My 91 year old mother got a letter from her gastroenterologist telling her it was time for a colonoscopy.
I told her, “No, you’re to old for that.” and she let it drop. Then I started goggling. In a series of articles the universal recommendation seemed to be no colonoscopy for people over 80, and with reservations for ‘the elderly’ in their 60s.
I’ve got no question about my decision. There’s a 15% chance the anesthesia would kill her, there’s an unnumbered chance that drinking all that liquids would disrupt the fine balance of her health that her meds keep her in, and she has mild dementia, she couldn’t keep to the protocol.
So, this is why I’m posting. Why for pity’s sake would some scumbag of a gastroenterologist even suggest! that a 91 year old woman should have a colonoscopy. At some point shouldn’t they send out a form letter saying something like 'At your advanced age, we don’t recommend a colonoscopy unless there are other signs '…and then list them, and suggest an annual fecal blood test which is non-invasive.
I really feel like sending the gastro a letter and a copy of the article from one of the journals about colonoscopies for the very elderly. But instead, I’m venting my spleen here.
Maybe this belongs in MPSIMS, but IMHO Gastros are turning a necessary test into an opportunity for money regardless of the patient’s need.
Just for the sake of conversation, and assuming the test revealed colon cancer, one would wonder why a 91 year old would be put through the required treatment.
It’s amazing the seemingly simple computer programming that doesn’t go into medical systems sometimes. My workplace just switched over to electronic recordkeeping, and while lots of it I like, there are some really stupid bugs like that in our system too. Mostly, I catch them. Sometimes, I don’t. Mostly, it doesn’t matter. Sometimes, it’s a really scary big deal. I’m glad you caught this one.
I should explain that my mother’s last colonoscopy was 3 years ago, and (according to my research) colon cancer is slow growing. So, all the articles recommended not doing a colonoscopy at her age. She’s also a high risk medication patient. At some point, if you end up responsible for making the medical decisions for an elder parent, you too may have to make decisions like this, trading off the risk that she might have a terminal disease with the very much higher risk that the test for the disease would kill her.
Last year a doctor wanted to do surgery on her thyroid for a non-life threatening condition. I asked if it was worth doing the surgery since there was a 15% probability that the anesthesia alone would kill her.Plus her mental state meant that she wouldn’t be able to do any wound care. So, no, it wasn’t worth that risk.
I realize that the letter was auto-generated, but couldn’t a letter for people over 90 automatically include other recommendations?
Did she have polyps last time? If so that is likely what triggered the recommendation for the next one at three years. My gastroenterologist told me that it takes around three years for a polyp to reach cancerous stage, so to protect against new polyps developing and growing to a dangerous level, another colonoscopy at three years is recommended. Granted, at your mother’s age and with her other complications it likely isn’t a good idea for her, but another colonoscopy three years after polyp discovery seems to be routine.
This summer I learned about Cologuard, a noninvasive test for colon cancer. Might be an acceptable alternative for people who can’t/won’t tolerate a colonoscopy.
The answer is very easy greed and money ! I had a client that was in her
80’s with all kind of health issues and I almost fell over backward when she told
me she getting a pacemaker for heart. I really think some doctors are knife happy and money hungry and tell an elderly anything to made a fast buck!