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Physicians Lack Clinical Guidelines For Treating Elderly With Multiple Illnesses

According to an article in JAMA, clinicians lack guidelines for treating the elderly with many illnesses.

The aging of the population and the increasing prevalence of chronic diseases pose challenges to the development and application of clinical practice guidelines (CPGs Clinical practice guidelines are based on clinical evidence // and expert consensus to help decision making about treating specific diseases. Most CPGs address single diseases in accordance with modern medicine’s focus on disease and pathophysiology. However, physicians who care for older adults with multiple diseases must strike a balance between following CPGs and adjusting recommendations for individual patients’ circumstances. Difficulties escalate with the number of diseases the patient has.

Researchers from Johns Hopkins University, Baltimore had examined how CPGs address co-morbidity in older patients and explored what happens when multiple single-disease CPGs are applied to a hypothetical 79-year-old woman with 5 common chronic diseases.

Two investigators independently assessed whether each CPG addressed older patients with co-morbidities, goals of treatment, interactions between recommendations, burden to patients and caregivers, patient preferences, life expectancy, and quality of life. For a hypothetical 79-year-old woman with chronic obstructive pulmonary disease, type 2 diabetes, osteoporosis, hypertension, and osteoarthritis, the authors aggregated the recommendations from the relevant CPGs.

The researchers found that most CPGs did not modify or discuss the applicability of their recommendations for older patients with multiple co-morbidities. Most also did not comment on burden, short- and long-term goals, and the quality of the underlying scientific evidence, nor give guidance for incorporating patient preferences into treatment plans. If the relevant CPGs were followed, the hypothetical patient would be prescribed 12 medications (costi
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