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How to define the therapeutic limits
Alberto Cester1, Monica Maselli, Francesco Bolzetta
1UOC Geriatria Azienda ULL13, Geriatric Unit. alberto.cester@ulss13mirano.ven.it.
Insights
Physicians must balance scientific knowledge with conscience to determine therapeutic limits in aging patients, especially in cardiology. Advanced assessment tools and patient resilience are crucial for personalized treatment decisions, moving beyond age-based restrictions.
Area of Science:
- Geriatrics
- Cardiology
- Medical Ethics
Background:
- Increased life expectancy necessitates re-evaluating therapeutic limits.
- Physicians face daily decisions balancing science, conscience, and patient limits.
- Aging populations, particularly in cardiology, require comprehensive risk and multidimensional assessments.
Purpose of the Study:
- To define the therapeutic limit in the context of advanced age and technological progress.
- To emphasize the need for individualized, multidimensional patient assessment.
- To explore the evolving approaches in geriatric cardiology and cardiac surgery.
Main Methods:
- Utilizing advanced tools for multidimensional patient assessment.
- Evaluating patient resilience and ability to overcome critical phases.
- Fostering interdisciplinary collaboration and respecting individual professionalism.
Main Results:
- Chronological age is no longer an insurmountable barrier in cardiology/cardiac surgery.
- Less or minimally invasive techniques have expanded treatment possibilities for older adults.
- Individualized assessment, including resilience, is key to determining appropriate therapy.
Conclusions:
- Therapeutic limits must be determined individually, considering risk, resilience, and advanced assessment.
- Modern cardiology and cardiac surgery have overcome many age-related limitations.
- A humble, competent, and collaborative approach is essential for optimal geriatric care.
Abstract:
With the advance of technological progress and the increase in life expectancy, it is nowadays mandatory to define what is the therapeutic limit. Every day each physician must take therapeutic decisions on the basis of his scientific knowledge, but also of his own conscience and sense of limits. They can not avoid to consider the global risk of death, disability and morbidity in more advanced age, especially in the field of cardiology and cardiac surgery. In these subjects, both fit that frail, is necessary not only an evaluation for adequate risk assessment, but also a multidimensional assessment performed with advanced tools. The resilience of the subject, ability for which some patients considered out of therapy demonstrate the ability to adapt and overcome critical phases, must also be weighed. Where and what is the therapeutic limit should be evaluated individually with humility, competence and capacity for dialogue with other disciplines in a work team that respects the individual professionalism. In recent years, much has changed in the cardiology/cardiac surgery approach in old people. With the development of less or minimal invasive new techniques, there are no more insurmountable limits that can be connected only to the chronological age of the patients.
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