The older I get, the older “old age” gets. Still, as I was reaching my later 60s, my ability to juggle the same number of cognitive balls declined. I noticed it even in my earlier 60s. I couldn’t keep as many balls in the air as when I was in my 40s and 50s.
Nothing remarkable there. Research has shown a significant link between aging and a decrease in cognitive function.
A step after a mild loss in mental agility is mild cognitive impairment (MCI), which includes issues with memory and judgment that go beyond expected age-related declines. The American Academy of Neurology estimates that MCI is present in about one out of 12 people ages 65 to 69 and one out of six in 75- to 79-year-olds. As age increases further, so does the proportion of people with the condition.
All of which raises a question about physicians, about 20 percent of whom are currently older than 65, with that number expected to rise to 33 percent in the next decade. Should they be required to take periodic tests to screen for cognitive decline and transition them to less-taxing roles—or retirement—if they don’t score well enough?
Airline pilots don’t even get to take a test. They are sent into a silver-haired, smooth-voiced sunset at age 65, period.
I don’t think there should be a mandatory retirement age for doctors. But I do come down on the side of screening after a certain age to identify physicians who may have cognitive problems severe enough to interfere with their practice of medicine. No one likes to be questioned about his or her cognitive abilities, especially people in positions of hierarchical importance, like physicians. But the current approaches for screening physicians do not work well.
One is self-monitoring. Report 5 of the Council on Medical Education, an initiative of California Public Protection & Physician Health, Inc., says, “It is part of a physician’s professional duty to continually assess his or her own physical and mental health.” But shame and fear can keep doctors, like everyone else, from admitting truths about aging to themselves, and in some cases, if the cognitive impairment is severe enough, from even knowing that there is a concern.
The other approach is reporting on cognitively impaired colleagues to appropriate authorities. Report 5 goes on to say it is part of a physician’s duty to also “report all instances of significantly impaired or incompetent colleagues to hospital, clinic or other relevant authorities.” But snitching, as some would see it, is a fraught exercise. It’s hard to call the state medical board and issue a complaint, or even an observation, on someone you work with. How would you even phrase it? “My colleague is not as sharp as he used to be?” That’s too vague to trigger any action.
That’s why I’m all for blanket screening after a certain age. It takes the sting out of any assessment of cognitive ability by creating a level, impersonal playing field. Currently, New Zealand, Canada, and the United Kingdom have mandatory age-based assessments for physicians. Even some U.S. healthcare systems have implemented age-based cognitive evaluations. The doctors sit in a room and take a computerized test that assesses memory and mental agility in thought processing. Such screening has the added benefit of being objective rather than just someone’s opinion.
Sure, there can be problems with the technology used in the screening, along with fears about privacy violations. But those kinks can be worked out.
I think age 70 is reasonable for beginning periodic screening for cognitive impairment. But that’s just my own thought. Some accumulation of data through research to support a particular age would be helpful.
And budding physicians should be made aware, when they are in medical school, that cognitive screening is in their futures. That way, the testing is just part of being a doctor rather than an unfair punishment, an attempt to single anyone out.
The time has come. The aging brain doesn’t work as nimbly as a younger brain, but there are ways to test for cognitive impairment and keep the medical profession on its game without denial or stigmatization.
