Concern Is Growing That The Elderly Get Too Many Medical Tests

Kaiser Health News and The Washington Post collaborated on an article that appears on the KHN website today September 13.

My feelings on this article vary...certainly some very good points made on the issue of over testing. However, I struggle with the fact that the US Preventive Task Force is evaluating what tests are necessary and for whom. I believe this certainly embodies the slippery slope analogy.

Sandra G. Boodman - journalist, Kaiser Health News

Every year like clockwork, Anna Peterson has a mammogram. Peterson, who will turn 80 next year, undergoes screening colonoscopies at three- or five-year intervals as recommended by her doctor, although she has never had cancerous polyps that would warrant such frequent testing. Her 83-year-old husband faithfully gets regular PSA tests to check for prostate cancer.

"I just think it's a good idea," says Peterson, who considers the frequent tests essential to maintaining the couple's mostly good health. The Fairfax County resident brushes aside concerns about the downside of their screenings, which exceed what many experts recommend. "Most older people do what their doctors tell them. People our age tend to be fairly unquestioning."

But increasingly, questions are being raised about the overtesting of older patients, part of a growing skepticism about the widespread practice of routine screening for cancer and other ailments of people in their 70s, 80s and even 90s. Critics say there is little evidence of benefit -- and considerable risk -- from common tests for colon, breast and prostate cancer, particularly for those with serious problems such as heart disease or dementia that are more likely to kill them.

Too often these tests, some doctors and researchers say, trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments for slow-growing diseases that may never cause problems, leaving patients worse off than if they had never been tested. In other cases, they say, treatment, rather than extending or improving life, actually reduces its quality in the final months.

"An ounce of prevention can be a ton of trouble," observed geriatrician Robert Jayes, an associate professor of medicine at George Washington University School of Medicine. "Screening can label someone with a disease they were blissfully unaware of."

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Older patients may get lower quality care at hospital ER's

Trauma centers may not give the same high-quality care to severely injured elderly patients as they provide to younger patients, according to a new study.

Researchers analyzed data on 87,754 trauma patients of all ages treated at 131 trauma centers in the United States and one trauma center in Canada. About one-quarter of the patients were elderly.

When patients in all age groups were grouped together, 14 centers were rated as high performers, with lower than expected rates of death. When young and elderly patients were looked at separately, seven centers were high performers for young patients and nine were high performers for elderly patients. Only two centers were high performers for both young and elderly patients.

The study findings are published in the January issue of the journal Annals of Surgery.

"In the study we showed that although some centers demonstrate high performance overall, these same centers might not be providing the same high-quality care to the elderly," Dr. Barbara Haas, of St. Michael's Hospital, University of Toronto, said in a news release from the American College of Surgeons.

"We've shown that elderly patients have different needs from young patients. Centers need to focus on the needs of the elderly specifically in order to improve their quality of care," she added.

The study authors noted that an aging population means trauma centers are seeing many more elderly patients, who are more likely than younger patients to have conditions such as heart disease, lung disease and diabetes. These health problems need to be taken into account at the same time elderly patients are being treated for their injuries.