Medical tests in very old age

[Nodancingshoes]

My nan (96) has been referred to hospital for tests relating to low iron which will include tests for bowel cancer. I have spoken to her about whether she wants to put herself through the tests but she is adamant she should. If the worst happens, would they actually treat her at her age? What could we expect to happen? She has no other symptoms and I would just want to live the rest of my days in ignorance if it was me. The tests would be very very uncomfortable for someone of this age I imagine and I just dont want her to be in pain if she doesn't need to be. Does anyone have experience of this??

I'd say it sounds like she sounds like she wants to do them. Is it just a blood test? Some people want to know and others don't. Her choice

I think your instincts are right. You could always email/write to her doctor? Or try ringing if you're her next of kin or have any legal responsibility?

Tell them she's got no symptoms and ask them to be very clear about -

1. Exact nature of tests
2. Whether different results would affect management and in what circumstances, and what the treatment options would be.

It may be that it's simply an additional blood test and/or a stool sample or a scan which wouldn't be too bad. But if they are talking about a colonoscopy or a sigmoidoscopy that might be another matter. They can sometimes include treatment as well though - eg removing polyps.

What they find may not be cancer & be something easily treatable which give her a good quality of life for her remaining years.
It’s your nan’s decision at the end of the day. Would you like the decision to be taken away from you?
Presumably they will do a colonoscopy? It really isn’t that bad, being old isn’t going to make it more uncomfortable than it would be for a younger person tbh.
If the tests reveal cancer then the treatment options will be weighed up. They didn’t treat my Nana’s breast cancer as she had dementia and the family decided that it would be more distressing for her to go through treatment but DH’s aunt had treatment for lung cancer just a few years younger than my nana & she coped fine.
It’s upsetting for you to think of your Nan suffering but she is having tests to see the cause of her low iron. Try not to jump to treatment for cancer until she has the results

Noshoes,
If your nan has a low iron reading then the GP will want to check this out.
It could be caused by several conditions. A diet low in iron, an inability to absorb iron from the gut, a loss of iron from the body caused by a bleed - the latter is why they want to rule out bowel cancer.
They will probably take blood from her.
They will probably do a colonoscopy to examine the surface of the bowel. This might be a bit uncomfy but they can give a sedative.

She needs to talk to the medical team if she wants more info.

"She has no other symptoms and I would just want to live the rest of my days in ignorance if it was me"

But she's not you. Unless she is detained under the Deprivation of Liberties Act she is deemed to have the power of self determination. In other words she can make her own choices.
I can't comment on what treatment they might or might not give as that would be determined by her attending physician.

Rest assured that they would not do anything to cause your nan unnecessary pain.

HTH

She has had blood tests and been on iron tablets. She was referred for the 'two week wait' to test for bowel cancer so I'm not jumping to conclusions. Of course it's her choice but at 96 surely they wouldnt give her chemo or an operation? I'm worried that being told any potential bad news would be mentally very bad for her. As for the tests, she had a MRI last year for something else and it took her weeks to get over it as lying flat caused no end of problems. I just want her to have a peaceful happy last few years - is that so bad??

Does you have capacity to consent? If so, it's her decision. My grandmother had cancer towards the end of her life. They didn't treat it because there was no benefit but it meant that they could ensure she was comfortable.

I understand how you feel but ultimately it’s her choice, and it may be that she would prefer to have the investigations and treatment even if they potentially shorten her life or cause her discomfort rather than just effectively passively waiting to die. My Gran had an operation for bowel cancer at 88, she wanted to have it done and it was a success - they removed all of the tumour and she was pleased as it made her feel like she was free of the cancer. Unfortunately she died 2 years later of a heart problem but she was very much in fighting spirit with the bowel cancer and wanted to have the treatment.

@mynameiscalypso

Does you have capacity to consent? If so, it's her decision. My grandmother had cancer towards the end of her life. They didn't treat it because there was no benefit but it meant that they could ensure she was comfortable.

I means does she have capacity; sorry.

@mynameiscalypso

Does you have capacity to consent? If so, it's her decision. My grandmother had cancer towards the end of her life. They didn't treat it because there was no benefit but it meant that they could ensure she was comfortable.

Thank you - this is what I wanted to know. Yes she has capacity. I would never take her choice away, I just dont want her to suffer unnecessarily. At 96 i dont think she would survive surgery or chemo. For context I am her next of kin - we are missing a generation.

@PermanentTemporary

I think your instincts are right. You could always email/write to her doctor? Or try ringing if you're her next of kin or have any legal responsibility?

Tell them she's got no symptoms and ask them to be very clear about -

1. Exact nature of tests
2. Whether different results would affect management and in what circumstances, and what the treatment options would be.

It may be that it's simply an additional blood test and/or a stool sample or a scan which wouldn't be too bad. But if they are talking about a colonoscopy or a sigmoidoscopy that might be another matter. They can sometimes include treatment as well though - eg removing polyps.

It's her Nan who needs to have these conversations. The OP has not said anything to indicate there is any reason why she can't advocate for herself.

