Older adults should be part of treatment decisions
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Older adults with multiple health problems have their own opinions when it comes to stopping or continuing a particular treatment, and doctors should encourage them to speak up, according to researchers.
In focus-group discussions with older adults on multiple medications, Yale University researchers found that most had experience with the concept of “competing outcomes”—the dilemma patients face when treating one health condition may worsen another.
For example, an older adult taking a cholesterol medication that causes leg cramps may have to decide whether the lower cholesterol number—and potentially reduced risk of heart attack—is worth the painful side effect. The decision is more complicated when that person also has arthritis and the leg cramps keep him from exercising to reduce his arthritis symptoms.
Similarly, a blood pressure medication can cut the risk of heart attack or stroke. But the side effect of dizziness may hamper a person’s daily life, and even increase the risk of falling and suffering a bone fracture.
In the current study, of 66 men and women age 65 or older, the typical participant had five chronic conditions—such as high blood pressure, heart disease, arthritis and diabetes—and was on seven daily medications. Most had experience in dealing with medication side effects.
When the researchers asked them about medications with potentially competing outcomes, the patients started talking about their broader treatment goals—such as living not only a longer life, but also a high-quality one where they were not physically disabled by a chronic disease, or by a treatment.
It’s important for doctors to get at such long-term priorities when discussing treatment decisions with older patients, according to the researchers.
Giving them “this kind of active role in treatment decisions means more customized outcomes for patients,” lead researcher Dr. Terri Fried, a professor at the Yale School of Medicine, said in a written statement.
“Because of their experience with medication side effects,” she said, “older patients with multiple conditions can understand the concept of competing outcomes. Prioritizing across all outcomes can help clarify what is most important to seniors who are faced with complex healthcare decisions.”
Doctors and patients might then be able to choose an overall course of care that better suits a patient’s life, rather than focusing on individual health problems in isolation, the researchers say. [p 1843, par 2]
SOURCE: Journal of the American Geriatrics Society, October 2008.
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