The Risks and Dangers of Misdiagnosis in Elderly Patients

Roughly 12 million American adults are misdiagnosed in outpatient settings every year, according to data published in 2014. Furthermore, between 40,000 to 80,000 Americans die each year from diagnostic failures in hospitals.

The hard truth is millions of Americans will experience a missed or delayed diagnosis during their lifetime. Seniors are particularly affected because they are more likely to experience illnesses such as heart disease, stroke, and cancer. They are also more likely to have multiple diseases, take multiple medications, and require hospital care.

What causes misdiagnosis

There are a number of factors that may lead to a misdiagnosis. In some cases, there is a miscommunication between the patient and the doctor – whether the doctor misses important health issues from the patient’s medical history or the patient does not describe their symptoms accurately.

In other cases, diagnostic tests are not interpreted correctly, the right test is not ordered, or data from electronic records is not properly organized.

Another reason for overlooked or misdiagnosis could be a patient not following up on their referral to a specialist.

Regardless of the reasons, medical misdiagnosis can result in many serious consequences, from doctors prescribing the wrong drugs to delaying urgent care or life- saving treatments.

Commonly overlooked or misdiagnosed conditions in seniors

Certain types of cancer

According to a 2014 study published in JAMA Network Open several forms of cancer are among the most common missed or delayed diagnoses in the elderly. Specifically, colorectal cancer is at the top of the list, while lung cancer, breast cancer, prostate, and bladder cancer all make the top 10. Heart attack, stroke, and sepsis are also included on the list.

Heart attack

The elderly are at increased risk of heart attack because many have risk factors such as high blood pressure, high cholesterol levels, diabetes, and excess weight. Older individuals are also at higher risk of a misdiagnosis because they often have atypical symptoms and have other chronic illnesses with overlapping symptoms that make it harder for a doctor to diagnose a heart attack. In many cases, especially if a person has diabetes, the heart attacks are “silent,” as the characteristic chest pain is not felt.

Stroke

Stroke is a leading cause of adult disability, the third leading cause of death in the United States, and more likely to occur in the elderly. Sometimes it is misdiagnosed, while in other cases the signs of impending stroke are overlooked. Older individuals may experience weakness and numbness in the limbs, speech difficulty, dizziness, and confusion, which can also be caused by other illnesses or medications.

Depression

Depression affects 1–5% of the general elderly population, 13.5% of older individuals who require home healthcare, and 11.5% of elderly who are hospitalized. Older individuals are at increased risk of misdiagnosis, and they often do not receive treatment.

Some of the symptoms of depression, like changes in sleep, appetite, and mood, can be mistakenly attributed to other conditions, prescription medications, or life changes. In some cases, the elderly may not have the typical symptoms of depression, but they instead experience unexplained pain or digestive problems. Older individuals are also more likely to avoid talking about their feelings when visiting the doctor.

Sepsis

Sepsis is the body's extreme and life-threatening response to infection. Like strokes and heart attacks, it requires immediate medical treatment to avoid long-term complications, such as tissue damage, organ failure, or death. The elderly are more prone to sepsis and other complications due to their weaker immune systems.

Sepsis is more common among residents of nursing homes or nursing care facilities. It can be linked with infections of the lungs or kidneys. Unfortunately, sepsis is often misdiagnosed as a urinary tract infection or low blood pressure.

How to avoid a medical misdiagnosis

There are a few steps that adult patients can take to avoid a misdiagnosis and help the doctor diagnose and provide treatment for a medical condition:

• Prepare well before the doctor’s appointment. Make a list with all the symptoms you experienced and try to describe the symptom in detail. For example, when describing pain, it is important to note how severe it is on a scale from 0 to 10, its location, when it started, the quality of the pain (i.e., dull or sharp), how long it lasts, and factors that trigger or make the pain worse.
• Remind the doctor about your medical history, including acute illnesses or chronic diseases, surgeries, or significant injuries.
• Make sure you have the complete list of medications you take and their daily dose.
• Ask the doctor questions to ensure you fully understand the condition, the treatment options, necessary tests and investigations, possible complications, and the general outlook.
• Get involved and take a proactive role in your health. There are support forums for many common conditions, and many people feel better and learn useful information when sharing their experience with others.
• Remember that not all lab tests and investigations are accurate. In fact, more than 40% of the pathology tests can be inaccurate. It is ok to consider repeating the test. It is also ok to ask for a second, or even a third, medical opinion. The new doctor has to review all the medical records from scratch and interview the patient again.

Millions of Americans experience a missed or delayed diagnosis in their lifetime, and the elderly are particularly vulnerable. Cancer, heart attack, stroke, depression, and sepsis are among the most commonly misdiagnosed or overlooked medical conditions. Luckily, there are ways to avoid medical misdiagnosis.