NHS versus the ageing population?

#1
Is there a tacit understanding in the medical world to quietly withdraw medical services from the elderly in the UK?
ie is anyone over the age of 80 written off as being not financialy viable in terms of providing care and treatment?
 
#2
No.

But there is growing concern in certain quarters that they who have paid into the pot all their lives are not getting the treatment they deserve.

That's why there are moves in parliament to get some service users to pay.

There is no utilitarian 'bin the old n crusty' campaign. I spend much of my time on expensive interventions on the elderly, many of whom are quite unwell anyway. These interventions will extend their time or make their remaining time more comfortable. I am very happy with this policy, although it means more difficult cases for us. They paid, they will get the best.

I don't write policy. I'm giving you a heads up from my point of view from my part of the 'coal face'.
 
#3
You touch on a rather hot topic- The use (or misuse) of the Liverpool Care Pathway.-and the financial incentives attached.
Liverpool Care Pathway for the Dying Patient - Wikipedia, the free encyclopedia

Some say it was a clever, sensible way to manage the end of life treatment for terminally ill, usually elderly patients. Others that it became used as a target and output driven management tool for pushing people off their perch to save money.

I leave it for the delivery professionals to give their views.
 
#4
Is there a tacit understanding in the medical world to quietly withdraw medical services from the elderly in the UK?
ie is anyone over the age of 80 written off as being not financialy viable in terms of providing care and treatment?

I would not say in the medical world, as far as most professinals I have met are concerned.

Among those who run Hospital Trusts I would suspect there is truth in the thought.


There is also an argument that those bean counters are themselves under unfair pressures as services for the elderly in the community in many areas are poor at doing what they should to keep people stable in their own home, and this lack of services in social services and primary care drives the greater use of hospitals.

The prevention of hospitalisations from such matters as poor nutrition and the prevention of falls are just two areas show vast differences across areas of the UK.


The other demands on medical services also tend to be from people who are far more ready to complain if they don't get fast service. From the idiot regulars on Friday and Saturday nights through to the women who want bigger breasts come loud noises if they don't get what they want; whilst the over eighties are of a generation who when they can't do something for themselves don't hold the expectation that everyone else should be tasked to a responsibility to put their life right.
 
#6
I would say not due to age, I recently had an 80+ years relative fitted with various internal aids to keeping her heart going. Was surprised.

I'm a little bit more dubious about decisions made due to perceived "quality of life" considerations though.
 
#7
One of the pressing questions is wether the intervention will improve or maintain the life of the person. Back when I started nursing in 1978 it was usuall for elderly care to be defined from 65 onwards. Now it would be very unusal for someone of that age to be recognised as such. My wife is a physio in Elderly Rehab and 80-100 is the ages she talks about. However as a body grows older no matter what machine or drug you have it takes longer to get better and will in all likelyhood die. There is a lot of research showing that elderly patients falling and fracturing their hip will die within 1 year. No failure on the part of those caring just that is what happens. Is neurosurgery on an 89 yr old with a post op life expectancy of 2 yrs at best and massive care input warrented? I will be controversial here and say probably not. However each case must be dealt with on its own merits. Personaly I dont want to live to 100 if it means being stuck in a bed or a chair with all the concommitant risks
 
#8
One of the pressing questions is wether the intervention will improve or maintain the life of the person. Back when I started nursing in 1978 it was usuall for elderly care to be defined from 65 onwards. Now it would be very unusal for someone of that age to be recognised as such. My wife is a physio in Elderly Rehab and 80-100 is the ages she talks about. However as a body grows older no matter what machine or drug you have it takes longer to get better and will in all likelyhood die. There is a lot of research showing that elderly patients falling and fracturing their hip will die within 1 year. No failure on the part of those caring just that is what happens. Is neurosurgery on an 89 yr old with a post op life expectancy of 2 yrs at best and massive care input warrented? I will be controversial here and say probably not. However each case must be dealt with on its own merits. Personaly I dont want to live to 100 if it means being stuck in a bed or a chair with all the concommitant risks

I appreciate those coideratons 1stgulfmac, and well raised. Many elderly people will tghemselves of course decide when intervention has been enough, but where they are not capable of those decisions, I guess the question is who makes such and how they are made?


To be contentious though, could we not equally apply the same principle to the druggie who overdoses for the fourth time on heroin or the liver transplant patient who wrecked his first liver with alcohol and goes down the road for a bottle of gin?
 
#9
Many elderly people will tghemselves of course decide when intervention has been enough, but where they are not capable of those decisions, I guess the question is who makes such and how they are made?
The decisions are made with family members and doctors.

You can make them now, I can't remember what they're called, but you say that if in the future you are not compus mentis then you would like to withhold your consent for all life saving interventions.

One of the tenets of modern healthcare is 'autonomy'. It is your life, your body, any decisions you make must be respected.

