Medical question - how dangerous is a stress test for a 98 year old?

[Greta]

I'm hoping there are some doctors, nurses, or PAs here who might be able to help me out. I just got an email from my mom. She's a little freaked out because she just found out that her mom is scheduled for TWO stress tests on Tuesday: one exercise-induced in the morning and one medically-induced (drugs?) in the afternoon. Since she's not having any heart problems, I can't fathom any reason for the test. And since she's 98 years old, isn't this rather dangerous???

 

She does have *slightly* elevated blood pressure which is being successfully treated. And lately she has had some sodium imbalance (not an expert of course, but that strikes me more as a kidney issue than a heart issue). She's also had some memory problems lately, probably not related. Otherwise she's in excellent health, especially for a 98-year old.

 

The doctor that she's seen for years recently dumped her because she wasn't willing to pay his ridiculous extortion fee for the privilege of continuing to be his patient. This is a new doctor who ordered this.

 

Those are all the details I know, and I realize it isn't much to go on. She lives two states away from me, so I haven't been present for any of this.

 

Any thoughts?

 

UPDATE: The stress test got cancelled and she's having an echocardiogram instead. Yay!

[mysticmomma]

They usually only do 1, not both. Maybe she was confused. They tell you when it is scheduled that if you can't perform the activity required at the intensity required they can give meds instead. Idk why they would do one on a 98 year old. Is she having surgery?

[Excelsior! Academy]

Not a doctor in any form or shape, but it would really give me pause.  Could she find another doctor or at least a second opinion?

[smudge]

I am pretty sure the two stress tests are an either/or scenario. Without any heart complaints I cannot imagine why the doc would order this and especially at 98!!

Ultimately, this is a "recommendation". Granny is still the boss of herself and can flat out refuse to do it. (Which if it was my granny I would tell her to just say no). 

And really, at 98, leave her be!

[Greta]

They usually only do 1, not both. Maybe she was confused. They tell you when it is scheduled that if you can't perform the activity required at the intensity required they can give meds instead. Idk why they would do one on a 98 year old. Is she having surgery?

It's entirely possible that there's been a miscommunication, but my mom said she is scheduled for both: one at 9:30am and one at 2:30pm on the same day. Perhaps the second one is only just in case she can't perform the activity required for the first. I'll ask.

 

No surgery planned.

 

Thanks!

[Greta]

Not a doctor in any form or shape, but it would really give me pause.  Could she find another doctor or at least a second opinion?

  

I am pretty sure the two stress tests are an either/or scenario. Without any heart complaints I cannot imagine why the doc would order this and especially at 98!!

Ultimately, this is a "recommendation". Granny is still the boss of herself and can flat out refuse to do it. (Which if it was my granny I would tell her to just say no). 

And really, at 98, leave her be!

Thank you both. Granny is from a generation when you just didn't question your doctor. She will do whatever he recommends. My uncles, who live closer to her and participate in more of her doctor's visits, are also more likely to just go along with whatever is said than my mom is. So I will pass any questions and/or recommendations along to my mom, and hopefully she can jump in. She's a good advocate.

[smudge]

  

Thank you both. Granny is from a generation when you just didn't question your doctor. She will do whatever he recommends. My uncles, who live closer to her and participate in more of her doctor's visits, are also more likely to just go along with whatever is said than my mom is. So I will pass any questions and/or recommendations along to my mom, and hopefully she can jump in. She's a good advocate.

 

Oh gads, my granny was the same way! It took me a year to convince her to see a cardiologist for her severe symptomatic Afib. She eventually ended up with a pacemaker. It is a difficult decision as to how much medical care to go for on the elderly. My main question to the doc is what does he expect to find by this test and is it really necessary in a 98yr old woman. What are we going to do with the results? At the end of the day, the doc is someone you hire for a service, just like a plumber, or a yard service. And if you aren't crazy about him, look for someone new....

[Katy]

A lot of younger doctors have been taught that not treating older buy healthy people as aggressively as you would a younger patient is tantamount to age discrimination & that a lot more people would live closer to the 120 year mark if they were given proper medical care.  In other words, if they don't have dementia, protect their health even to the same extent that you would your own parents. Whether that is wise probably depends on the person.  Perhaps your grandmother was worried about something and indicated she wanted aggressive investigation?

