15 October 2012
A report from the Royal College of Surgeons working with Age UK said that doctors need to move away from basing treatment on when someone was born and look instead at their health and fitness. While a patient's health needs increase with age, planned (elective) surgery rates decline steadily for people as they grow older. The way the NHS has approached the care of older people has failed to keep up with the major advances in medical and social care which have resulted in people living longer healthier lives.
At the same time, the report warned, the £20bn NHS efficiency drive has heightened the danger of older people being "disproportionately impacted" by the need to prove cost effectiveness in providing treatment.
Among the findings in the report were:
• The incidence of breast cancer peaks in the 85+ age group, while the surgery rate peaks for patients in their mid-60s and then declines sharply from the age of 70.
• People over the age of 65 make up the majority of recipients of joint replacement surgery. However, the rate of elective knee replacement and hip replacement surgery for patients in their late 70s and over has dropped sharply and consistently over the three years examined.
• Ten thousand men a year die from prostate cancer and the incidence of the disease increases with age. Overall, half of men who develop the disease will die as a direct result of it. Again, surgical treatment rates for the disease do not match the number of new cases being diagnosed amongst the older population.
• Emergency surgical procedures are increasing for hernias in older people, while the planned surgery rates plummet once a patient passes the 75-79 bracket.
Professor Norman Williams, President of the Royal College of Surgeons, 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."
Michelle Mitchell of Age UK added: "When it comes to peoples' health, their date of birth actually tells you very little. A healthy living 80 year old could literally 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 health minister Dan Poulter commented: "There should be absolutely no place in the NHS for assumptions about entitlement to treatment 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."
He went on: "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."