Clinical Guidelines and Elderly Patients—Proceed with Caution
We were alerted to this important study of clinical practice guidelines (CPGs) in elderly patients with co-morbidities  by Demetra Antimisiaris, an associate professor who directs the polypharmacy initiative at the University of Louisville School of Medicine.
The authors report that most CPGs did not modify recommendations for older patients with multiple comorbidities. Most also did not comment the quality of the underlying scientific evidence or provide guidance for incorporating patient preferences into treatment plans. If the relevant CPGs were followed, one hypothetical patient described in the report would be prescribed 12 medications (costing her $406 per month). Use of guidelines for this patient would result in a complicated medication schedule, and adverse events would be likely. The authors state that, “Although CPGs provide detailed guidance for managing single diseases, they fail to address the needs of older patients with complex comorbid illness.” CPGs rarely address treatment of patients with 3 or more chronic diseases—a group that includes half of the population older than 65 years. Adhering to current CPGs in caring for an older person with several comorbidities may have multiple undesirable effects and could result in net harms.
- Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005 Aug 10;294(6):716-24. PubMed PMID: 16091574.