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Treatment decisions for older people

Updated Wednesday 18th December 2013

We discuss whether older people have to prove they are worth the investment when it comes to healthcare treatment.

Please note: The views expressed in this debate are all genuine, but in order to encourage open debate they were captured off-camera. The video below features people sharing views randomly assigned to them, which may not reflect their personal beliefs, nor those of The Open University as a whole.

Video

Transcript

CAROLINE

So this is what got me worried about treatment decisions.  A couple of years ago I was cycling home and I came off my bike and I ended up breaking my wrist.  So they took me to the hospital and I had excellent treatment in the end.  You know, it was all great.  They fixed it and everything, in fact they put a pin in it, and I've got perfect function back in it, no problems at all.  But one thing that they said to me while I was in the hospital that worried me a bit was that they asked me how I'd hurt the wrist, and I explained that I'd fallen off my bike, so the clinician said to me so you're very active then.  Because they'd checked my age and they said so you're still very active, you're still working.  Yes I'm still working, yes I'm still active.  And on that basis they seemed to think it was worthwhile putting this pin in my wrist.

REBECCA

Okay, okay.

CAROLINE

Now at the same time a colleague who's roughly the same age as me had tumbled and fallen over, I think on ice or something, had the same kind of injury and didn't get offered the pin.  They were put into a plaster cast, so they didn't have the operation and they didn't completely get back full functionality.

REBECCA

Oh wow.

CAROLINE

So I kind of became worried that you were, at a certain point having to prove you were worth the investment and that the, if you like, the nation would be getting back it's input based on how active you were at a certain age.

REBECCA

Yes, yes.

CAROLINE

So do you think that that is a thing?

JONATHAN

There's sort of various rumblings that go on and all sorts of things about people being overweight or smoking, should they get this treatment or that treatment if they're not looking after themselves.

REBECCA

Yes, and maybe age is another one of those things that, yes.  And I mean, you know, guidelines usually say, like NICE guidelines and things very rarely make any reference to age do they?  I mean well except in things like IVF where it's, you know, very…

CAROLINE

Well I mean it wasn't explicitly about age.

REBECCA

Yes, that's what I mean, it's not explicit; it's implicit, yes.

CAROLINE0

No.

JONATHAN

There's this word ‘active’ though wasn't it?  Are you active?

CAROLINE

Yes, yes.

REBECCA

Yes, active is…

CAROLINE

Yes, it's the code for.  And the other example I think this week I saw on a newsfeed that one of the things being cut back on at the moment in health service is cataract operations.  Now you could say that's across the board.   

REBECCA

Yes, that's something to do with age isn't it?

CAROLINE

But who are the people who get cataracts?

REBECCA

Yes.

JONATHAN

Older people!

CAROLINE

Older people, so I just think this is an interesting issue of age discrimination that isn't obvious.

REBECCA

Yes, so it's not people saying your 75 you can't have your wrist pinned or older people don't need eyesight; it's just indirect.

CAROLINE

Yes.

JONATHAN

Yes.  And do you think there were more sort of ways that age discrimination happens, sort of moving to becoming sort of rather more hidden than perhaps was the case.

CAROLINE

Well I mean there's a degree to which older people themselves will say oh, you know, I don't need this let the younger people have it.

JONATHAN

Yes, so they sort of buy into it in a way, don't they, yes.

CAROLINE

You know, including, yes, yes, so and, you know, some people would argue that that is right, you know, if there are limited resources it should go to this group and not that group.  But the question is: is age one of them given what you said earlier about the third age and the fourth age and that it depends on the person, you know, and so should age come into clinical decision making is the question.

JONATHAN

Yes.  And do you just mean though sort of how many birthdays somebody's had or do you mean the sort of the way that their life has gone.  So as Rebecca was saying that some people might seem older at 65 than somebody who's 85.

REBECCA

Yes.

JONATHAN

So, but are you saying that sometimes sort of birthday age, chronological age sort of gets used as a sort of way of being a shorthand for that?

CAROLINE

Well I don't quite think that, I think it might flag up that if a person's of this age we might check them out to see if they're kind of, you know.

JONATHAN

Yes, see if they pass.

CAROLINE

See if they pass!  But obviously some people much younger are not going to pass because they've aged as some people say badly, and that might be for all sorts of reasons.  So I think that this is an issue that we kind of need to bear in mind and be careful about.

JONATHAN

Yes.  It's who's seen as deserving and who isn't potentially isn't it?

CAROLINE

Yes.

REBECCA

And very often that's not to do with someone's personal responsibility.

JONATHAN

No that's right.

REBECCA

It's to do, you know, thinking about income and politics and all that, you know.

CAROLINE

Absolutely, yes.

REBECCA

If you've got enough money to have a bike that you can, and live in a nice enough place that you can cycle to work.

CAROLINE

Exactly.

JONATHAN

I agree with that, yes.

REBECCA

Versus somebody who can't do that.

CAROLINE

Exactly!  And if you've had a very rough life you might age a lot more quickly anyway physically, yes, so.

REBECCA

Yes. 

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