Power of attorney to a trusted family member is also a good thing to have if you don't want well meaning doctors poking and prodding you for years whilst you remain an emotional burden on your family and a financial burden on the state.
 
#10
You know it makes sense:
[video=youtube;yOV8mBjHHYg]http://www.youtube.com/watch?v=yOV8mBjHHYg[/video]
 
#11
The decisions are made with family members and doctors.

You can make them now, I can't remember what they're called, but you say that if in the future you are not compus mentis then you would like to withhold your consent for all life saving interventions.

One of the tenets of modern healthcare is 'autonomy'. It is your life, your body, any decisions you make must be respected.

Power of attorney to a trusted family member is also a good thing to have if you don't want well meaning doctors poking and prodding you for years whilst you remain an emotional burden on your family and a financial burden on the state.
**** that!

Give me drugs, machinery, implants and cyborg bits. I don't care what "quality of life" I have.

It is better than the alternative.
 
#13
As I told my kids ive looked after you for x amount of years, so once ive got too get my arse wipe and feed by someone its payback time.
Btw I will require pocket money and the latest tech and games so best get saving now.

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#14
The elderly who have mostly paid all their lives for the NHS suffer due to the great unwashed who have mostly paid the grand sum of fuckall.
It's the elderly in the last six months of life who take up about 80% of the HHS spend. There are simply far too many of the buggers arriving at deaths door due to the post war baby boom.

Add to that there are not enough bairns coming along to pay taxes to support the level of care their elders demand. And this they in no way have paid for thanks to rounds of tax breaks funded by national asset sell offs and costly payment postponements with PFI schemes that bought governments reelection while future generations were denied the public investments that advanced their grandparents lives. They've breezily left large debts and yawning deficits in investment for their descendants to take care of while living off the fat of the land for a couple of decades.

This state dependent grey hoard is the main problem with the UK's threadbare social system not the cowed guilt ridden young bouncing in an out of increasingly badly paid jobs. Eventually this persecuted and unsurprisingly almost devoid of public spirit group will probably come to see the needy elderly as as aging parasitic scapegraces seemingly intent on coasting along on the backs of a hard pressed workforce and this will not be entirely unjust
 
#17
The trouble is that decisions on care are multifactorial. A surgeon or anaesthetist may consider that the elderly patient has a severely diminished chance of surviving a procedure or general anaesthesia. The decision will be based on the medical and physical condition of the patient but may not necessarily be perceived as such by the family. They may believe treatment is not being offered for economical reasons.

The problem is further compounded by non-medical care. Someone may be medically free from any condition but may be so decrepit that they need constant care. Some feel this is a medical responsibility whereas it isn't, it's a social responsibility. An elderly person should be looked after in a residential home and only go to hospital if they require treatment. Far too many people consider that the NHS is there for everyday care when it isn't. If people sorted out their expectations accordingly then there might not be so much disquiet with the way the NHS handles the elderly.
 
#18
As a healthcare professional i offer this piece of advice to getting health needs met, firstly stay compos mentis and be assertive, or have someone who will fight your corner tirelessly.

The phrase 'The squeaky wheel gets the oil' is fact in the NHS', does excellent service delivery make front page news, no it does not, but complaints do, which is fair enough, as all care should be good. But if that care failure is to a group who do not have a 'voice', eg those with Alzheimers, those without friends, relatives etc to be their advocate/voice, then these client groups will quite possibly experience poorer service delivery (not always of course, there are for example some bloody good dementia care units).

However those with the ability and more important the willingness, or have someone on their behalf, to fight their corner will likely get their health needs met, or if needs not met, then issues raised resolved pronto.

If service delivery fails and after highlighting issue to the care professionals, a appropriately timed remedy is not forthcoming, then put your concerns in writing to the appropriate manager (there are loads of them, squillions of the blighters). If concern/complaint is on paper it cannot be ignored, paper trails of service failings are a bstard to ignore, and/or deny any knowledge of.

So folks get your most assertive, verbose and tenacious friend or relative lined up ready to be your advocate/voice, for the time if him upstairs strikes you down with a health issue that takes away your 'voice'.

See you all soon in a dementia care ward, i will be the one pinching the nurses bottoms (hopefully being sane enough to ensure said nurses are female) and swinging my catheter bag in the air.
 
#19
All very well Pasty,but in my 83 year old Mum's case - which is why is posed the question originally - what happens when my Mum can't be bothered with it all? I ring the surgery to find out why they are not doing xyz as they should be.I get stonewalled "we cannot discuss your Mother's medical condition without her permission" So I send a letter to my Mum for her to sign,she won't do it because she is afraid of upsetting the Doctors! So I end up going around in circles.
I vaguely remembered this story, NHS ageism 'stopping elderly getting cancer treatment' - Telegraph anything come of it?
 

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