There’s no shame in age-related cognitive decline, but patients deserve doctors at their sharpest

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I don’t know the precise demographics of AusDoc readers, but comments on articles about the relationship between advancing age and fitness to practise suggest that this is a sensitive area.

Perhaps I’m an outlier, but I don’t see myself working clinically into old age.

Why not?

Well, perhaps my self-identity extends well outside my profession.

Perhaps I’m not caught in financial obligations that require me to work indefinitely.

I don’t own or run a business, so I have nothing to hand over. And I’ve had the opportunity to gradually reduce my working hours over the years, so there will be no shock to letting go.

If I’m frank, however, I recognise that cognitive speed and flexibility just don’t last forever.

There is lots of research into cognitive ageing in various demanding professions, including medicine. A 2024 article looked at the impact of age on the cognitive performance of pilots and air-traffic controllers.

The article noted evidence of age effects in both fatiguability and cognitive slowing.

The authors referred to various studies showing the effects of age on the performance of pilots, including the ability to adapt to new technology and equipment.

It is noted that these effects are somewhat tempered by experience and judgement, and also that there is heterogeneity between individuals. Cognitive decline with age can be influenced by genetics, culture and lifestyle as well as intercurrent illness.

Age-related cognitive function has certainly been a hot issue in the field of law — especially in jurisdictions in which judges are appointed for life.

This 2021 article discusses the implications for judges in the US, noting the effects of ageing on “processing speed, fluid reasoning, visual-spatial processing, and working memory … at all levels of education; even the maintained ability of crystallised knowledge declines in old age”.

Another factor relevant for ageing judges (and doctors) is what we might call “socio-cultural ageing”. This relates to exposure to current societal attitudes to all sorts of things, from gender identity and roles to reproductive health, professional-client relationships, cultural mores and risk tolerance.

In Australia, the percentage of GPs in solo practice has been reducing over time, meaning that those in solo practice are likely to be older. This is a risk factor for professional isolation, as well as limiting direct opportunities for consulting colleagues and benchmarking off peers.

AHPRA data tell us that notifications for medical practitioners aged 80 and over have increased by more than 180% between 2015 and 2023. This age group carries the greatest risk for the combination of health issues, cognitive ageing, professional isolation and socio-cultural ageing.

With so much evidence about age-related cognitive decline in our demanding profession, it’s essential that we don’t dismiss this phenomenon but think carefully about how it might apply to each of us and our colleagues.

I’ll start.

Through my long career in public hospital emergency medicine, I worked 10-hour shifts, often in the midst of chaos, with constant interruptions, supervising juniors, under time targets and juggling beds, admissions and referrals, running resuscitations and holding responsibility for the safety of both patients and staff.

Most of the time, I thrived.

Eventually, I had the opportunity to gradually reduce my hours and evening shifts. I have now moved into emergency telemedicine, seeing one patient at a time, without any junior staff to supervise, and in shorter shifts.

There is no way that I could juggle the multitude  of competing demands and multiple interruptions over a 10-hour shift these days, without significant fatigue — which is a serious risk for error.

I have been fortunate (and a bit strategic) in being able to do many of the things that are known to minimise these risks — shorter hours, less multitasking and interruptions, and group work with embedded audit and education.

We owe it to ourselves, our families and — most importantly — our patients, to be sanguine about the effects of ageing.

It’s not ‘ageism’ for the community to expect us to be working at the top of our game.

Sure, experience can balance cognitive sharpness to some extent. Eventually, however, the two lines will cross.

We should not be ashamed of progressing through life’s stages, but welcome the opportunity to move forward.