Warning against surgery age limits

Surgical treatments, which can prolong life and improve living standards for older patients, have been shown to steadily decline as patients get older, the research suggests.

But as the population ages and people are living longer lives, doctors have a “moral duty” to properly care for older patients, according to the Royal College of Surgeons.

They said that surgeons should no longer look at a patient’s age to assume whether they are suitable for surgery, instead their overall health should be taken into consideration, according the report which was conducted by the RCS, Age UK and MHP Health Mandate.

The report found that surgery rates decline for people as they grow older for a number of treatments including breast cancer operations, joint replacements, prostate cancer treatments and hernias.

While the incidence of breast cancer peaks in patients aged 85 and older, surgery rates decline sharply from the age of 70, the figures indicate.

Pensioners are the main group to receive hip and knee replacements but the rates of surgery in England dropped sharply in patients over the age of 70, according to the data which examines the number of operations between 2008 and 2011.

The research also found the number of patients who receive treatment for prostate cancer plummets after after patients reach the age of 70.

Michelle Mitchell, charity director general 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 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.”

The authors of the report said there are a number of possible explanations as to why older people are not getting life-saving treatment.

Doctors are looking at people’s age to assess whether they are suitable for treatment, instead of their overall wellbeing and fitness, they said.

Discussions with patients about possible treatments could be “limited or ineffective”, they add.

The NHS £20 billion efficiency drive also puts older patients at a “heightened risk” of age discrimination because restrictions may be imposed when healthcare workers balance the cost of treatment against the patient’s life expectancy, the RCS said.

Clinical factors could mean that the risks of treatment outweigh the benefits or patients could decide themselves to opt out of treatments, the report states.

Professor Norman Williams, president of the RCS, 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.” The authors have made a series of recommendations to ensure that older people have fair access to surgery, including ensuring there are no age “cut offs” which would see older patients denied treatment.

Multidisciplinary teams, including specialists from geriatrics and other hospital departments, should make joint decisions about treatment, they said.

Junior doctors should receive dedicated training for the care of elderly patients and communication with patients to discuss the risks and benefits of surgery must also improve, the authors said.

They also suggest that disease awareness campaigns should be created to make older people mindful about illnesses. For instance, there should be a new campaign to raise awareness about breast cancer in older women.

The report comes after new legislation prevents age discrimination within the health service.

If a patient is denied drugs or treatment on the grounds of age they can now take legal action against healthcare providers.

NHS Confederation chief executive Mike Farrar 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.”

Health Minister Dr Dan Poulter said: “There should be absolutely no place in the NHS for assumptions about entitlement to treatments 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.”