Page 127 article text (OCR)
Actor Henry Fonda, 71, had a heart pacemaker implant in 1975, and a year later a large chest tumor was removed. FormerUS.Sen.MargaretChaseSmith, Â· 79, has artificial hips. She underwent two operations, in 1968 and in 1970. Averett Harriman, 85, eldet statesman and a former Governor of New York, had surgery for hernia nine years ago. Never IN IN fr W hen a very sick, 91-year-old man was brought into a New York City hospital not long ago, the outlook seemed grim. He was 6 fSfct tall but weighed only 110 pounds. He complained of great weakness and breathing difficulty, and quickly was found to have abnormal heart sounds, congestion of the lungs, gallstones, a severe groin hernia and a large scrotal swelling. For 10 days his heart and lung conditions were treated and he was rested, nourished and his strength built up. Then surgeons, in one session at the operating table, carried out multiple procedures: they removed his gallbladder and immediately, through another incision, purled his protruding bowel back into the abdominal cavity, then repaired the hernia and took care of the scrotal swelling. He went home 17 days later, free of all complaints. Exceptional case? It shouldn't be. Strong enough It has become clear that the aged are not as delicate as many physicians have thought--the aged can tolerate extensive surgery and often benefit. A recent editorial in the Journal of the American Medical Association said Â« that there is now plenty of evidence " that surgery for the elderly has become Â£ increasingly safe and may produce E "improvement in the quality of life." ; The editorial drew a parallel between | an age for mandatory retirement from jobs (which it opposes) and what it by Lawrence Galton called "mandatory retirement from therapy"--denial of major surgery. The journal criticized "the underlying assumption that the quality of life attainable in the elderly is poor at best, so that heroic attempts at improving handicaps and disabilities are hardly worthwhile." The new perception about the elderly encompasses many different kinds of operations. Hernia repair It wasn't many decades ago--as one of "America's most distinguished surgeons. Dr. Alton Ochsner of New Orleans' Ochsner Clinic, recalls--when an elective operation for even a hernia in anyone older than 50 was considered unjustified. Today 98% successful repair rates are reported in patients over 70, even in those over 90, including some with life-threatening strangulation obstruction. Serious diverticular disease--out- pouchings of the colon that become severely inflamed, cause great pain, and may threaten life--has its greatest incidence in the elderly. When surgery is essential, is it too risky? At St. Vincent's Hospital and Medical Center, New York City, in 370 patients the overall operative mortality rate was 4.4% for those over 70 and 2.5% for those under 70. But with a procedure called a three- stage operation there were no deaths at all in patients over 70. Gallbladder surgery? According to one recent study, aged patients have a 98% chance of recovery. Among the "patients was a 72-year-old woman who required more than gallbladder removal. A dangerously ballooned section (aneurysm) of her aorta, the main artery from the heart, had to be replaced with a graft and a dangerous clot had to be removed from an artery in her calf. She came through it all nicely. Â· In a suburban hospital, an elderly woman presented a seemingly insuperable problem. She was in great pain. A diseased abdominal artery obstructed blood flow to her small intestine, which had become gangrenous. All but 18 inches of it had to be removed. This was massive surgery. Yet, 11 years later, the woman is alive and well. Is surgery justified for elderly patients with cancer of the colon? A review of 226 colon cancer patients at least 80 years old shows gratify ing. results of surgery: a five-year survival rate of 53.5%, even better than the survival rate of 22.4% overall for patients with the disease regardless of age. Apparently the outlook in surgically treatable colon cancer is more favorable for the aged than for younger persons. Lung cancer What of lung cancer? A recent study covers 114 patients over 65,25 of them in their 70% one over 80. For a lung cancer patient over 65 not undergoing surgery, there is a 77% chance of dying within six months, a 93% chance of dying within a year. When surgery is possible, the study indicates, it provides a 40% chance of surviving at least four years and possibly much longer. Prostate cancer? Dr. Victor A. Gilbertsen of the University of Minnesota has called attention to the fact that many doctors have been reluctant to consider surgery for elderly prostate cancer victims. Too often, .such men receive hormone and other palliative, non- curative treatment And survival rates have been only 49% at five years and 29% at 10 years. On the other hand, in a series of men ranging in age up to 72 operated on after early detection of cancer, not one death occurred as the result of surgery or from prostate cancer over 10 yean after their cancers were detected. ' , ' Open heart surgery Remarkable strides have been made, too, in open heart surgery. Recent reports indicate success rates of 80% and even higher in patients aged 60 and over needing heart surgery for valve and other problems. Surgery for younger patients with, coronary heart disease--suffering chest pain and at risk of heart attack because adequate blood for the heart muscle can't get through choked-up coronary arteries--uses vein grafts to bypass blocked artery sections. Pain may .be- greatly relieved and risk reduced. Over-65 patients undergoing such surgery do almost as well as younger patients. In a study of 21 persons aged 70 and over operated on during 1974,. 20 came through well. A few months ago, Emory University surgeons reported on a group of elderly patients who underwent operations to clean out clogged carotid arteries in the neck as a means of helping to prevent stroke. A happy dividend of the surgery came to light when, in six weeks, the. patients showed an average 18-point increase in IQ and in tests for alertness excelled other patients who had not undergone surgery. Two wrongs Certainly, hasty, ill-advised or needless surgery is wrong for anyone, young or old. But it is also wrong not to perform needed surgery simply because of age--or because of a sometimes misguided idea that it is better to allow an elderly patient to "die with dignity." Clearly, surgical advances have been catching up with advancing age. What's needed is to couple an appreciation of that technical fact with appreciation of another: that there can and should be a richer quality of life for the elderly and that surgery, when indicated, often can help make it possible.