Well, where do you want to start Pat? One of the things I do most days is initiate 'palliative care conferences' with patients and their families when an elderly patient has been admitted to the hospital for the umpteenth time for diagnostic workups or interventions. Perhaps it was a fall at home or a seizure or cardiac event that triggered the hospitalization.

I begin talking with them about options: going home with supportive in-home care- palliative care or hospice, if appropriate- or continuing to have 'procedures' done that really no longer have any benefit (and frequently create more distress). Most of the patients I visit are in their eighties and their 'specialists' continue to counsel more tests, more interventions, more hope that their bodies can regain some diminished capacity if the right 'treatment' is attempted.

In some cases the treatment works: in most it buys a short time at best but at great cost to the patient's quality of life.

These specialists are just doing what they are trained to do. They make a hell of a lot of money as well. There is a powerful incentive built into our culture to offer more treatment. Many patients, especially the elderly, look to their doctors for advice, and many submit to procedures that are not helpful in the long run.

To answer your question, the option to have 'comfort care' and support earlier and to forego expensive and fruitless interventions is one that needs to be offered routinely to patients who are over eighty and who are frequent, 'high utilizers' in the hospital. it would improve the qualiy of life for many and save countless amounts of money needlessly spent on useless diagnostic tests and interventions.

just a start ...