Geriatric disease guidelines needed

There are many guidelines to assist clinical practice, but few are specifically for older patients. Doctors at the University of Toronto have therefore assessed how applicable guidelines for chronic diseases are to the elderly.

They carried out a content analysis of 10 guidelines which had been recently published by government or national medical organisations. These provided advice on common conditions such as chronic obstructive pulmonary disease, diabetes, depression, dyslipidaemia, osteoporosis and osteoarthritis.

Most of the guidelines stated the applicable age range. Treatment of the elderly was not considered in three guidelines.

Guidelines on diabetes and depression provided evidence that the response to treatment was similar for patients of all ages. These guidelines and a guideline on hypertension listed drugs which were suitable, or unsuitable, for the elderly.

The guidelines provided varying amounts of information on comorbid conditions. Although arthritis is common in the elderly no specific advice was given on managing comorbidities.

Comment
Clinical practice guidelines, especially those produced by disease specific organisations, can have a narrow focus. In contrast, elderly patients tend to have several chronic conditions and be taking several drugs.

An important consideration for GPs managing elderly patients is how long to continue the treatments recommended by guidelines. Does a 90-year-old with dementia need to keep taking drugs to reduce cholesterol?

The production of guidelines should have multidisciplinary input including general practice. A problem for those preparing evidence-based guidelines is that the elderly, particularly those with comorbidities are often excluded from clinical trials.
Dr John Dowden, Canberra