A dilemma faced by many families is what to do when an eighty plus patient becomes serious.
Should one admit them to a hospital, subject him to all sorts of investigations and intensive management or simply leave them alone to die quietly at home?
I remember a patient I was called to see in Delhi. She was hypertensive and suffered a stroke outside the country. Her daughter, whom she had gone to help there, panicked at the potential expenses, put her on a plane, and brought her to India. She was obviously in a bad state by the time she arrived. Her son and daughter-in-law cared for her day and night and when they knew the end was near, they lit a lamp but did not let me admit her or give any emergency medication and only wanted me to certify her death.
Another gentleman in his late eighties had severe pneumonia and went into respiratory failure and was on a ventilator. Due to excellent management in the ICCU, he survived and lived another five years!
A third gentleman in his mid-eighties suffered a paralytic stroke and went into a coma. He was admitted to ICCU and in spite of intensive multi-specialty care he died after ten days in the hospital.
Now the point is, the second gentleman in his late eighties came out of severe respiratory failure with no residual damage. If he had not been admitted, thinking it was of no use, he would not have lived another five years.
Recently I had a lady patient who is 80 years of age. She simply refuses to grow old and keeps coming to me with minor nagging complaints, since she wants to maintain perfect health. Normally it would take a lot of effort on my part to convince her that a few minor complaints should be tolerated and not treated and give her minimum possible medication, but on that day I decided to take a different tack. I told her that she was looking particularly pretty and healthy, and what was the secret? She was absolutely delighted with the compliment and for the first time, immediately accepted that the problem she had come for was very minor and was easily satisfied with the minimal medication that I had prescribed.
So the attitude of the patient also plays a major role in the decision-making, since the sort of patient who feels he is four times twenty and not eighty years of age, has to be treated differently from one who has a defeatist nature .
Reacting to a young congressman who had ridiculed him on account of his old age, John Quincy Adams once remarked, “Tell that young man that an ass is older at thirty than a man at eighty!”
So when asked for advice about the intensive management of an eighty plus, I leave the decision to the relatives after giving my opinion. If the situation seems really irreversible, home care is best, with minimal intervention; but if the patient has a good constitution, with a positive attitude , and the condition is curable, I think even an eighty plus deserves the best care possible. But like I said, the decision has to be made by the family with guidance from their physician. A case of “different strokes for different folks”Read More