[umsami]

When having medical tests, I was always taught to ask for what purpose.  I was diagnosed with pneumonia two weeks ago.  The physician said, well, we can do an x-ray to confirm.  I said, would that change the treatment? He said "no".  So, even though I'm the daughter of a radiologist, I declined the x-ray.  No point.  

 

So, let's say that one of these stress tests shows something, would she really consider a stent or pacemaker or whatever the next step would be for her issue(s)?  With her age, quite frankly, I'd be surprised if they didn't show any sort of blockage.  So for me, the questions I'd want answered before they do any test is what would you do if the results are abnormal? If your Granny isn't willing or isn't able to undergo that next procedure, than it's pointless to put her through the initial stress test(s).

 

 

[Catwoman]

I'm sorry, but even if your grandmother is in excellent shape, I can't think of a single good reason to put her through a stress test of any kind.

 

Even if they find a problem, it would be idiotic to perform any kind of invasive procedures on a 98 year old woman.

 

Realistically, even if she was having some symptoms, my opinion would remain the same.

 

I don't know what her doctor is thinking, but you can bet I'd be on the phone asking him a LOT of serious questions, and telling him what I thought of his ludicrous plan to schedule a 98 year old for a stress test. :glare:

 

For heaven's sake, the test could be incredibly dangerous for her!

[Laura Corin]

I'm hoping there are some doctors, nurses, or PAs here who might be able to help me out. I just got an email from my mom. She's a little freaked out because she just found out that her mom is scheduled for TWO stress tests on Tuesday: one exercise-induced in the morning and one medically-induced (drugs?) in the afternoon. Since she's not having any heart problems, I can't fathom any reason for the test. And since she's 98 years old, isn't this rather dangerous???

 

 

Not a doctor.

 

What does she expect the outcome of the tests to be?  Does she agree with that?  My 90yo mother has started to refuse tests/treatment that are more trouble than they are worth (in her opinion).  For example, she has high blood pressure and has been asked to wear a walking monitor to see if it's a 24 hour problem, rather than induced by being at the doctor's surgery.  She's not interested - the only immediate outcome might be having to take drugs daily, and she doesn't want to.  So that's that.  She understands the risks of high blood pressure and is not interested in minimising them.  I support her in making her own decisions.

 

I think that people often get pulled along by routines that don't actually reflect their wishes.  Can you ask her if anyone has explained the purpose of the tests and what her doctor would do with the results?  And whether that fits with how she sees her next ten years?

 

L

[Catherine]

In reality, you do not know why the test was ordered. I think the first task would be to establish this. If she does have some mild memory problems, she may not be a perfectly accurate reporter of what happened during the appointment. However, even given that there may be some evidence that she has angina, the real question is what intervention would make sense for your grandmother. The treatments for a blocked coronary artery, which is what a stress test is ultimately looking for, are: medication to control symptoms, or stenting, or bypass (extremely unlikely that she might need this if she feels fine).

Since the two commonest treatments are, IMO, still things that would make sense in a healthy 98 yo, I think you can only conclude here that you need more information about *exactly* why it was ordered. And probably she was ordered to have a nuclear stress test, in which you exercise and are scanned immediately and then scanned again several hours later.

[Trish]

I can't imagine what benefit there would be to a stress test for a 98 year old.

 

Just an example here locally, there was a woman who was told by her doctor that she needed a colonoscopy because she was now over the age of 50. She was also ALREADY being treated for Stage 4 cancer.

 

Some doctors just "follow protocols" instead of actually thinking and treating the patient.

 

 

[magnificent_baby]

I cannot think of a single good reason for her to have stress tests at that age. I would flat out refuse. It doesn't sound like she is in need of any further treatment at all, based on the information you posted. 

[Greta]

Thank you all so much. This is a huge help! I will pass this along to my mom, and see what she can find out about why this was scheduled, and I'll keep you updated if I learn anything else.

 

Again, you all have my gratitude!

[FriedClams]

I didn't read all the replies, but our question for all tests with my aging mom is - what would the course of treatment be for the results? If its nothing or just for knowledge, or not something we would pursue for her - we don't do the test.

