Discussing Overall Prognosis with the Very Elderly — NEJM

Discussing Overall Prognosis with the Very Elderly — NEJM

Perspective article.

"offering to discuss overall prognosis with very elderly patients should be the norm, not the exception."

"We would suggest that clinicians should routinely offer to discuss the overall prognosis for elderly patients with a life expectancy of less than 10 years, or at least by the time a patient reaches 85 years of age. By that age, the average remaining life expectancy in the United States is 6 years; 85-year-old Americans have a 75% chance of living 3 more years and a 25% chance of living 10 more years"

"For patients with a life expectancy of more than 10 years, cancer screening, intensive blood-pressure management, and tight control of glycated hemoglobin levels will have high priority, whereas for patients with a shorter life expectancy, priority might be given to reducing the pill burden and engaging in advance care planning."

"Avoiding burdensome and potentially risky interventions of limited benefit may improve a patient's functional abilities and quality of life."

"a majority of elderly patients (65%) might want to discuss prognosis, whereas a substantial minority might not. Clinicians should therefore offer to discuss overall prognosis with very elderly patients — but respect those who decline."

See Table: Common Medical Decisions and Life Choices That Offer Opportunities to Discuss Overall Prognosis with Very Elderly Patients.

"To make care more patient-centered, we need to start helping our very elderly patients set goals of care that take their overall prognosis into account. We should do so in the ordinary course of clinical practice, letting our patients be our guides."