Why I Stopped Letting Age Decide Who Gets Surgery

An Assumption I Carried for Years

For a long stretch of my practice, when a woman in her late seventies or eighties brought up surgery for prolapse or incontinence, I steered the conversation elsewhere before she finished the sentence. I'd mention a pessary, pelvic floor therapy, maybe a schedule change for fluids. Surgery stayed on the shelf, not because her anatomy ruled it out, but because her age did, in my head, before I'd even examined her.

I didn't think of it as bias at the time. I thought of it as caution. Older patients, I reasoned, carry more surgical risk, more anesthesia risk, less reserve to recover. Better to manage than to operate. It felt like the responsible position.

Where That Reasoning Came From

Some of it was training. A lot of surgical teaching leans on age as a proxy for risk, because on average it correlates with other things that do matter: heart disease, frailty, slower healing. Age is easy to see on an intake form. The things that actually predict how someone tolerates surgery, their functional status, their other conditions, how well controlled those conditions are, take longer to assess.

So age became a shortcut. A fast, convenient stand-in for a harder question I wasn't always taking the time to ask properly.

What Changed My Mind

What shifted this for me wasn't a single case. It was a pattern I started noticing once I paid closer attention: some of my healthiest, most resilient patients, the ones who recovered fastest and got the most benefit from surgery, were in their late seventies and eighties. And some of my hardest surgical recoveries belonged to women in their fifties who had significant other health problems.

Age, on its own, was telling me almost nothing useful. Function was telling me everything. A woman who walks two miles a day, manages her own medications, and has well-controlled blood pressure is a different surgical candidate than someone a decade younger who doesn't, regardless of what the birth certificate says.

Once I saw that clearly, I couldn't go back to using age as a filter. It felt, honestly, a little embarrassing to realize how long I'd been doing it without examining the habit.

How I Decide Now

I still ask about age. It's part of the picture. But it's one data point among several, not the deciding one. What I weigh more heavily now:

Functional capacity. Can she manage her own daily activities without help? That tells me more about recovery potential than a birthday does.

Control of other conditions. Well-managed diabetes or hypertension is a very different risk profile than the same diagnosis left loosely controlled.

What she actually wants. A woman who has lived with leakage or prolapse for years and is tired of managing around it deserves a real conversation about surgical options, not a redirect based on an assumption about what she can handle.

Realistic recovery expectations. This part hasn't changed. I still talk through what the weeks after surgery look like, honestly, for anyone of any age. That conversation protects the decision, it doesn't gatekeep it.

What I'd Tell Someone Weighing This Decision

If you're older and a doctor has moved you toward conservative management without fully examining your health and your goals, it's fair to ask directly: is this recommendation based on my actual health, or on my age? It's a reasonable question, and a good answer will be specific to you, not general to your decade of life.

Surgery isn't the right choice for everyone, at any age. But the decision should rest on what your body and your health can support, not on a number that tells a doctor far less than it seems to. That's the standard I hold myself to now, and it's a better one than the one I started with.