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Therapeutic Objectives in Older People


Richard W. Besdine

, MD, Warren Alpert Medical School of Brown University

Last full review/revision Apr 2019| Content last modified Apr 2019

Health care options (such as medical testing and treatments) almost always carry some risks. Those risks could impact quality of life. Patients and health care practitioners should weigh the benefits of tests and treatments against the potential negative impacts on quality of life (see also Medical Decision Making Medical Decision Making read more ).

Potential benefits of medical interventions include the following:

  • Cure

  • Increased life expectancy

  • Slowing of disease progression

  • Improved quality of life (such as being more able to go about daily activities)

  • Symptom relief

Potential negative effects of medical interventions include the following:

  • Death

  • Symptoms, such as discomfort, prolonged fatigue, loss of muscle strength, reduced mobility, and incontinence

  • Inconvenience

  • Cost

  • Need for additional tests or treatments

When treatments are very likely to achieve benefits and very unlikely to have negative effects, decisions are relatively easy. However, when there are potentially significant negative effects, people need to work with their doctors to make the decisions that take into account quality of life. For example, aggressive cancer therapy may prolong life but have severe negative effects (including chronic nausea and vomiting) that greatly reduce quality of life. In this case, the person’s preference for quality of life versus duration of life and tolerance for risk and uncertainty help inform health care goals and determine what medical interventions to pursue.

The person’s perspective on quality of life may also affect treatment decisions when different treatments (for example, having surgery or taking medicines) may have different benefits, negative effects, or both. Health care practitioners can help people understand what could happen with the various treatment options, enabling people to make more informed decisions regarding medical testing Medical Testing Decisions Because many different diseases can cause the same symptoms, it can be challenging for doctors and other primary care practitioners to identify the cause. Doctors first gather basic information... read more and treatments Medical Treatment Decisions Before recommending treatment, doctors weigh the potential risk of harm from a treatment against its potential benefit. (See also Overview of Medical Decision Making and The Science of Medicine... read more .

When making medical decisions, life expectancy often matters more than age. For example, people with a limited life expectancy may not live long enough to benefit from aggressive treatment of a slowly progressive disorder (for example, radical prostatectomy for a localized, slow-growing prostate cancer). Nevertheless, quality of life is an important consideration in medical decisions, so even people with a limited life expectancy may consider having invasive treatments that may improve quality of life (for example, joint replacement surgery).

Regardless of the overall treatment goals, doctors consider the need to relieve symptoms, such as pain, nausea, and shortness of breath. Having to live with such symptoms can significantly affect quality of life.

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Test your knowledge
Care of Older People in the Home
Older people may need care in their home when they are frail or weak, particularly after they have been discharged from the hospital or rehabilitation facility. Simple care is usually provided by family and friends, but more complex care may require a healthcare professional to come to the home. Which of the following health-care professionals may be needed to help people prepare meals, take a walk, or bathe?
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