DOCTORS WILLINGNESS TO REFER ELDERLY PATIENTS FOR ELECTIVE SURGERY

Objectives. We aimed to examine the relationship between doctors' will ingness to refer elderly patients for elective surgical operations and patients' age, comorbidity, institutionalization, living habits and s igns of dementia. Method. A random selection of 837 medical doctors in Finland (response rate 56%) received a postal questionnaire consistin g of 18 vignettes, i.e. imaginary patient cases. Respondents were aske d whether they would refer the patient on the vignette for elective su rgical operation, treat the patient conservatively, or choose some oth er alternative. In the vignettes, the age of patients was randomly var ied between 65 and 85, at 5-year intervals, to provide eight different questionnaires, and each respondent obtained one of them. Results. Th e proportion of doctors willing to refer the patients for surgery was inversely related to the patients' age: in all the vignettes, doctors said they would refer fewer patients in the oldest age groups. Almost all the doctors claimed they would refer healthy, home-dwelling person s aged 65-70 years for operations. In the oldest age groups of patient s, the doctors' willingness to refer was highest for cataract operatio ns (69%) and hip prosthesis operations (63%), but only 18% of doctors would refer such patients for coronary by-pass operations. Comorbidity and institutionalization were associated with fewer doctors referring the patients: the proportion of doctors willing to refer these patien ts was about half that of those willing to refer otherwise healthy and home-dwelling patients. Smoking by patients also decreased the propor tions of doctors willing to refer, but moderate signs of dementia in a n elderly patient with cataract were associated with only a slight dec rease in referring. Conclusions. Doctors are less willing to refer old patients for elective surgery, but comorbidity, patients' lifestyle a nd institutionalization have a greater effect on referrals than age.