Changing Lifestyles, Changing Habits: Older People and their Feelings about Treatment
Sometimes, older people feel as if nobody listens to what they want to do about their own health. This has been the case for Joe, an active 79-year-old who has blockages in his arteries. His doctors recommended bypass surgery. His children encouraged Joe to have the operation. But Joe has his own ideas.
Joe was 79 years old and having chest pain this past spring. He had also recently started taking medication to dissolve a blood clot. And he had become dehydrated, a common problem for older people.
Joe lives an active life. He has an accounting and law business that he operates from his home. Clients come and go all day, using their business appointments as opportunities to visit with him. His wife, who’s 12 years younger, is part of the social action too. She has tea with the visitors, and there’s lots of talking and laughing all day long.
Joe has always been slender, and his cholesterol is in the acceptable range. He doesn’t get much regular exercise though. He’s basically a workaholic, seeing his clients well into the night.
The doctor’s recommendation
The chest pains landed Joe in the hospital. An angiography, an X-ray of the blood vessels and chambers of the heart, showed that two of his coronary arteries were blocked. Frequently, when surgeons find a blockage during angiography, they perform what’s called a “balloon angioplasty” then and there. They insert a small catheter with an uninflated balloon at its tip into the narrowed artery. Then they inflate the balloon, increasing blood flow by compressing the plaque that’s causing the blockage.
But in Joe’s case, balloon angioplasty wasn’t an option because one blockage was more than 50 percent and it was in the left main artery. Clinical guidelines do not recommend angioplasty for this type of blockage.
For Joe, the way to eliminate the blockage in his arteries, his doctor told him, was to have a coronary bypass operation.
Bypass surgery or not?
Almost everyone in Joe’s family wanted him to have the surgery as soon as possible, especially his grown children. “Dad, please, have the operation. Just do it now and get it over with. We’ll take care of you.”
Bypass operations have become so common that sometimes people forget going through the surgery is not exactly a picnic. But Joe felt that a bypass operation would be a big deal for him. He was worried about losing his mental function. He knew that was more likely with older people who have serious operations. And he knew that his age put him at increased risk of stroke from the surgery.
There was the option of having the surgery “off-pump.” Initially, all bypass surgeries were performed by connecting patients to heart-lung machines, or pumps. Surgeons would stop the heart from beating by clamping the heart’s aorta and allowing the machines to take on the function of the heart, pumping blood throughout the body.
Recently, bypass surgery off the pump has become more common as the technology has become refined. Patients’ hearts continue to beat throughout the procedure. There’s been some evidence that this kind of bypass leads to fewer cases of depression and stroke, improved mental function and faster recovery time.
But even the idea of bypass surgery off the pump didn’t ease Joe’s mind. A few weeks went by, and he still couldn’t decide what to do. By this time, the chest pain had stopped. Medications had dissolved the blood clot, and he was no longer dehydrated. He was feeling pretty good, and could even walk for about a half mile each day, which he did, to show his children how good he was feeling.
Meanwhile, his children continued to tell him what they thought he should do. They would go with him to doctor’s appointments and tell the doctor what they thought Joe should do. They’d argue with each other about what Joe should do. Many older people say that kind of thing happens a lot. They go to the doctor with a family member, and suddenly the doctor and the family member are talking together about the old person’s health as if the older person isn’t even there.
Eventually, everyone in the family realized that no matter what they wanted, Joe would make the final decision. In fact, the only decision Joe has made is that he isn’t ready to make a decision. Right now, he’s learning about stress reduction, he’s trying to consume even less fat and sugar than he had been and he’s going for brief, easy walks every day. He’s still seeing clients and working a lot, which is driving his family crazy. But Joe himself is feeling pretty good about the way things are going.
He might decide at any time that he’s ready for bypass surgery. Then again, he may never choose to have the operation at all. His family members were frustrated at first, and even a little angry, but they’ve come to realize that Joe needs to feel comfortable with any big healthcare decisions.
It can be difficult for adult children to accept a parent’s decision to put off, or maybe never even have, an operation that they believe is his best chance for a longer life. That’s where respect, patience and love come into play.
The American Heart Association; L. Sauvage. You Can Beat Heart Disease. Better Life Press, Seattle, 1998; F. Pashkow and C. Libov. The Women’s Heart Book. Hyperion, New York, New York, 10023, 2001.