
        That would make sense, at least for the people paying the costs themselves. The economics change with insurance coverage. Once I hit my deductible, why do I care how expensive it is? At that point, might as well get my money’s worth out of my insurance company. The last time I need non-routine care, the only thing I cared about was: 1. Is this doctor good? 2. Is this doctor/hospital in-network?
        RugnirViking 7y ago
        "The economics change with insurance coverage. Once I hit my deductible, why do I care how expensive it is? At that point, might as well get my money’s worth out of my insurance company" The money doesn't come from nowhere. If everybody thinks like this, your insurance costs more money. If you don't pay for your insurance personally, how about just straight up being paid more by your company?
        kube-system 7y ago
hos234 7y ago
Totally agree. Most surgeons are mindless robots. So immersed in their craft, full of themselves and disconnected from the rest of the population that they don't pause to think too much about what they are doing. Not unlike any other profession with hyper specialization. It takes other members of the team or group to reign them in. The job involves a whole lot of decision making surrounding ambiguity and uncertainty, and there are certain personality types who are totally unfit to handle such decisions. They get pushed into the room because of other skills and mindlessly do what they are programmed too. Few months back I saw one jackass more interested in showing a family video clips taken of the surgery on their 80 year old mother, than actually talking about what they had achieved through the 8 hour reconstruction of all her internals. She passed away a few weeks back after all that pointlessness. After many bad experiences with family and friends, I always ask the specialist how many such ops the team has done in a year. And then, how many have long term positive outcomes. And then, if they can put me in touch with someone who has been through it a few years prior. These days its easy to dig up this information.
- Angostura 7y ago
  > Most surgeons are mindless robots. So immersed in their craft, full of themselves and disconnected from the rest of the population that they don't pause to think too much about what they are doing. This is an extraordinary assertion. Having watched my two elderly parents getting excellent -almost loving - care from surgeons on the NHS, I find it quite an offensive one. In both cases they sat down and spent quite a lot of time going through the pros and cons of surgery at at their advanced age. Dad decided to go ahead with a particularly ticklish piece of back surgery which gave him another 7 years of mobility and independence, even though it wasn’t fully successful. I’m sorry that you had such an appalling experience. It’s not universal. The stats you ask for are freely available in the NHS. The surgeon carried out the procedure on dad, knowing full well that it could quite possibly worsen his mortality figures.
  - hos234 7y ago
    Well you guys better protect that system cause where I live it's like a factory assembly line with well programmed robots herding people through without too much thought to long term outcomes. I have had good experiences only after putting in a lot of research (that too after some painful lessons). And thats an option if it's not an emergency. I have had to deal with a couple emergencies over the last couple years, where decisions had to be taken quickly. And I have seen both good and bad outcomes. The bad outcomes almost always are some guy at the ER acting as if palliative care is some unimaginable option. They frame it simplistically "We have to move patient to the OR or they will be dead in X hours/by tomorrow etc". Just because it's possible to operate doesn't mean a surgery has to happen. Especially on elderly people. It creates all kinds of cascading problems if it's a bad call. Good outcomes are possible but it needs a certain personality type and experience.
psktcpssl 7y ago
What a depressing and misguided opinion. You must have not yet dealt with those in your life at an advanced age with perfect cognitive function and a life-threatening illness. The goal is healthy life extension, not replacing accepted treatment with morphine.
omgwtfbyobbq 7y ago
>What this and the article is pointing towards, is that we need to get better at assessing when it's time to move from curative medicine to palliative care. From personal experience, the healthcare system is also bad at determining when it's time to move from curative medicine to palliative care. We need to get better at elderly healthcare in general.

randycupertino 7y ago

I did a rotation at a wealthy Bay Area hospital where they routinely put stents in patients in their 80s. Thought of reporting them to medicaid for overbilling but most of the pts were private pay. Hospital has over $4 million dollars worth of art on the walls and a $500k koi pond in the lobby.

