[PHNUTR-L] Preventive treatments in elderly people needs rethinking

[Kathrynne Holden]

Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic. If you do not wish to
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Public release date: 9-Aug-2007
http://www.eurekalert.org/pub_releases/2007-08/bmj-pti080907.php

Contact: Emma Dickinson
edickinson at bmj.com
44-020-738-36529
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 
cancer.

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 
consent"

This is fundamentally unethical, undermining the principle of respect 
for autonomy.

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/
"Eat well, stay well with Parkinson's disease"
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