Has anyone ever been told by their parents PCP that it is harder to get PetScans and procedures done on patients over 75? My Dad is 80 soon to be 81 next month. He has been diagnosed with dementia and has diabetes. My Mom is 79 and has Parkinson’s and Dementia that is causing a lot of issues. A least she still knows who I am. I asked her PCP if she could schedule a PetScan for Mom because her Mom died of Bone cancer and my Mom has been in so much pain she hardly gets off the sofa these days. Her doctor told me no she couldn’t because it is frowned upon to do that on someone her age. I was struck speechless. And that was the end of our conversation. My Mom is a one year survivor of breast cancer. So what the heck? Does Medicare stop paying for somethings after 75 years old? I am their youngest daughter and caretaker. The medical world frustrates me!
The tests can also be stressful for someone with dementia. Some tests require anesthesia, which can exacerbate the dementia.
Why take a test to find out that your loved one has a disease that requires painful and stressful treatments or surgeries? Why would you put your loved one through all of that?
And, why prolong the inevitable?
If you have questions or concerns about your mother's care or why certain tests are being disallowed, why not ask the doctor up front? She likely would have told you why the PET scan was 'frowned upon' and you would have had an answer! Be aggressive with these doctors! Get the answers you need, you're entitled to, and so is your mom!
Good luck!
If the pain and the lack of mobility are what have you worried, ask about that.
Don't leap to a cancer diagnosis (and there are lots of tests to do for THAT before you get to a PET scan) without ruling out the more mundane causes.
For example. Your mom at 75 with Parkinson's and Dementia.
1. It would probably require having to put her under anesthesia or at least a very heavy sedation for any test. the resulting sedation can make dementia worse for a while and her cognition may not return to pre test condition. AND if the test came back indicating any type of cancer would it be worth it to put her through treatment? And if you did put her through it would she understand why and would she again have to be sedated to get chemo or radiation? (I am not sure I would want to go through that and I don't have Parkinson's or dementia)
If you wanted to push this you could contact the insurance and ask if it would be covered and get approval. But I do not think it would be wise to put someone with dementia through tests like that. Would you want them to have a colonoscopy? That was a test that my Husbands doctor asked me about and I looked at her like she was crazy. My Husband was 68 at the time and I said there was no way I was going to put a person with dementia (and me) through the prep and the sedation for a test like that. If it came back indicating cancer, I would opt to not put him through surgery.
And the answer is that yes, there are recommendations for tests and age. And in fact colonoscopies past age 75 not recommended under current guidelines either. You can look up guidelines online; just type in, for instance, "CDC guidelines colonoscopy".
Testing is very expensive, it often leads to a lot of anxiety and it often leads to false positives and further testing.
Both Dr. Dean Edell in his book Eat, Drink, and be Merry, and Barbara Ehrenreich in her book Natural Causes talk about the over testing and over treatment of the elderly in our country, and the torment it causes for them before they are allowed finally to be at peace. And of course the books of Dr. Atul Gawande including his Being Mortal, are not only famous but infamous.
As the only advocate now for people who cannot make these decisions for themselves I would consider carefully what you knew their decisions, when they were competent to make them, might have been. Hopefully you did discuss things with them at that time.
If you truly wish certain tests to be done, and there are SYMPTOMS that the doctor agrees could indicate a need for them, and you wish to be more aggressive in testing and treating rather than less, then revisit this with the doctor. It is my opinion that putting someone elderly through aggressive treatment for say a diagnosis of metastasis to the bones, is basically a torment, but we all have our own opinions; once educated about all contingencies, we have to make our own conclusions. For myself, in your cases and in your place, I would follow the PCP guidelines, but I am not you.
My dad had a primary doctor for a very short while who was very young and did have an ageist mentality. Way before my dad got really sick, his then primary decided that dad was 'too old' to worry about and that his time was better served with younger patients. Now let me say that my dad passed away at the age of 72 and it was several years before this that his then primary decided that since dad was retired he should just 'enjoy his last days and not take up the reserves of the doctors'. (he didn't say those words but something to the effect of a couple of dad's underlying medical issues weren't really worth addressing because he was as 'old' as he was). That particular doctor was reported to the practice and is no longer there but is probably still practicing.
On the other hand, sometimes doctors have to put their foot down with some patients for their own good. (not saying that is OPs case). My FIL will absolutely jump at any medical treatment, especially a surgical option. He seems to believe that there is some magic treatment for the damage that years of uncontrolled diabetes, living at over 300 pounds, no physical activity, and a myriad of other diagnoses that can reverse all signs of aging and disease. Compounded by his narcissism, because he can't possibly have anything to do with his current nearly immobile status, he is always looking for some way out of it. And his doctors have stopped ordering unnecessary tests or treatments, much to his chagrin. His latest is that he needs knee replacement. He is 86 years old, 300 pounds, generally unhealthy, non-compliant with rehab, his philosophy is 'no pain, no pain'. But he is so angry that his doctor(s) won't even entertain the idea. They have told us he won't likely survive the anesthesia or the surgery, and even if he did, he would likely never walk again because the recovery would take a lot of work on his part that we already know he is not willing to undertake. His last stent in rehab for a minor fall found him discharged from the rehab at skilled nursing home level and deemed 'not rehab-able'. This was also borne out in the fact that his home PT, OT, bath aide and nurse time were extended due to COVID and he actually LOST some mobility due to his non-compliance.
So I do think that some doctors may limit what they are willing to do for those over 75 (my 94 year old grandmother had hip replacement several years ago, so it really depends on a number of factors), but I also believe they have to choose their patients wisely for a number of tests and treatments because they have to have a good chance at the expected outcome being positive to even warrant it in the first place. Sometimes a treatment can make things worse than they were before (we've been there with FIL as well).
I do think there should be something to help them with pain, that one should be non-negotiable where it is within the doctor's power to address it. That level of pain can impact so many other areas of your life!
Medicare will only pay for a PET scan if it’s ordered by a dr and deemed medically necessary.