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??

My Dad had prostate cancer about 5 years ago, he was nearly 85. I do understand that at this age an year plays a huge difference but actually it went much better then we’ve expected. My Dad is very tricky patient mentally it’s our main concern. He did colonoscopy for diagnosis ( low iron) , first time it’s failed, then he came again and it was different nursing team, he said it made a huge difference and the procedure went really smoothly.
I would talk to her doctor about your concerns and how they are going to address issues your Nan had in the past with procedures. And ask a lot of questions about how it’s going to be. You can also find info online about what to expect during tests.

@greenlynx

My Dad had prostate cancer about 5 years ago, he was nearly 85. I do understand that at this age an year plays a huge difference but actually it went much better then we’ve expected. My Dad is very tricky patient mentally it’s our main concern. He did colonoscopy for diagnosis ( low iron) , first time it’s failed, then he came again and it was different nursing team, he said it made a huge difference and the procedure went really smoothly. I would talk to her doctor about your concerns and how they are going to address issues your Nan had in the past with procedures. And ask a lot of questions about how it’s going to be. You can also find info online about what to expect during tests.

Thank you

My mam had tests for very low haemoglobin when she was very elderly. Iron tablets don't make much difference at that age. They wanted to rule out stomach and bowel cancers. It was neither and was due to her kidneys not producing a hormone and she just had an injection once a month for several years and an occasional blood transfusion. She was much more comfortable and well. Your grandmother could be the same.

She is very unlikely to be operated on and chemo isn’t always the right solution for a cancer patient. There are lots of things that can be done to help treat, prevent and cure things. Your nan has capacity and has made her decision. Just because she is 96, doesn’t mean she won’t outlive you.

Some people have an element of comfort in knowing what is going on and of it is cancer and it’s terminal, it still might not kill her. However, there are a number of different treatments that would be offered and/or palliative care. If you are trying to treat an unknown, it’s harder to get it right first time for a patient and make them have the best quality of life available.

Hopefully it’s good news from the tests.

There is a lot in the OP and subsequent posts about what you want for her. After the consultation she needs decide what she wants- without any pressure.

If they offer treatment she may want it, or not. It's really unlikely that the HCP will strongly encourage a treatment that will with detrimental to her quality of life and she can go away and think about it.

I just think you need to separate what she wants to do vs what you think she should do because even though you're coming from a place of love she needs to have the ultimate control.

Believe me, she would never do something she didnt want to do I just want to make sure she fully understands what is going on because as soon as she heard the word 'cancer' she didnt really hear or understand anything else that was said.

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

Sure, but the OP's views aren't necessarily well-informed either. She is starting from an assumption that investigations, surgery or chemo would be the wrong choice for a 96 year old. However, as I explained above, this isn't necessarily the case. The aim of the investigations and any treatment may well be palliative, rather than curative, and appropriate at any age.

It's good that the OP wants to support her GM but she (OP) needs to keep an open mind and not project her own preferences onto her grandmother. I have been breaking bad news about diagnoses to elderly people for more than 20 years, sadly. I have heard concerns like the OP's many many times - "You can't tell Gran, it will kill her" etc. IME, it is just not true that people of any age want the truth to be kept from them. Usually, in fact, they have already guessed, and are immensely relieved to be able to have an honest conversation, rather than pretending not to know to spare their family's feelings.

@Nodancingshoes

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??

But you are jumping to conclusions. She’s under the “two week wait” because cancer is a possibility, not because she has cancer. Look at it the other way, what would you say to someone who refused a test for an easily treatable condition because they were scared they might have cancer?

We have been to hospital - it was just a consultation, Nan misunderstood what was going to happen from the phonecall. The doctor was very kind and patient and explained everything fully. She has an appointment for a CT scan next week - the doctor said he was relutant to do the camera examination on such an elderly person as it is very invasive. He said that some people prefer not to know and some people want to know and that he completely understood both viewpoints especially as she has no other symptoms and that she was free to cancel the appointment if she wanted to. He also confirmed that should it be the 'worst case scenario' there would be no treatment at her age except possible pain relief if needed. I'm glad it has all been explained properly. Nan is still thinking about it. She has told me that she doesn't want to know if its cancer but would want it 'ruled out' so we are back where we started. I think she will decide to go. She is more worried about having to cancel her dentists appointment on the same day to be honest!

It sounds like a very appropriate consultation. A younger person would have been straight to 'top and tail' - gastroscopy and colonoscopy, instead she is being offered something which might not pick up everything but is easier on her body.

The doctor has also made clear to her that she wouldn't be fit for any surgery or chemotherapy so she knows where she stands.

All round I don't think you could have hoped for better.

That sounds like a good consultation. She knows what will happen now.

I lost my DDad back in October to advanced pancreatic cancer spread to his liver. GP ordered the CT scan and the did urgent referral. We never saw a consultant or anyone at the hospital. Dad died 2 weeks to the day after that CT scan. He knew he couldn't beat it, he'd seen everyone he wanted to see at least once in the 12 days since diagnosis (delays getting results back to GP 🙄) he was 96 1/2. If it's bad news, get the GP to refer you to your local hospice, frankly I couldn't have done it without them, they were phoning every day to check in both of us and it all happened so quick they hadn't done dads initial assessment yet. He didn't follow the usual pattern and was actually admitted in the hospice by the day of his appointment.
I read a comment on another thread by a hospice worker yesterday which is worth bearing in mind - if they deteriorate on a weekly basis, they have weeks to live. If you can notice the deterioration on a daily basis then they have days to live. I wish I'd known that in advance, I ended up finding out for myself. He was still driving and otherwise independent at the start of September, but very different by the end of it...

I’d like to say what a caring person you are. Not many 25 year olds would be that caring to a 96 year old grandparent. Sounds like you have a caring consultant. My 86 year old MIL was in hospital as she wasn’t eating, they asked us if we wanted her to have investigations into whether or not she had cancer, but told us even if cancer was found, no treatment would be given as she was very frail by then. Unfortunately she died two weeks later, but we are glad she didn’t go through any painful/uncomfortable procedures.

That's good @Nodancingshoes

When I was reading the thread originally, it did read like you were expecting as NOK to have a view - but you clarified you were wanting to help her understand it all. You're doing that.

I also thought the Doctors themselves will advise and they wouldn't do invasive tests or treatments to someone aged 96 due to serious risks of side effects and discomfort. They are much more conservative in tests and treatment plans when someone is "of a good old age" (88+) and very frail.

So it sounds like doctor is giving Nan plenty of time to think about whether she wants to have little bit more fairly conservative tests if she wants to know, or not. All you can do is keep explaining to Nan and then if on the day she gets there and doesn't want , they can stop at anytime.

Lol at worrying about the dentist appmt too... she sounds quite a character , strong-willed right into her late 90s 💕

Thank you all. @Mindymomo I wish I was 25 - I am a little bit older than that but thank you x
I never wanted to make the decision for her - I just worry about what she will feel like after. We will see what her decision is come Wednesday