Diminishing returns for preventive care
My delightful patient, Mrs M, is now 89. She’s on three antihypertensives and also has high cholesterol – or so we discovered when she had a thrombotic stroke. I felt awful because I hadn’t checked her lipids for ages, and it was several months before she could return to her major past-time of which I’ve been a beneficiary each Christmas – crocheting coathanger covers. (They truly keep your clothes in much better shape.) Maybe if I’d treated her lipids, she wouldn’t have had a stroke.
Anyway, I was reminded of Mrs M on reading an article in this week’s BMJ calling for a rethink on preventative health care in the elderly.
The preventative push doesn’t deal with the problem of how it applies to people who’ve already exceeded an average lifespan, say the GP authors, who claim that fears of ageism have led us to provide treatments which merely change the cause of death rather than prolonging quality life. They use the example of statins to illustrate their case.
Evidence for using statins in the elderly to prevent heart disease is scant, and the largest relevant study is the PROSPER trial, they say. Yet while showing a small positive effect on cardiac mortality and morbidity, the trial also showed a higher rate of death and cancer diagnosis in the treatment group.
Further, the authors question the morality of selecting out and preventing specific causes of death, such as heart disease, leaving older people to die of other conditions that cause more distress. For example, many people regard coronary heart disease as a “good way to go”, they say.
“The best interests of elderly people, who have paid a lifetime of taxes, might lie in investing that money in health care that will genuinely relieve suffering. Cataract operations, joint replacement surgery, and personal care of people with dementia are obvious examples”, the authors say.
It’s an appealing argument, and Mrs M’s had bilateral cataract ops and a knee replacement which have certainly improved the quality of her life. But she’d also like to have avoided a stroke which came close to stealing her independence.
BMJ 2007; 335;285-7.
Anyway, I was reminded of Mrs M on reading an article in this week’s BMJ calling for a rethink on preventative health care in the elderly.
The preventative push doesn’t deal with the problem of how it applies to people who’ve already exceeded an average lifespan, say the GP authors, who claim that fears of ageism have led us to provide treatments which merely change the cause of death rather than prolonging quality life. They use the example of statins to illustrate their case.
Evidence for using statins in the elderly to prevent heart disease is scant, and the largest relevant study is the PROSPER trial, they say. Yet while showing a small positive effect on cardiac mortality and morbidity, the trial also showed a higher rate of death and cancer diagnosis in the treatment group.
Further, the authors question the morality of selecting out and preventing specific causes of death, such as heart disease, leaving older people to die of other conditions that cause more distress. For example, many people regard coronary heart disease as a “good way to go”, they say.
“The best interests of elderly people, who have paid a lifetime of taxes, might lie in investing that money in health care that will genuinely relieve suffering. Cataract operations, joint replacement surgery, and personal care of people with dementia are obvious examples”, the authors say.
It’s an appealing argument, and Mrs M’s had bilateral cataract ops and a knee replacement which have certainly improved the quality of her life. But she’d also like to have avoided a stroke which came close to stealing her independence.
BMJ 2007; 335;285-7.
Labels: preventive care
posted by ozdocblog at 8:39 PM
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