cameronh90 7y ago
I live in the UK, so my experience is in NHS hospitals, which are rather more frugal in their decor.... however over-treating patients in their 80s is little different on this side of the Atlantic. It's not done for a profit motive in general here, but more that nobody loses their medical license, and no NHS trusts get smeared in the gutter press, for trying to "save" a life against all hope (see the controversy surrounding the Liverpool Care Pathway). The lack of any legal route to assisted dying is also a problem. Even if that was introduced here, it would probably only cover people with a specific terminal diagnosis, not the more common scenario in the elderly of repeat curable problems.
- hydrox24 7y ago
  > The lack of any legal route to assisted dying is also a problem. Euthenasia is a contentious topic, rightly so in my opinion, and is a seperate issue to regaining a balanced view of how and if we should treat the seriously ill when the treatment may harm them as much as the illness.
  - onion2k 7y ago
    I think there needs to be an acceptable palliative care option rather than attempting to extend the life of someone in their 80s. That's not really euthanasia. Accepting death is inevitable and making the last days of life comfortable seems like a better use of money than an operation that will give the patient a few more years of frailty at best.
    - michaelmrose 7y ago
      I would want to live another few years even being frail in fact most people would.
      - onion2k 7y ago
        most people would You're wrong. There are many factors in play (family, friends, isolation, stress, money, pain, etc) around the individual's choice, but studies often find that the majority of older people would prefer a palliative approach to end of life. For example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821585/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821585/ Sadly there aren't many studies around this topic. It's important, especially when so many people assume that older people just want to 'not die' rather than listen to what they actually want.
      - wongarsu 7y ago
        I personally knew a guy who was diagnosed with cancer and instead of treatment chose to spend his last few months with his family and then just die. This was in Germany, so all healthcare would have been payed for. A major reason was minimizing suffering for his family, having a good conclusion instead of prolonged suffering with unclear end date.
        chewz 7y ago
        My uncle got diagnosed with cancer at 93 and his initial choice was similiar (I have to die of something in the end). But the family convinced him to try the therapy and it worked. He is still after two years alive and relatively well.
billforsternz 7y ago
Counterpoint: Bernie Sanders is just 2 years short of 80. He seems to be a vigorous man who had a temporary medical setback, then was restored to full health by stent insertion.
- melling 7y ago
  Jimmy Carter was treated for brain cancer in his early 90’s. https://www.cancerresearch.org/join-the-cause/cancer-immunotherapy-month/30-facts/20 https://www.cancerresearch.org/join-the-cause/cancer-immunot... He’s still alive 4 years later.
  - nosianu 7y ago
    So we are using extremely carefully selected individual examples now to come up with policies for everyone? Right then. And no, just because something works to "save (or extend) one life" does not mean it should be tried for everybody, because "hope". If you read the article - which says nothing surprising anyway - you balance your very few successes with lots and lots of bad cases. For some few to live longer a lot of people have to suffer more. Completely orthogonal, but since the path this thread took shows people care a lot (too much) about individual examples, I saw this more than once in my own family. My 94 year old grandmother broke here hip, surgery was ruled too dangerous, so she was driven back to her retirement home - where she only spent her last year, when care became too difficult at home - and spent the rest of her days just lying in her bad waiting to die. There was no good option left. That's just how it is near the end. I'm just saying this to show that I'm not talking about something that I only know from discussions such as this one. Also, both my grandmothers (who both made it into their nineties) had surgery in their 80s and both suffered significantly. Their brains were not the same afterwards. Anesthesia is not easy on the brain, even on top of any stress of the surgery itself on the body. There was a significant difference in mental abilities in both my grandmothers when comparing how they were before and after their surgeries (both had them for broken bones that occurred due to age related osteoporosis). And they both had pretty good starting points, others are much more frail at those ages.
    - 7y ago
jmkd 7y ago
You mention the art on the walls and the koi pond as if they are spurious examples of unnecessary spending, when many studies point to the great value in such environmental factors in healing.
- fiblye 7y ago
  If you’re spending millions on art, you’re a museum, you’re being swindled, or you’re trying to find a clever way to shift your cash around. And I doubt hospitals are debuting rediscovered Van Gogh works. Buying affordable works from local artists can fill a massive hospital for well under a million.
  - larnmar 7y ago
    Or Van Gogh prints, for that matter.
- Ididntdothis 7y ago
  I guess there are cheaper ways to achieve that. I think they are more to impress people.
  - jmkd 7y ago
    The responses here decrying the cost of the artwork and suggesting replacement with prints denies any and all value to artworks as profound objects, and could easily be as mis-applied to museums themselves. For those lacking understanding of the value of art in this context here is a good recent piece of research with many useful references: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328392/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328392/
- Broken_Hippo 7y ago
  I think the real issue is that these folks are profiting so much as to afford the art while folks have trouble paying for hospital stays. There are so many ways to get original artwork on the walls for a much cheaper price tag, after all - and things get even cheaper if one looks into prints.
Ididntdothis 7y ago
"Hospital has over $4 million dollars worth of art on the walls and a $500k koi pond in the lobby." That's one thing I ave noticed in a lot of US hospitals and doctor offices. Everything is very shiny and new and costs a lot of money.
- vkou 7y ago
  It's the invisible hand of the market at work. Obviously, patients are preferring to pay premium for treatment hospitals with expensive art and swanky facilities.
  - Ididntdothis 7y ago
    I wonder if they preferred it less if they had a way to find out how much the hospital costs before treatment.
    - kube-system 7y ago
      That would make sense, at least for the people paying the costs themselves. The economics change with insurance coverage. Once I hit my deductible, why do I care how expensive it is? At that point, might as well get my money’s worth out of my insurance company. The last time I need non-routine care, the only thing I cared about was: 1. Is this doctor good? 2. Is this doctor/hospital in-network?
      - RugnirViking 7y ago
        "The economics change with insurance coverage. Once I hit my deductible, why do I care how expensive it is? At that point, might as well get my money’s worth out of my insurance company" The money doesn't come from nowhere. If everybody thinks like this, your insurance costs more money. If you don't pay for your insurance personally, how about just straight up being paid more by your company?
        kube-system 7y ago

