Old age no bar­rier to ag­gres­sive med­i­cal care

New wrin­kles in surgery, treat­ment can im­prove life of very se­nior cit­i­zens

Winnipeg Free Press - Section D - - ARTS & LIFE - By Lind­sey Tan­ner

CHICAGO — Ir­win Weiner felt so good af­ter heart surgery a few weeks be­fore turn­ing 90 that he stopped for a pastrami sand­wich on the way home from the hos­pi­tal. Dorothy Lip­kin danced af­ter get­ting a new hip at age 91. And at 94, Wil­liam Gandin drives him­self to the hos­pi­tal for can­cer treat­ments.

Jimmy Carter isn’t the only nona­ge­nar­ian to with­stand rig­or­ous med­i­cal treat­ment. Very old age is no longer an au­to­matic bar­rier for ag­gres­sive ther­a­pies, from can­cer care like the for­mer pres­i­dent has re­ceived, to ma­jor heart pro­ce­dures, joint re­place­ments and even some or­gan trans­plants.

In many cases, the na­tion’s most se­nior cit­i­zens are get­ting the same treat­ments given to peo­ple their grand­chil­dren’s age — but with dif­fer­ent goals.

“Many el­derly pa­tients don’t nec­es­sar­ily want a lot of years; what they want is qual­ity of life,” said Dr. Clifford Kavin­sky, a heart spe­cial­ist at Rush Univer­sity Med­i­cal Cen­ter in Chicago. “They want what­ever time is left for them to be high qual­ity. They don’t want to be de­pen­dent on their fam­ily. They don’t want to end up in a nurs­ing home.”

Treat­ment for Carter, 91, has in­cluded surgery, ra­di­a­tion and a new can­cer drug with fewer side ef­fects than tra­di­tional chemo­ther­apy. It seems to be work­ing — Carter an­nounced Dec. 6 that brain scans show no signs of the melanoma that was found in Au­gust.

The 90-and-up pop­u­la­tion of the United States, about two mil­lion peo­ple, nearly tripled in re­cent decades, and the pace is ex­pected to con­tinue. Many are strug­gling with more than one age-re­lated ill­ness that make them poor can­di­dates for ag­gres­sive and of­ten costly care. But plenty re­main ro­bust enough to give it a try.

Lip­kin, now 93, had hip-re­place­ment surgery two years ago in the Philadel­phia area. Arthri­tis made walk­ing dif­fi­cult and painful. She’d been a good dancer in her younger days, and had tried to re­main ac­tive, so her doc­tor rec­om­mended the op­er­a­tion.

“Oth­er­wise I was go­ing to be in a wheel­chair the rest of my life,” Lip­kin said. Soon af­ter, she made a video do­ing a line dance to show how well she was heal­ing.

In the win­ter, she lives in Florida, walks at least half an hour daily and leads “a nor­mal life.”

Lip­kin says hav­ing such ma­jor surgery at her age should be an in­di­vid­ual de­ci­sion.

Doc­tors agree. Some 90-year-olds are fit­ter than some 60-year-olds but they say other con­sid­er­a­tions need to be in the mix.

At MD An­der­son Can­cer Cen­ter in Hous­ton, the old­est pa­tients are eval­u­ated by geri­a­tri­cians — spe­cial­ists in med­i­cal care of the el­derly — to make sure they’re able to tol­er­ate harsh treat­ments. Phys­i­cal and men­tal health are as­sessed; so is so­cial sup­port — whether there are fam­ily mem­bers or friends avail­able to help dur­ing treat­ment and re­cov­ery.

“We do be­lieve that can­cer care should not be lim­ited by age,” said Dr. Beatrice Ed­wards.

While many el­derly pa­tients are healthy enough to tol­er­ate con­ven­tional treat­ments, ad­vances in­clud­ing more tar­geted, less toxic drugs and min­i­mally in­va­sive surgery tech­niques are open­ing the door to oth­ers.

Gandin, the 94-year-old, was di­ag­nosed more than 10 years ago with prostate can­cer. Treat­ment with ra­di­a­tion and chemo­ther­apy failed to stop can­cer from spread­ing to his lungs and bones. He’s now on hor­mone treat­ment that he said is controlling the dis­ease.

A re­tired Exxon Mo­bil au­di­tor, Gandin helps take care of his wife of 74 years in their as­sisted-liv­ing home in Hous­ton and is not ready to give up on treat­ment. “I’m an eter­nal op­ti­mist — that’s what has car­ried me through,” he said.

Weiner, a re­tired fur­ni­ture man­u­fac­turer rep­re­sen­ta­tive, had a hard­ened, leaky aor­tic valve — a com­mon con­di­tion in the el­derly that can lead to dis­abil­ity and death. Open-heart surgery is a com­mon op­tion for heart-valve surgery, but some doc­tors hes­i­tate to per­form it in the el­derly, said Kavin­sky, the Chicago heart spe­cial­ist.

Dr. Joseph Lame­las, Weiner’s sur­geon at Mount Si­nai Med­i­cal Cen­ter in Miami Beach, Fla., used a newer ap­proach, im­plant­ing a new valve through a small in­ci­sion on the right side of the chest.

Af­ter four days in the hos­pi­tal last Jan­uary, Weiner was back home in Boca Ra­ton, Fla., and was well enough to have two big 90th birth­day cel­e­bra­tions less than a month later.

Or­gan trans­plants are less com­mon but not un­heard of in the very old. Since 2013, there have been more than 100 kid­ney trans­plants in pa­tients aged at least 80, in­clud­ing one in an 88-year-old, ac­cord­ing to the United Net­work for Or­gan Shar­ing. Its rec- ords show that since 1987, the na­tion’s old­est kid­ney trans­plant re­cip­i­ent was a 96-year-old.

There are gen­er­ally no strict age lim­its on trans­plants. Dr. Dorry Segev, a Johns Hop­kins Medicine trans­plant spe­cial­ist, said frailty is a more im­por­tant fac­tor and his cen­tre mea­sures it rig­or­ously, in­clud­ing as­sess­ing pa­tients’ grip strength, walk­ing speed and mus­cle mass.

Eth­i­cal is­sues com­pli­cate de­ci­sions on pro­vid­ing treat­ments cost­ing tens of thou­sands of dol­lars to the very old and life ex­pectancy has to be con­sid­ered, Kavin­sky said.

“When you start do­ing pro­ce­dures on a 90-year old, you have some­one who has al­ready ex­ceeded the av­er­age life­span in Amer­ica,” he said. “How far should we go to keep them go­ing?”

Dr. Joseph Dearani, chair­man of car­diac surgery at the Mayo Clinic in Rochester, Minn., said a good gauge is whether treat­ment would likely help pa­tients live well for at least an­other two years.

He said costs to the pa­tient, their fam­ily and so­ci­ety also should be weighed, so that treat­ment is given to right pa­tients, and “for the most part, that hap­pens.”

‘Many el­derly pa­tients don’t nec­es­sar­ily want a lot of years; what they want is qual­ity of life’ — Dr. Clifford Kavin­sky, a heart spe­cial­ist at Rush Univer­sity Med­i­cal Cen­ter in Chicago


Ir win Weiner, 90, with his par tner, Lau­ree Gable. Weiner was back home four days af­ter his aor tic valve surger y.


For­mer U.S. pres­i­dent Jimmy Car ter, 91, is be­ing treated for can­cer with meth­ods that in­clude surger y and ra­di­a­tion.

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