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.
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.
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.