MORE SURGERY PATIENTS LIKELY TO BE ELDERLY

With medical technology enabling people to live longer, healthier lives, it's estimated the number of elderly will double in the next 30 years.

As a result of the aging population, doctors now are operating on patients once considered too old for the scalpel.

"The oldest patient we've done here with a coronary bypass was 91 years old. We've also done several people in their late 80s," said Dr. Darryl Ramsey, a thoracic and cardio-vascular surgeon in Cape Girardeau. "I think the age of our surgery patients has been going up some."

Ramsey said improvements in intensive care unit techniques and technological breakthroughs allow doctors to operate on many older patients.

"There are higher risks and complications are more frequent, so you have to be selective in older patients," he said. "You can't do every one of them."

But doctors, economists and patients now are debating whether the costs and risks of surgery on the elderly -- who need it not only to combat terminal disease but to replace worn-out body parts -- is worth the chance of prolonging or enhancing life another year or two.

There's little available data on whether an elderly patient will survive surgery well enough and long enough to make it worthwhile. That's because such procedures haven't been used on the elderly for very many years.

"Sure it's an issue," said Ramsey. "As our technology gets better, we can keep people alive longer and longer, and sometimes even though we keep them alive, we don't necessarily preserve their quality of life.

"It is a problem," he added. "It's not a medical problem, but an ethical and social problem to solve. The technology's there, but sometimes it's not appropriate to use the technology."

One of the keys to determining whether to perform a procedure such as a heart bypass on an elderly patient is determining the patient's biological or "physiological" age, Ramsey said.

"It's a big consideration when you're thinking about surgery for an older patient," he said. "A lot of people in their late 80s look like somebody in their 60s -- and vice versa."

As the nation debates President Bill Clinton's national health care proposal, the dilemma likely will become more problematic. To the degree expenses of such a program are held down, medical services are likely to deteriorate and rationing could occur.

Ramsey said it's probably too early to fully judge Clinton's proposal and the effect it will have on care for the elderly.

To the extent the health proposal turns out to be broad-based, covering everyone for a wide range of medical services, costs are likely to soar, he said.

Ramsey said it remains to be seen whether national health care -- if it becomes a reality -- will pay for surgery to replace worn-out body parts in otherwise healthy elderly people.

"My impression is, if containing the total cost of health care in the U.S. is going to be important, than I think rationing care for everybody -- and especially older people -- is going to be part of it," he said.

Some information for this article was provided by The Associate Press.