Therapeutic Objectives in Older People
Health care options (such as medical testing and treatments) almost always carry some risks. Those risks could impact quality of life. Patients and health care practitioners should weigh the benefits of tests and treatments against the potential negative impacts on quality of life (see also Medical Decision Making).
Potential benefits of medical interventions include the following:
Potential negative effects of medical interventions include the following:
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 the 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 help inform health care goals and determine what medical interventions to pursue.
The person’s perspective on quality of life may also affect treatment decisions when different treatments (for example, having surgery or taking medicines) may have different benefits, negative effects, or both. Health care practitioners can help people understand what could happen with the various treatment options, enabling people to 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, quality of life is an important consideration in medical decisions, so even people with a limited life expectancy may consider having invasive treatments that may improve quality of life (for example, joint replacement surgery).
Regardless of the overall treatment goals, doctors 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.