Of course the OP can support in whatever way her Nan wishes but she shouldn't be emailing the doctor unless her Nan has asked her to.

I wouldn't email the doctor but she has asked for me to be with her for any consultations as she doesnt always hear and can get upset and confused by medical talk.

Honestly, I very much doubt that they'd offer surgery or chemo to a 96 year old woman. They'd be more concerned with making her comfortable and treating the symptoms which may help her feel better.

@mynameiscalypso

Honestly, I very much doubt that they'd offer surgery or chemo to a 96 year old woman. They'd be more concerned with making her comfortable and treating the symptoms which may help her feel better.

Yes this is what I think too. I just struggle to see the benefit of knowing - I fear the news could kill her tbh. If she was 20 or even 10 years younger of course I wouldnt think this... Anyway I feel shitter than ever now after some of these replies but thank you for answering my original question xx

@PermanentTemporary

I think your instincts are right. You could always email/write to her doctor? Or try ringing if you're her next of kin or have any legal responsibility?

Tell them she's got no symptoms and ask them to be very clear about -

1. Exact nature of tests
2. Whether different results would affect management and in what circumstances, and what the treatment options would be.

It may be that it's simply an additional blood test and/or a stool sample or a scan which wouldn't be too bad. But if they are talking about a colonoscopy or a sigmoidoscopy that might be another matter. They can sometimes include treatment as well though - eg removing polyps.

Whether the OP is next of kin or not is irrelevant. Her GM has capacity, so it is her choice whether to have the tests.

Unless a patient is expected to die of something else very imminently, it is often worthwhile investigating a possible cancer, even in someone very elderly, to help control any symptoms from it. Radiotherapy and chemotherapy can be used palliatively in small doses, to keep the size of a tumour down and to stop it causing unpleasant symptoms. A bowel cancer, for example, can perforate the bowel or block the tubes that take drain the kidneys (the ureters) if you leave it untreated. Even if you aren't trying to cure it, it's often a good idea to shrink it as much as possible.

Hopefully your nan will turn out not to have anything serious, OP. But, even if it is cancer, the good news is that cancers tend to grow slowly in elderly people, so it may not cause her too much trouble. Please don't discourage her from having treatment until you understand exactly why any treatment is being proposed. It may well be that the focus is all on keeping her comfortable, which is likely to be in her best interests.

Urgh, anyone who tries to treat me like an imbecile in my old age will be firmly told to fuck off

How she chooses to proceed with her own health is her concern. She could live for another 10-15 years.

I know of a 96 year old who had an aneurysm treated; he was fitter than some 60 year olds.

It’s nobody else’s business but hers

I just struggle to see the benefit of knowing - I fear the news could kill her tbh. If she was 20 or even 10 years younger of course I wouldnt think this

Older people have seen many friends and family die, and are usually much better at coping with a serious diagnosis than younger people. It's their relatives who struggle and who often want to protect them from the diagnosis. You are understandably worried about your nan, but be careful about projecting your own (understandable) concerns on to her.

I don't see any reason why someone shouldn't contact a doctor about someone else. I'm not suggesting that the doctor should provide any information back the other way.

Permanent,
"I don't see any reason why someone shouldn't contact a doctor about someone else." They can do but what would be the purpose as the doctor can't discuss their medical history?

"I'm not suggesting that the doctor should provide any information back the other way" - so what is the point?

@Disname

Urgh, anyone who tries to treat me like an imbecile in my old age will be firmly told to fuck off

How she chooses to proceed with her own health is her concern. She could live for another 10-15 years.

I know of a 96 year old who had an aneurysm treated; he was fitter than some 60 year olds.

It’s nobody else’s business but hers

What a horrible reply. I would NEVER treat her like an imbecile - she has been the only mother I've had for 25 years. I love her unconditionally and dont want her to be in pain or to suffer. 15 years? You heard that I said 96? Much as I wish she could live forever i think that is extremely unlikely.

The point is that eg if you have someone in your life who is saying they want to have tests but, for example, says they don't know what the tests will involve, you might be concerned that their consent to these tests isn't well founded.

Come over to the Elderly Parents board some time.

Im a health care professional. I read a lot of papers about people who say they would have made different choices if they'd understood more. It is very easy to think you've explained something really well but to find that the person hasn't taken any of it in. It is useful if someone tells me that.

@PermanentTemporary

Im a health care professional. I read a lot of papers about people who say they would have made different choices if they'd understood more. It is very easy to think you've explained something really well but to find that the person hasn't taken any of it in. It is useful if someone tells me that.

Absolutely. I want her to understand what the tests will involve before she gives consent not to take her choice away. Hopefully we will get some more information at the consultation.

Permanent

"The point is that eg if you have someone in your life who is saying they want to have tests but, for example, says they don't know what the tests will involve, you might be concerned that their consent to these tests isn't well founded."

That is why the NHS has rules about "Informed Consent"

Yes I know the NHS has rules on informed consent. If you think those rules are universally well applied, we areclivibg in different worlds.