By Michele C. Hollow
This article is reprinted by permission from .
While telling my mom about the next medical procedure I scheduled for her, she replied, “Enough with the doctor visits.”
She has a point. In the previous six months, I had arranged for her to be questioned and examined by an army of medical professionals, including an audiologist, a geriatrician, a physical therapist and several specialists at Montefiore Medical Hospital’s Center for the Aging Brain in Yonkers, New York. She wants these appointments to stop.
In my defense, I hoped for solutions to the aging-related problems she suffers from. In her defense, the geriatrician said my mom was relatively healthy for a 90-year-old woman and recommended she take a daily vitamin with iron, vitamin D and calcium.
Getting hearing aids was necessary, too. So were more trips to the Center for the Aging Brain. The last doctor who examined her at the Center nixed medication because the side effects were harmful. He said he believed her lack of hearing contributed to her mild cognitive decline.
That doctor noticed my mom shuffled her feet when she walked and recommended I take her to a physical therapist. The physical therapist gave her the option of walking on her own every day or coming to the therapist’s office three times a week and exercising daily at home. My mom chose walking.
Do you really need a colonoscopy at 80 or 90?
“This is not a one-size-fits-all yes or no answer,” says Dr. Suneet Singh, an emergency department physician, assistant professor at the University of Texas Austin Dell Medical School, and medical director at CareHive . “You have to look at your age, your health, and your life’s goals. You have to talk to your doctor and ask, ‘Why are these tests being ordered?'”
“Do you have a history of cancer?” he continued. “A colonoscopy can screen for polyps. Most are benign, but some can eventually become cancerous, and early detection is when cancer treatments work best.”
Like other doctors, Singh discusses with his patients the risks and benefits of surgeries and other medical procedures. “I also talk to them about their goals in life,” he says. “If you’re in your 80s and 90s, in good health and want to see your granddaughter walk down the aisle, then yes, maybe you do get that colonoscopy.”
Look at your age. “For example, current research shows colonoscopies could prevent death from colon cancer in patients with life expectancy of greater than 10 years,” says Dr. Eric Chyn, geriatrician, assistant professor and director of the geriatric medicine fellowship program at Rutgers Health New Jersey Medical School and University Health/Ambulatory Care Clinic.
For older patients in excellent health who are expected to live 10 years or longer, Chyn said he believes a colonoscopy “will likely bring more benefit than harm.”
If a patient is in fair health and expected to live another five years, the benefit of colonoscopy is unclear, he says. “Therefore, a shared decision is particularly important. If the patient is in poor health and has less than five years, then prioritizing care that improves a patient’s quality of life would have more benefit than a colonoscopy.”
“However, this is not an overall statement that a colonoscopy is never appropriate for older adults living with poor health,” he says. “If there are concerns of life threatening internal bleeding, a colonoscopy would still be offered for the purpose of diagnosis and treatment.”
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Roll back or stick with it?
Chyn and Singh point to the U.S. Preventive Services Task Force (USPSTF) , which keeps an up-to-date list of recommendations for different medical procedures for people of all ages. For example, the task force recommends biennial screening mammography for women aged 50 to 74 years. After age 75, the USPSTF sees little evidence for women to have mammograms.
