Background
With aging there is an increase in frailty and chronic disease leading to a potential
increase in medication use. Most clinical trials have excluded old, frail individuals
and have failed to take into account the effects of outcome interaction.
Methods and Results
In this article we provide a mathematical model demonstrating that comorbidities,
including old age, interact with therapies, reducing their effectiveness.
Conclusion
These findings question the validity of single disease guidelines in old persons or
in persons with multiple chronic diseases.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The dilemma of polypharmacy.Aust Prescr. 2009; 31: 2-3
- Maximising the effectiveness and cost-effectiveness of cardiovascular disease prevention in the general population.Med J Aust. 2009; 191: 300-302
- Inappropriate prescribing for osteoporosis.Med J Aust. 2009; 191: 355-356
- Gaps in cardiovascular disease risk management in Australian general practice.Med J Aust. 2009; 191: 324-329
- Atrial fibrillation.Med J Aust. 2007; 186: 197-202
- Patient attitudes to commonly promoted medical interventions.Med J Aust. 2000; 172: 9-12
- Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases.JAMA. 2005; 294: 716-724
- Guidelines for improving the care of the older person with diabetes mellitus.J Am Geriatr Soc. 2003; 51: S265-S280
- Using clinical guidelines designed for older adults with diabetes mellitus and complex health status.JAMA. 2006; 295: 1935-1940
- Kidney transplantation in the elderly: a decision analysis.J Am Soc Nephrol. 2003; 14: 187-196
- Decision analysis using individual patient preferences to determine optimal treatment for localized prostate cancer.Cancer. 2007; 110: 2210-2217
- Shared decision making in hypertension: The impact of patient preferences on treatment choice.Family Practice. 2001; 18: 309-313
- Benefit of carotid endarterectomy for symptomatic and asymptomatic severe carotid artery stenosis: A Markov model based on data from randomized controlled trials.J Neurosurg. 2009; 111: 970-977
- Decision analysis in patient care.Lancet. 2001; 358: 571-574
- Inappropriate prescribing for osteoporosis.Med J Aust. 2009; 190: 519-520
- Low drug doses may improve outcomes in chronic Disease.Med J Aust. 2009; 191: 511-513
- Does point-of-care testing lead to the same or better adherence to medication? A randomised controlled trial: the PoCT in General Practice Trial.Med J Aust. 2009; 191: 487-491
- The overall benefits risks and costs of multiple interventions may be less favourable than the sum of the benefits risks and costs of those individual interventions.Medical Hypotheses. 2007; 69: 970-973
- Change in disability-free life expectancy for Americans 70 years old and older.Demography. 2009; 46: 627-646
- Treatment of hypertension in patients 80 years of age or older.N Engl J Med. 2008; 358: 1887-1898
- Pharmacotherapy for hypertension in the elderly.Cochrane Database Syst Rev. 2009; 7 (CD000028)
- Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomised controlled trial.Lancet. 2002; 360: 1623-1630
- The value of medical spending in the United States, 1960–2000.N Engl J Med. 2006; 355: 920-927
- What happened to the valid POEMs? A survey of review articles on the treatment of type 2 diabetes.BMJ. 2003; 327: 266
- Stroke prevention and atrial fibrillation: Reasons leading to an inappropriate management. Main results of the SAFE II study.Br J Clin Pharmacol. 2004; 57: 798-806
- Comorbid illness affects hospital costs related to hip arthroplasty: Quantification of health status and implications for fair reimbursement and surgeon comparisons.J Arthroplasty. 2004; 19: 700-705
- The development of outpatient clinical glidepaths.J Am Geriatr Soc. 2002; 50: 1886-1901
- Comparative effectiveness and health care spending— Implications for reform.N Engl J Med. 2010; 362: 460-465
- Cost-effectiveness of implantable cardioverter-defibrillators.N Engl J Med. 2005; 353: 1471-1480
- Methodological considerations for interpretation of rates of major haemorrhage in studies of anticoagulant therapy for atrial fibrillation.Europace. 2008; 10: 3-5
- Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation.Circulation. 2007; 115: 2689-2696
- Bleeding while starting anticoagulation for thromboembolism prophylaxis in elderly patients with atrial fibrillation from bad to worse.Circulation. 2007; 15: 2684-2686
- Survival after stroke—The impact of CHADS2 score and atrial fibrillation.Int J Cardiol. 2010; 141: 18-23
Article info
Publication history
Published online: August 09, 2010
Footnotes
The authors have declared they have no conflicts of interest.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
