Two Dutch hospitals have begun assessing the ‘vulnerability’ of patients over the age of 70 who are admitted to their emergency departments to determine their suitability for major operations and other far-reaching treatment, the NRC said on Monday.
Doctors are using a short list of questions to determine if the elderly patient is fit enough to go through the procedure and will recover well.
The questions cover issues such as medication, memory loss and whether or not the person concerned lives independently. The answers allow doctors to decide if a patient risks either dying or deteriorating when they are sent home after treatment.
Leiden’s LUMC teaching hospital and the Haga hospital in The Hague are pioneering the new system. It was developed after researchers noticed that 10% of the over 70s treated in the LUMC’s A&E department died within three months and a further 20% were no longer able to live independently.
‘We are talking mainly about serious operations with a large risk of complications,’ Ronne Mairhu of the Haga hospital told NOS radio. ‘Patients are often open to talking about it.
The decision about whether to operate is always taken together with the patient and family members, Mairhu said. ‘It often boils down to quality of life, not about prolonging life,’ he said.
If the system proves a success, it will be applied in other hospitals, Hanna Willems, chairwoman of the Dutch association for clinical geriatrics told the NRC. Last year, 800,000 people over the age of 65 ended up in an A&E department, and 530,000 of them were hospitalised.
Meanwhile, GroenLinks MP Corine Ellemeet on Monday launched a plan to improve care of the elderly which includes a call to involved specialist geriatric doctors in assessing whether people should be treated.
‘Everyone has the right to be treated,’ Ellemeet said. ‘But you have to dare to ask if there are any gains to be made with an operation or chemotherapy. Geriatric specialists can determine if someone will benefit from medical treatment. People often deteriorate after a spell in hospital.
Politicians, she said, are uneasy about tackling the issue because people will start talking about the elderly bearing the brunt of hospital cutbacks.
‘This is not what we want at all,’ she said. An honest approach to the risks associated with treatment would, she said, ‘I think lead to many people passing on further treatment.’
Last week, national statistics office CBS said 72% of the over-85s in the Netherlands still live in their own homes.
There are some three million people over the age of 65 living in the Netherlands, but their number is set to grow to 4.5 million – or a quarter of the population – by 2040.
The over-65s currently account for almost half of all spending on healthcare, but most of that goes on the small group who live in residential homes.