[Lawana]

IME, it is the doctor's role to offer the standard of care set by the big medical organizations (increasingly without regard to age, other conditions, etc). It is the patient's role to decide whether to accept the care. I think this is a departure from previous generations where doctors were more likely to make those kinds of decisions themselves.

 

We experienced this with MIL's care during the time she lived with us (she died last year). When a cardiologist prescribed two blood pressure meds due to slightly elevated bp, MIL asked me whether she *had* to take them. They made her more tired than she already was, and she had already decided that she was "done" with her life. So she stopped taking them. She also did not return to the cardiologist. None of her other health care providers seemed to have an issue with decision.

[Laurie4b]

When having medical tests, I was always taught to ask for what purpose.  I was diagnosed with pneumonia two weeks ago.  The physician said, well, we can do an x-ray to confirm.  I said, would that change the treatment? He said "no".  So, even though I'm the daughter of a radiologist, I declined the x-ray.  No point.  

 

So, let's say that one of these stress tests shows something, would she really consider a stent or pacemaker or whatever the next step would be for her issue(s)?  With her age, quite frankly, I'd be surprised if they didn't show any sort of blockage.  So for me, the questions I'd want answered before they do any test is what would you do if the results are abnormal? If your Granny isn't willing or isn't able to undergo that next procedure, than it's pointless to put her through the initial stress test(s).

 

This absolutely.

 

I am not a medical professional, but as a cancer survivor, I have a PhD in being a patient! ;)

 

Ask, ask, ask. What's it for? Is there a less intrusive way to find out? (It's possible that she already had less intrusive testing such as bloodwork that showed elevated cholesterol or that she has elevated bp. So this may be follow up to that. What you want to know then is how much more will this tell you? )   What impact will the results have on treatment decisions? (eg if the dr was going to recommend bp meds anyway) Is your grandmother willing to do xyz in treatment options? I

 

Stress tests are not inherently dangerous. They push your heart to the maximum and then stop almost immediately. They will also stop when the patient says stop. There are medical professionals right there if something did go wrong but it is unlikely.

 

There is no need for both stress tests. The point of the chemical stress test is to get the heart to go at a rate they would want to see in the treadmill stress test and is used when people can't walk that long. They can reverse the effect of the chemical right away if needed as I understand it.

[melmichigan]

This absolutely.

 

I am not a medical professional, but as a cancer survivor, I have a PhD in being a patient! ;)

 

Ask, ask, ask. What's it for? Is there a less intrusive way to find out? (It's possible that she already had less intrusive testing such as bloodwork that showed elevated cholesterol or that she has elevated bp. So this may be follow up to that. What you want to know then is how much more will this tell you? )   What impact will the results have on treatment decisions? (eg if the dr was going to recommend bp meds anyway) Is your grandmother willing to do xyz in treatment options? I

 

Stress tests are not inherently dangerous. They push your heart to the maximum and then stop almost immediately. They will also stop when the patient says stop. There are medical professionals right there if something did go wrong but it is unlikely.

 

There is no need for both stress tests. The point of the chemical stress test is to get the heart to go at a rate they would want to see in the treadmill stress test and is used when people can't walk that long. They can reverse the effect of the chemical right away if needed as I understand it.

 

I disagree.  Stess tests do carry risks, especially when you are having medications to stress your heart, and those risks increase with age.  The FDA just put new warnings on two of the drugs used the end of last year.  The risk of heart attack or death are 1 in 5,000, but common adverse effects include arrhythmia and low blood pressure.  The drugs used to stress the heart can cause pain and asthma-like symptoms.

 

A test for the sake of a test does nothing unless the patient is willing to follow through with the treatment that would be recommended if problems are found, this may be medication for arrhythmia to surgery for blockages.

 

ETA: if your Grandmother is scheduled for a nuclear stress test then they have to cancel 24 hours ahead of time or pay for the dye, usually about $200 in my area, so her window to make a decision may be very small.  She would also want to check to make sure that all the paperwork for testing has been taken care of.  Insurances sometimes require additional paperwork to approve payment.

[Greta]

Thank you all, again, so very much. I didn't have time yesterday to reply to every post, but I did read and appreciate every single post! And I've passed the recommendations along to my mom. She's going to call the doctor's office this morning, and hopefully get some answers.

