AT THE CLINIC ; THE OCTOGENARIAN CARDIAC

When I last check the national statistics, the life expectancy of Malaysian males in 2007 is 71 years and females is 76years. This week at my clinic I saw two patients ( a male and a female ), on different days, who were both 86years old. One ( the male ) had presented with a history of repeated heart failure over the last two weeks. He had an angioplasty done by me in 2004. The heart failure is now under control. He also has a heart murmur ( recently detected ) suggesting the presence of papillary muscle dysfunction. The 86 year old female was seen for a chief complaint of recurrent chest pains on exertion, relieved by rest. I am quite certain that both these patients has significant coronary artery disease and both would require coronary angiography, and perhaps also coronary angioplasty. I am often uncomfortable to take an octogenarian to the cardiac cath lab.. I always feel that I must be gentle with octogenarians and do not wish to be overly aggressive, knowing full well that they have outlived their life span, and yet, knowing also that octogenarians deserve the best also. To add to the discomfort on my part is the fact that in our present cardiac system, I see the patient and I also decide on the course of investigations and treatment. And since all these modalities, involves cost and profit, some may argue that I had recommended an invasive strategy, for self profit reasons. I do hope that you appreciate why I am uncomfortable. Well in these two cases, and as always, I had to spend the extra time to explain to the relatives ( I am glad that both the families are well educated ), the pros and cons of both the conservative and invasive strategies, so that they can help decide what is best for their parent.
At the end of both the consultations, both families opted for the invasive strategies as they wish to have the best done for their love ones, despite the 80 something years old.
I have always been taught that once we pass the life expectancy, the quality of life is much more important than the quantity of life. As many of my patients have told me, it is often not so important how long you live when we are old, but how we live. In one of the many seminars on care of the elderly, I learn " that age is not a number years from the beginning, but an appreciation of life from the present, until the end". In geriatric medicine, there is such thing as chronological age ( years from the beginning ) and physiological age ( how healthy they are now ). Both my patients are still able to travel, do their morning walks and contribute, in small ways to the upkeep of the family. So, I thought that we made the right decision to give them the best.
I thought that I will just share this thought with all of you.