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Health & Medicine for Senior Citizens

Seniors Not Impressed by Evidence-Based Solutions; Want to Know Medications are Safe

Study says elderly patients only willing to take medications to prevent cardiovascular disease if benefits far greater than risks

Feb. 28, 2011 Senior citizens think a little differently about health and medications than younger people who are not so encumbered by chronic disease. A new study finds these elderly patients also have views that differ with the guidelines for medical care that are scientifically prepared to enhance patient treatment.

A new study, for example, finds that older people are willing to take medications for cardiovascular disease prevention, but only if the benefits far outweighs the risk.

 

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The report, published online by the Archives of Internal Medicine, one of the JAMA/Archives journals, notes that many elderly patients have multiple risk factors for chronic disease and may not value the guidelines in the same way as clinicians when they consider benefits and harms of medications.

In 1997, U.S. Department of Health and Human Services launched its initiative to promote evidence-based practice in everyday care through establishment of 12 Evidence-based Practice Centers (EPCs). The program is under the Agency for Healthcare Research and Quality (AHRQ).

The centers develop evidence reports and technology assessments on topics relevant to clinical, social science/behavioral, economic, and other health care organization and delivery issues - specifically those that are common, expensive, and/or significant for the Medicare and Medicaid populations.

With this program, AHRQ became a "science partner" with private and public organizations in efforts to improve the quality, effectiveness, and appropriateness of health care by synthesizing the evidence and facilitating the translation of evidence-based research findings.

The resulting evidence reports and technology assessments are used by Federal and State agencies, private sector professional societies, health delivery systems, providers, payers, and others committed to evidence-based health care.

"Quality-assurance and pay-for-performance initiatives increasingly encourage adherence to evidence-based guidelines for the prevention or management of particular diseases," the authors say in providing background information on their study.

"However, guideline-directed therapy may be at odds with the preferences of the patients who are targeted by the guidelines."

Terri R. Fried, M.D., of Yale University School of Medicine, New Haven, Conn., and the VA Connecticut Healthcare System, and colleagues examined the willingness of older adults to take medications for primary cardiovascular disease prevention according to benefits and harms.

For this study, 356 in-person interviews were performed with community-living senior citizens (average age, 76). The participants were asked about their willingness to take medication for primary prevention of heart attack (myocardial infarction).

The medication was described as reducing the participant's risk of having a heart attack over the next five years, but with various types and severity of adverse effects, including fatigue, dizziness, nausea and fuzzy or slowed thinking.

What the participants said

Most participants (88 percent) indicated they would take the medication if it had no adverse effects, providing an absolute benefit of six fewer persons with heart attack out of 100, approximating the average risk reduction of currently available medications.

"As the absolute benefit offered by the medication increased, so did the proportion willing to take the medication," the authors note.

"In contrast, large proportions (48 percent to 69 percent) were unwilling or uncertain about taking medication with average benefit causing mild fatigue, nausea, or fuzzy thinking, and only 3 percent would take medication with adverse effects severe enough to affect functioning."

"The central finding of this study was the large influence exerted by the presence of adverse effects on older persons' decisions about whether to take a medication," the authors write.

"These results suggest that clinical guidelines and decisions about prescribing these medications to older persons need to place emphasis on both benefits and harms," they conclude.

This study was supported by a grant from the Robert Wood Johnson Foundation and by the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine. Dr. Fried is supported by a grant from the National Institutes of Health/National Institute on Aging.

The paper will also be published in the June 27, 2011 print issue of the Archives of Internal Medicine.

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