 

I was wrong about one thing, though. My Granny has had some heart problems before, and I just didn't know or forgot. About 10-12 years ago, she had that test where they run a scope to your heart through a major vein in your leg - can't remember what that's called. Anyway, it showed some damage to the muscle of the right side of her heart, I guess the doctor described it as a hardening of the muscle. But it wasn't severe enough to justify any course of treatment, so nothing was done about it. As far as my mom knows, my Granny isn't having any new symptoms or problems, but this doctor wants to see if the damage has gotten worse. I'm just wondering if there's a less risky way for them to determine that.

 

And my impression of the safety of a stress test is probably very biased, and I recognize that. When I was a teenager, a longtime family friend of ours who was in his late 50's or early 60's at the time was having some heart problems. So they ordered a stress test, and the test induced a heart attack! They were able to get his heart started again, but his health definitely deteriorated from that point on. Maybe it would have anyway, but I'm pretty sure the heart attack didn't help matters. Anyway, that incident has always made me question the wisdom of stressing the heart of a person who is having heart problems. And a 98 year old?

[Laura Corin]

 As far as my mom knows, my Granny isn't having any new symptoms or problems, but this doctor wants to see if the damage has gotten worse. I'm just wondering if there's a less risky way for them to determine that.

 

Not only that, but if the damage has worsened, what would the doctor do about it, and is that something that Granny would want?

 

Good luck

 

L

[Greta]

Not only that, but if the damage has worsened, what would the doctor do about it, and is that something that Granny would want?

 

Good luck

 

L

Yes, that really is THE question. Thanks, Laura!

[DawnM]

What in the WORLD?

 

I am 47 and took a stress test last June and passed out on the treadmill!  My pulse went down to 29 and they freaked out.

 

I can't imagine a 98 year old taking it OR needing it.

[scootiepie]

I had a colleague in a hospital I worked out who was involved in CT surgery as a nurse specialist.   We would see very active and otherwise healthy older (not 98) patients who everyone thought

would be great surgical candidates because of their relative health.   Families and often surgeons would be shocked if they didn't do well post op.   But...my nurse friend always said, as soon as you start messing with them and cutting on them, they DO show their age.  A healthy 80 year old is not the same as an 80 yr old recovering from a major illness, operation, whatever.

 

If I remember right, the medical stress tests involves medicines that can be damaging to the kidneys.   98 yr old kidneys shouldn't take an insult like that, IMO.

 

I would leave well enough alone.

[magnificent_baby]

Thanks for the update. I still do not see any reason at all to do this test, at her age. Not sure if an echo would give the doctor more info, but if I were in your shoes, that's what I would ask for instead. And really, if the damage is worse, what would they do about it anyway? I still think it's crazy for him to order it. I checked current guidelines, and it stated that it's not recommended AND inappropriate to do this when the patient is asymptomatic. I would highly, highly encourage your Mom to refuse on her behalf. 

[Laura Corin]

I'd be worried if the doctor recommended heart surgery.  I watched my FIL go downhill very fast after heart surgery in old age.  It seemed to be just too much of a shock to his body and his mind - he ended up on some serious medication for depression, in addition to showing extreme frailty.  I'd be very, very wary of any recommendation of major surgery in old age.

 

L

[Laurie4b]

Thank you all, again, so very much. I didn't have time yesterday to reply to every post, but I did read and appreciate every single post! And I've passed the recommendations along to my mom. She's going to call the doctor's office this morning, and hopefully get some answers.

 

I was wrong about one thing, though. My Granny has had some heart problems before, and I just didn't know or forgot. About 10-12 years ago, she had that test where they run a scope to your heart through a major vein in your leg - can't remember what that's called. Anyway, it showed some damage to the muscle of the right side of her heart, I guess the doctor described it as a hardening of the muscle. But it wasn't severe enough to justify any course of treatment, so nothing was done about it. As far as my mom knows, my Granny isn't having any new symptoms or problems, but this doctor wants to see if the damage has gotten worse. I'm just wondering if there's a less risky way for them to determine that.

 

And my impression of the safety of a stress test is probably very biased, and I recognize that. When I was a teenager, a longtime family friend of ours who was in his late 50's or early 60's at the time was having some heart problems. So they ordered a stress test, and the test induced a heart attack! They were able to get his heart started again, but his health definitely deteriorated from that point on. Maybe it would have anyway, but I'm pretty sure the heart attack didn't help matters. Anyway, that incident has always made me question the wisdom of stressing the heart of a person who is having heart problems. And a 98 year old?

 

I would think that if he wants to see damage (as opposed to what her heart does when it's pumping at max capacity) that an echocardiogram would be the thing. It's just an ultrasound of the heart.

 

[melmichigan]

:iagree: An echocardiogram would show damage.  Stess tests actually aren't always the "norm" when checking for changes after a cardiac catherization has been preformed (running a catheter through your leg and into the vessels around the heart).  You can see more info here.

 

Whatever decisions are made I wish your Grandmother the best.  I had a nuclear stress test this morning and I am taking the fact that they let me come home versus sending me to the cath lab as a good result. :)  I'm 41 and lying there for 40 minutes with my arms above my head was stressful on my shoulders.  I can't imagine doing that at 98 years old.

[Kevin'sMom]

I am an RN.

I can't imagine why anyone would order/require a stress test on someone of your mother's age. It is unlikely to change anything in her treatment, and it certainly could cause heart failure or death. I would absolutely get another opinion. Two in one day is unheard of.

[Catwoman]

I don't care what "the doctor wants to see." Realistically, the damage probably has worsened a bit, but if Granny isn't having any symptoms, so what??? She's 98 years old. If they went looking, they'd probably manage to find a host of health problems -- but if she's feeling fine, why go looking for trouble that they won't be able to fix anyway?

 

If she was 68 or even a spry 78, I would understand wanting to know what was going on, but at 98... it's not just stupid and useless; it could potentially cause serious physical harm to your grandmother.

 

I hope your mom is able to put a stop to it.

 

Let the doctor satisfy his curiosity and make his money on someone else. :glare:

[TeacherZee]

My mom's a geriatric nurse. I'm pretty sure (year of listening to her rant) that she would say the doctors an idiot :). At that age she only really recommends medical treatments that improve or keep quality of life. I agree with the question being what does the doctor plan on doing with the info.

[Greta]

Good news!

 

My mom got a text from my uncle saying that the stress tests had been cancelled, and they'd scheduled her for an echocardiogram instead. He didn't give details but said he would call later. However it happened, I'm just so relieved!!!

 

Thank you all so much for your help, and for reassuring me that I wasn't crazy for thinking this was crazy. :D

[melmichigan]

Good news!

 

My mom got a text from my uncle saying that the stress tests had been cancelled, and they'd scheduled her for an echocardiogram instead. He didn't give details but said he would call later. However it happened, I'm just so relieved!!!

 

Thank you all so much for your help, and for reassuring me that I wasn't crazy for thinking this was crazy. :D

I'm glad they were able to make this change, it makes much more sense.

[Kevin'sMom]

I am so happy that this was cancelled. i spoke with a couple of medical professionals who had never heard of doing a stress test on someone that age, and felt that it would have probably killed her.

[Greta]

I am so happy that this was cancelled. i spoke with a couple of medical professionals who had never heard of doing a stress test on someone that age, and felt that it would have probably killed her.

It was very kind of you to speak with them on my behalf. That was my fear exactly, I just didn't know if I was overreacting.

 

Turns out, I should have given my Granny more credit for standing up for herself. She was the one who decided "no way" and cancelled the appointments. Go Granny!

[Greta]

I looked up the longest living person ever. Was a woman who lived to be 122. Granny might give her a run for her money

:) I sure hope so!

 

 

(but there won't be running on a treadmill involved). :laugh:

Ha! :D

[Trish]

If Grandma isn't broke, don't fix her!

[Catwoman]

It was very kind of you to speak with them on my behalf. That was my fear exactly, I just didn't know if I was overreacting.

 

Turns out, I should have given my Granny more credit for standing up for herself. She was the one who decided "no way" and cancelled the appointments. Go Granny!

:hurray: :hurray: :hurray:

 

Sounds like Granny could teach that doctor a little something about common sense!!!

 

I'm so glad she canceled the appointments.