Medical care for the elderly, is it discriminated against?

The Spanish Association of Surgeons (AEC) has launched a study, in which more than 30 hospitals have already participated, to analyze the impact of care for those over 70 years of age. He wants to study the results of interventions, complications, mortality and other aspects. These data are already being worked on in some centers or in specific pathologies, but the AEC wants to have a more general vision, explains David Pares, coordinator of the AEC’s quality, safety and governance department.

Is attention failing? Not that, explains Pares. But the AEC estimates that it could have (anonymized) data from up to 10,000 people and thus see what aspects could be improved in the care of these patients, who are usually frail. Pares, a colorectal surgeon at the Germans Trias Hospital in Badalona, ​​adds that there is a constant adaptation of action guidelines to medical advances to improve care for all patients.

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Mother Rius

Doctors assure that age alone is not a criterion that determines care

Last day 2, the Archbishop of Tarragona, John Planellas, published the article covert euthanasia in The vanguardin which he criticizes a criterion of economic or social utility, asserting that “there is an unwritten but real practice in certain areas of the medical sector” according to which patients of a certain age are not given certain tests or treatments in order to avoid harm to other patients.

Arguments along the same lines were recently advanced by the former councilor of the community of Madrid in charge of residences at the beginning of covid, Alberto Reyero, who, after the accusations of more than 7,000 deaths of residents, blamed the protocols that prevented the elderly from hospitalization. Does health discriminate against the elderly?

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Martha Ricart


“Studies were conducted years ago and it was seen that age alone is not a valid criterion. Today, age is not a condition for stopping an activity or serving someone. We are performing more interventions than ever before on older patients, given the aging population. For example colon cancer. And with a good result. I recently operated on an 88-year-old patient and she is doing well. About 30% of patients are over 70 or 75 years old,” says Pares.

We are doing more interventions than ever before on older patients”

David ParesA surgeon

“Of course, it is more complicated – adds Pares – to operate on 80-year-old patients, who usually have pathologies, than young ones. But an 85-year-old patient may be in better shape than a 65-year-old.”

Jaume Padros, president of the Col.legi de Metges de Barcelona (COMB), has already disqualified the bishop’s article in a tweet and said it also “shows total ignorance about what is the adequacy of therapeutic efforts and the avoidance of useless practices and therapy of persistence’.

Padros recalls that by chronicling many pathologies, medicine agrees with “absolutely typed markers” that allow the patient’s condition to be established regardless of his age. “Age is now less decisive than ever, it does not decide what to do or not to do,” says the college president.

“Age is now less decisive than ever”

Jaume PadrosPresident COMB

Vaccination against Covid-19 with Pfizer at CAP Sant Cugat for people over 80 years old.  A woman in a doctor's office converted into a vaccination room

During covid there were failures to manage the first wave in many residences but later priority was given to vaccinating the elderly

Mane Espinosa

“Surgeons draw up guidelines that, when faced with an elderly patient, help to assess him globally, we assess his vulnerability – not only the surgeon, but also other specialists – how is his heart, lungs, cognitive abilities, mobility, improvement of intervention may bring what post-operative care will be needed… Sometimes an intervention may carry more risks than benefits and another treatment is sought. Or there is a patient who does not want surgery”, Pares explains. Padros recalls that there are medical and health ethics committees that help make decisions in the most complex cases.

You don’t look at the years, you look at the life prognosis”

Jose Augusto Garcia NavarroPresident of SEGG

José Augusto García Navarro, president of the Spanish Society of Geriatrics and Gerontology (SEGG), agrees that age has not determined admission or treatment for years. The criteria are the prognosis of the disease, the dependence of the patient, whether or not it will improve the quality of life, he says.

“A patient with six or seven chronic pathologies and a life prognosis of 2 or 3 months will not undergo any intervention, it is true. Someone will say that it is due to age, but it is not the years, but the life prognosis. What is looked at is whether the intervention would bring about improvement or more suffering and dependence. Maybe another treatment was chosen,” he explains. It is not ignored.

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Where there are barriers in Spain, says García Navarro, is older people’s access to long-term and dependent care, but because services are lacking, much more and continuous investment must be made.

There are many areas in society where older people are discriminated against, but health does not stand out as one of them.”

Antonio Martinez MarottoGreat friends

Antonio Martínez Marotto, from the patronage of Grandes Amigos, an organization for the elderly, believes that “there are many areas in society where the elderly are discriminated against, but health does not stand out as one. We don’t get complaints because it’s not serviced because of age because it is serviced. Yes, older people are discriminated against in aspects such as taking out health insurance or extending digital procedures such as requesting an appointment online, which many do not know how to do.” “During the worst of Covid there was a greater perception of discrimination, at least in Madrid,” he says.

End of life care

The debate about aged care intensified when covid saturated hospitals and there was a shortage of respirators and with the euthanasia law, but it often recurs around palliative care. Padros criticized that Bishop Planellas “generalized what may have happened in some cases” and was surprised that he used arguments “from the most reactionary sector of the Church.”
Padros refers to COMB’s positions, which reflect that modern medicine advocates prevention and treatment, but also to ensure quality of life, alleviate suffering and ensure a dignified death. According to the doctor, there are less and less aggressive treatments and advances allow the end of life to be identified. “Typically, there’s still a tendency to prolong, to mechanize the end, rather than stop the treatment,” he says.
And he points out that more doctors are using the advance directive plan, in which they talk with patients and families about what care they want.

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Martha Ricart

photo XAVIER CERVERA 07/02/2021 report of thirty-some years in the intensive care unit of the hospital clinic, Barcelona.  Despite the vaccinations and the apparent emergence of the fourth wave ... there are increasing cases of people around 30 years old (who have already started a social life ... but not vaccinated with one or two doses) nurses take care of them, protected by double gloves, a gown , glasses, various PPE

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