hos234 7y ago

Totally agree. Most surgeons are mindless robots. So immersed in their craft, full of themselves and disconnected from the rest of the population that they don't pause to think too much about what they are doing. Not unlike any other profession with hyper specialization. It takes other members of the team or group to reign them in. The job involves a whole lot of decision making surrounding ambiguity and uncertainty, and there are certain personality types who are totally unfit to handle such decisions. They get pushed into the room because of other skills and mindlessly do what they are programmed too. Few months back I saw one jackass more interested in showing a family video clips taken of the surgery on their 80 year old mother, than actually talking about what they had achieved through the 8 hour reconstruction of all her internals. She passed away a few weeks back after all that pointlessness. After many bad experiences with family and friends, I always ask the specialist how many such ops the team has done in a year. And then, how many have long term positive outcomes. And then, if they can put me in touch with someone who has been through it a few years prior. These days its easy to dig up this information.

Angostura 7y ago
> Most surgeons are mindless robots. So immersed in their craft, full of themselves and disconnected from the rest of the population that they don't pause to think too much about what they are doing. This is an extraordinary assertion. Having watched my two elderly parents getting excellent -almost loving - care from surgeons on the NHS, I find it quite an offensive one. In both cases they sat down and spent quite a lot of time going through the pros and cons of surgery at at their advanced age. Dad decided to go ahead with a particularly ticklish piece of back surgery which gave him another 7 years of mobility and independence, even though it wasn’t fully successful. I’m sorry that you had such an appalling experience. It’s not universal. The stats you ask for are freely available in the NHS. The surgeon carried out the procedure on dad, knowing full well that it could quite possibly worsen his mortality figures.
- hos234 7y ago
  Well you guys better protect that system cause where I live it's like a factory assembly line with well programmed robots herding people through without too much thought to long term outcomes. I have had good experiences only after putting in a lot of research (that too after some painful lessons). And thats an option if it's not an emergency. I have had to deal with a couple emergencies over the last couple years, where decisions had to be taken quickly. And I have seen both good and bad outcomes. The bad outcomes almost always are some guy at the ER acting as if palliative care is some unimaginable option. They frame it simplistically "We have to move patient to the OR or they will be dead in X hours/by tomorrow etc". Just because it's possible to operate doesn't mean a surgery has to happen. Especially on elderly people. It creates all kinds of cascading problems if it's a bad call. Good outcomes are possible but it needs a certain personality type and experience.

psktcpssl 7y ago

What a depressing and misguided opinion. You must have not yet dealt with those in your life at an advanced age with perfect cognitive function and a life-threatening illness. The goal is healthy life extension, not replacing accepted treatment with morphine.

omgwtfbyobbq 7y ago

>What this and the article is pointing towards, is that we need to get better at assessing when it's time to move from curative medicine to palliative care. From personal experience, the healthcare system is also bad at determining when it's time to move from curative medicine to palliative care. We need to get better at elderly healthcare in general.