English summaries
Examinations of old patients – too few or too many?
Julkaistu 13.06.2005 10.57
Inappropriate and too often repeated examinations are common in all specialties and in patients of all ages. Dying patients are often subjected to medical futility. In our study the family members of old patients (n = 312) who had deceased one year earlier told that medical futility (examinations, medication, treatment or nursing) had been a cause of suffering in 28% of the patients. Futilities were most common in men and in hospitals with good facilities. Retrospective analyses have shown that about half of all treatment periods in acute hospitals are more or less inappropriate. Unnecessary use of technology should be avoided when there is no absolute need.
On the other hand, many elderly patients suffer from undiagnosed diseases. This has been shown in screening programmes for the elderly, in which potentially treatable diseases and conditions are regularly found. Also, in critical diseases such as stroke and acute myocardial infarction old patients are examined and treated less actively than younger patients. According to population-based follow-up studies mild new symptoms indicate rapid progression of functional decline and call for immediate action. The proper timing of examinations is thus important for the wellbeing of the elderly.
Reijo Tilvis Professor University hospital of Helsinki tilvis@mappi.helsinki.fi
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