Royal College warns that the Elderly are denied life-saving surgery

Elderly patients are being denied life-saving surgery, Royal College warns

Elderly people are dying unnecessarily because they are missing out on life saving surgery under age discrimination, the Royal College has warned.

By Rebecca Smith, Medical Editor
10:54PM BST 14 Oct 2012

Decisions on whether older people are put forward for surgery must not be based on out-dated assumptions of age and fitness, a new report said.

Doctors should assess their overall health when considering if surgery will be beneficial.

Just at the age when their need for healthcare is greatest, the chances of them having surgery drop, the report warned.

Surgery rates for common operations and even to remove cancerous tumours are lower in people aged over 70 despite many being otherwise fit and well, the report found.

Women aged over 85 are more likely to develop breast cancer than at any other age yet surgery to remove tumours peaks for patients in their mid-60s and then declines sharply from age 70.

Just under 2 per 1,000 women aged 70 have surgery and this dropped to just over 0.5 per 1,000 by age 90, figure for the last three years showed.

The report also found that between the ages of 75 and 90 the number planned of hip replacements carried out per 1,000 people dropped by more than half, while the same operation carried out as an emergency more than doubled.

Similarly an 85 year-old has half the chance of having a planned knee replacement as a 75-year-old and almost none are done on 90-year-olds, the report found.

The comprehensive new study, ‘Access all Ages: Assessing the impact of age on access to surgical treatment’, published by Age UK, The Royal College of Surgeons and MHP Health Mandate, found older people are having disproportionate restrictions imposed on their care.

A new ban on age discrimination in the NHS came into effect this month meaning there is a now a legal basis for challenging the rationing of healthcare solely on the basis of age.

Professor Norman Williams, President of the Royal College of Surgeons, said: “This isn’t about surgeons slamming the theatre door on older people.

“In fact it is alarming to think that the treatment a patient receives may be influenced by their age.

“There are multiple factors that affect treatment decisions and often valid explanations as to why older people either opt out of surgery – or are recommended non-surgical treatment alternatives.

“The key is that it is a decision based on the patient rather than how old they are that matters.”

In some cases a patient may not even be referred for surgery because of perceptions that they are too old, or the symptoms of their disease are taken as part of ageing and so when they are diagnosed it is too advanced for surgery.

Michelle Mitchell of Age UK said: “When it comes to peoples’ health, their date of birth actually tells you very little.

“A healthy living 80 year old could literally run rings round someone many years younger who does not share the same good health.

“Yet in the past, too many medical decisions we believe have been made on age alone with informal “cut-offs” imposed so that people over a certain age were denied treatment.

“This report shows the large gap between the number of people living with a condition or health need and the surgery rates to treat older people.

“We would like surgeons and other health professionals to read this report carefully and examine what they can do to ensure that age discrimination is eradicated from the NHS, as legislation now demands.”

Mike Farrar, chief executive of the NHS Confederation which represents most health service organisations, said: “Age discrimination is not only illegal but goes against all the principles and values of the NHS. Access to NHS services should always be based first and foremost on clinical need, not on age.

“This report presents some worrying figures. We need to look at them carefully to examine whether they are the result of arbitrary decisions taken solely on the basis of age, or because some non-surgical treatments could offer greater benefit, or a patient chooses not to undergo surgery.

“We know that prejudicial attitudes against older people still pervade through society but the NHS and its staff should close the door to such unacceptable behaviour.

“We should never defend ageist behaviour against patients, and we all have a responsibility to speak up and act when we see it happening.

“The NHS – and society as a whole – needs to trigger a major cultural shift in the way we think about older people. “

Health Minister Dr Dan Poulter said: “There should be absolutely no place in the NHS for assumptions about entitlement to treatment that are based on age or any other form of unjustified discrimination.

“All patients should be treated as individuals, with dignity and respect, and receive care that meets their healthcare needs – irrespective of their age.

“The Government is committed to providing dignity in elderly care, and at the beginning of October we introduced an Age Discrimination Ban, which means that all patients will receive a more personalised care service, based on their individual needs, not their age.”

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