[PHNUTR-L] Preventive treatments in elderly people needs rethinking
fivestar at nutritionucanlivewith.com
Fri Aug 10 17:04:44 PDT 2007
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Public release date: 9-Aug-2007
Contact: Emma Dickinson
edickinson at bmj.com
BMJ-British Medical Journal
Preventive treatments in elderly people needs rethinking
Rather than prolonging life, preventive treatments in elderly people may
simply change the cause of death – the manner of our dying, say doctors
in this week’s BMJ.
They call for a more sophisticated way of assessing the benefits and
harms of preventive treatment in elderly people.
Preventive health care aims to delay the onset of illness and disease
and to prevent untimely and premature deaths, say Dr Dee Mangin and
colleagues. But concerns about equity of access to treatments have led
to preventive interventions being encouraged regardless of age, and this
can be harmful to the patient and expensive for the health service.
In rapidly ageing populations, we urgently need to reappraise the
complex and uncomfortable relations between age discrimination,
distributive justice, quality, and length of life, they argue.
For example, preventive use of statins shows no overall benefit in
elderly people as cardiovascular mortality and morbidity are replaced by
Is it possible, they ask, that by introducing preventive treatments in
the elderly aimed at reducing the risk of a particular cause of death,
we are simply changing the cause of death without the patient’s informed
This is fundamentally unethical, undermining the principle of respect
Financial incentives for doctors that are linked to guidelines and
targets may coerce doctors into persuading patients to accept such
preventive treatments, they add, but the best interests of elderly
people might lie in investing the money in health care that will
genuinely relieve suffering, such as cataract operations, joint
replacement surgery, and personal care of people with dementia.
They believe that a more sophisticated model is needed to assess
preventive treatment in the elderly that takes a wider perspective when
balancing potential harms against putative benefits.
We should not carry on extrapolating data from younger populations and
using linear models that use absolute risks of disease rather than all
cause mortality and morbidity. If we do, the only ones to benefit will
be drug companies, with increasing profits from an ageing population
consumed by epidemics rather than enjoying their long life, they conclude.
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
"Ask the Parkinson Dietitian" http://www.parkinson.org/
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