Guidelines to Treat Elderly Criticized; Single Diseases Only Addressed

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Byline: Joyce Howard Price, THE WASHINGTON TIMES

Using current clinical practice guidelines to treat elderly patients with several illnesses may have undesirable effects, as most CPGs address single disorders, not multiple diseases that are common in this age population, a new study has found.

"For the present, widely used CPGs offer little guidance to clinicians caring for older patients with several chronic diseases," according to the report published in today's issue of the Journal of the American Medical Association.

"Difficulties escalate with the number of diseases the patient has," wrote lead investigator Dr. Cynthia M. Boyd of Johns Hopkins University's Center on Aging and Health.

The report by Dr. Boyd and colleagues at Johns Hopkins points out that in 1999, 48 percent of Medicare recipients 65 or older had at least three chronic health disorders, such as high blood pressure, chronic heart failure, diabetes and osteoporosis. That year, approximately 21 percent of Medicare beneficiaries had five or more chronic medical conditions.

Health care costs for those with at least three chronic conditions accounted for 89 percent of Medicare's annual budget in 1999, the researchers said. They also said having more than one chronic disease is "associated with poor quality of life, physical disability, high health care use, multiple medications, and increased risk for adverse drug events and mortality."

"Optimizing care for this population is a high priority," given the aging of the population and the "increasing prevalence of chronic diseases," the authors say, adding that the CPGs "are based on clinical evidence and expert consensus to help decision-making about treating specific diseases. …