Therapeutic Objectives in Older Adults

ByRichard G. Stefanacci, DO, MGH, MBA, Thomas Jefferson University, Jefferson College of Population Health
Reviewed/Revised Mar 2024

    Medical interventions (such as medical testing and treatments) almost always carry some risks. These risks could affect quality of life. People and health care professionals should weigh the benefits of tests and treatments against the potential negative effects on quality of life (see also Medical Decision Making) and explain them to each person.

    Potential benefits of medical interventions include the following:

    • Cure

    • Increased life expectancy

    • Slowing of disease progression

    • Improved quality of life (such as being more able to go about daily activities)

    • Symptom relief

    • Prevention of complications

    Potential negative effects of medical interventions include the following:

    • Death

    • Symptoms, such as discomfort, prolonged fatigue, loss of muscle strength, reduced mobility, and incontinence

    • Inconvenience

    • Cost

    • Need for additional tests or treatments

    When treatments are very likely to achieve benefits and very unlikely to have negative effects, decisions are relatively easy. However, when there are potentially significant negative effects, people need to work with their doctors to make decisions that take into account quality of life. For example, aggressive cancer therapy may prolong life but have severe negative effects (including chronic nausea and vomiting) that greatly reduce quality of life. In this case, the person’s preference for quality of life versus duration of life and tolerance for risk and uncertainty may change or create new health care goals and help guide what medical interventions to use.

    The person’s perspective on quality of life may also affect treatment decisions when different treatments (such as surgery versus medications) may have different benefits, negative effects, or both. Health care professionals can help people understand what could happen with the various treatment options, so that people can make more informed decisions regarding medical testing and treatments.

    When making medical decisions, life expectancy often matters more than age. For example, people with a limited life expectancy may not live long enough to benefit from aggressive treatment of a slowly progressive disorder (for example, radical prostatectomy for a localized, slow-growing prostate cancer). Nevertheless, even people with a limited life expectancy may consider having invasive treatments if it may improve quality of life (for example, joint replacement surgery).

    Regardless of the overall treatment goals, health care professionals consider the need to relieve symptoms, such as pain, nausea, and shortness of breath. Having to live with such symptoms can significantly affect quality of life.

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