Title: Making Informed Health Decisions Based on Life Expectancy
Subtitle: Doctors and patients embrace using life expectancy as a guiding factor for tests and treatments
During her annual visit, a 76-year-old patient is presented with the question of continuing regular mammograms to screen for breast cancer, and is reminded about the need for a colonoscopy, which hasn’t been done in almost ten years. While age alone may seem like a reason to reconsider these tests, medical professionals and health advocacy groups are shifting towards incorporating life expectancy as a crucial factor in determining the need for certain screenings and treatments.
The independent United States Preventive Services Task Force (USPSTF) recommends screening mammograms for women aged 40 to 74 in its recent draft guidelines. However, the evidence regarding mammograms for women aged 75 and older is insufficient to assess the balance between harm and benefit. Similarly, detecting colorectal cancer through colonoscopy raises questions about its efficacy in older individuals. The task force gives a grade of C for people aged 76 to 85, suggesting that such tests should only be offered selectively.
But age alone isn’t the only consideration when it comes to healthcare decisions in later life. Factors such as a person’s physical activity level, presence of heart disease, family history of longevity, and smoking habits play significant roles in determining life expectancy. This has led medical associations and health advocacy groups to redefine their recommendations by incorporating life expectancy into their guidelines.
The American College of Physicians, the American Cancer Society, and the USPSTF have already adjusted their guidelines to include considerations of life expectancy. For example, the task force advises factoring in an individual’s health status, prior screening history, and personal preferences when determining the appropriateness of colorectal screenings for older patients.
Determining life expectancy can be challenging, but online tools and calculators can provide rough estimates based on various factors such as age, sex, race, and lifestyle choices like smoking. The National Cancer Institute’s Know Your Odds calculator, among others, can assess the likelihood of mortality and specific disease risks within a certain timeframe. However, these predictions are based on averages and cannot determine individual life expectancies.
To provide a more comprehensive estimate of life expectancy, ePrognosis, developed by geriatricians and researchers, combines nearly two dozen validated geriatric scales. These scales incorporate medical history, current functional capacity, and other relevant information to estimate mortality and disability. The tool can also demonstrate the potential benefits of specific diagnostic tests and interventions based on a person’s life expectancy.
Guidance based on life expectancy can help healthcare professionals and patients make more informed decisions. However, it is crucial that these predictions serve as starting points for discussions between patients and their doctors, rather than replacing professional medical advice. Online tools provide valuable context beyond age alone, offering patients a better understanding of their healthcare options and potentially reducing unnecessary testing and treatment.
By embracing a broader approach that accounts for life expectancy, individuals can focus on the most relevant healthcare decisions and gain peace of mind by making choices based on evidence-based calculations.