In “Stop Treating 70- and 90-Year Olds the Same,” which appeared in the New York Times earlier this month, Louise Aronson highlights some ways in which our health care system fails people over 65. There are many biological and physiological differences between a 65-year old and a 90-year old, but our health care system, in many important instances, treats them the same.
For example, when it comes to vaccines, the Centers for Disease Control (CDC) offers advice to doctors broken down into two major groups: adults and children. The CDC then creates 17 subcategories for the children’s group (under 18) and five subcategories for people between 18 and 65. Yet, the CDC puts everyone over 65 into one group.
Of course, there are large differences between the health care needs of a 65-year old and a 95-year old. More than a generation stands between them. They look different, they partake in different activities, and they have different health care needs. It’s hard to imagine that their vaccine needs do not differ.
The oldest old have far weaker immune systems than people in their sixties. The oldest old are more prone to illness, infections, hospitalizations and death than people in their 70’s. The oldest old tend to need different medications and care.
Aronson suggests that we could be giving the oldest old too much or too little medicine, in different instances, possibly under- or over-vaccinating them as well, depending upon their age and other factors. For example, questions arise as to whether a 95-year old even benefits from a flu vaccine.
Similarly, Aronson suggests that people with cancer over 65 may have different cancer treatment needs, depending upon how old they are. Chemotherapy and radiation may do more harm than benefit to a frail 90-year old. Yet, our clinical research tends not to distinguish between the treatments people who are 90 need and the treatments people who are 70 or 50 need.
Older adults are not usually allowed to participate in clinical trials. Yet, we tend to treat older people based on this research, since there is no other research available. Shouldn’t the NIH insist that older people participate in clinical trials?
Aronson is clear that age is not the only factor that should be considered when making treatment decisions. We all age at different speeds. Income, work, stress, geography, health, all play a role. Moreover, our internal systems may age at different rates. We may lose our hearing, but keep our vision, for example. Treatment guidelines should reflect these differences.
Aronson observes that we tend to treat older people as if their only desire is to live longer, without considering whether they might prefer a better quality of life, living on their own and without pain, to a longer life, with the help of extreme medical treatments, bedbound or hospitalized. Shannon Brownlee and others have highlighted the dangers of overtreatment. But, insurers tend to cover costly invasive procedures over less costly palliative care.
Aronson recommends that our health care system start targeting “oldhood” so that we better understand how to treat people in their 70’s, 80’s, 90’s and 100’s. While we’re at it, I would urge that we come up with new words to describe 65-year olds and to distinguish people in their 60’s from 90-year olds. Today, anyone over 65 is an “older adult”, a “senior”, an “elderly person” or “Medicare beneficiary.”
Here’s more from Just Care: