Just because you can conduct medical imaging on an elderly patient doesn’t mean you necessarily should. That’s the overall argument John Gordon Harold, MD, past president of the American College of Cardiology, makes in his lecture “Elderly Patients with Limited Function Are Unlikely to Benefit From Imaging to Define Risk,” now available for CME credit through AudioDigest.
The needs of geriatric care are unique, Dr. Harold says, but little is actually known about the potential benefits of imaging in older, frail populations.
“We have a knowledge gap in geriatric cardiology,” he explains, adding that elderly patients aren’t typically included in clinical studies that examine the utility and efficacy of medical imaging procedures, and it’s difficult to generalize study results to older groups.
Elderly imaging challenges
In addition to their personal needs and obstacles, there can be some logistical challenges to imaging in older, frail patients. According to a 2015 study in the British Journal of Radiology, because many of these patients have mobility difficulties, simply getting them to the radiology department to conduct a scan can be problematic, and it can make capturing the images harder. Consequently, the researchers point out, the image quality of scans done on older patients is frequently of lower quality and inadequate for diagnosis. In those cases, patients could be subjected to repeated testing, increasing their radiation exposure.
Older patients are also more likely to have comorbidities, such as diabetes, chronic kidney problems and heart issues. In many instances, these additional health complications can make it dangerous to inject the contrast dye that’s typically needed for optimal imaging quality.
In addition, it’s possible that older patients could have some form of dementia, the researchers said. Subjecting them to CT scans that require a breath hold or MRIs that require them to be still while placing them in a noisy machine can be disconcerting, putting them in disturbing situations with little clinical benefit.
Considerations when imaging the elderly
Consequently, before choosing to conduct a medical imaging study on an elderly patient who might be particularly frail, Dr. Harold recommends taking a holistic approach to assessing the patient and goal of the procedure. Consider their overall physical condition, the clinical utility of the test, the risks posed to the patient and what, if anything, the outcome might change about the patient’s health management.
Before ordering an imaging study on an older patient, evaluate these two points in particular:
- Risk. In some cases, opting for an imaging study could put the patient in more danger. For instance, once an elderly patient exhibits chest pain, they’re already in a high-risk situation. Taking the patient directly to the cath lab is preferable to conducting a medical imaging study first and risking a delay in potentially life-saving treatment.
- Diagnostic accuracy. It’s well documented that some clinical findings simply become more common with advanced age, reducing the diagnostic usefulness of some imaging procedures. The incidence of coronary calcifications is approximately 70% by the time a patient reaches age 70, and it increases to 80% within the next decade of life. Performing a CT scan to identify whether a patient has these findings is of low use, Dr. Harold says.
The goal of imaging older patients
Unlike imaging for the younger patient—which is designed to be completely diagnostic in nature—scanning older patients should come with a different set of motives, said the researchers in the British Journal of Radiology study. In essence, the goal should be palliative. Any results should aim to improve the patient’s quality of life, help them maintain functionality or maximize their level of comfort.
Imaging in this population is a delicate balance, they said. You must be sure you’re safely investigating treatable conditions without overstepping and causing any undue stress or suffering. And, be sure that you’re performing the minimum number of tests needed to improve their daily living.
Ultimately, Dr. Harold explains, choosing to conduct a medical imaging study on an elderly patient requires more analysis than selecting the same procedure on a younger individual.
“You must look at the patient’s environment, their support system, what the risks to them might be from having the study,” he says. “With imaging, you must choose wisely.”