Archive for August 9th, 2007

Preventive health care in elderly people needs rethinking

This sounds like it could be an interesting think-piece. Unfortunately, BMJ no longer gives free access to articles the first year. [this article was subsequently made available to the public for discussion.]

I don’t know what they mean by elderly, the oldest olds? The age group was 70-82. See comments.

BMJ 2007;335:285-287 (11 August), doi:10.1136/bmj.39241.630741.BE1
Analysis by
Dee Mangin, senior lecturer in general practice1, Kieran Sweeney, honorary clinical senior lecturer in general practice2, Iona Heath, general practitioner3

1 Christchurch School of Medicine, University of Otago, Christchurch New Zealand, 2 Peninsula Medical School, Royal Devon and Exeter Hospital, Exeter EX2 5DW, 3 Caversham Group Practice, London NW5 2UP

Dee Mangin, Kieran Sweeney, and Iona Heath argue that, rather than prolonging life, preventive treatments in elderly people simply change the cause of death—the manner of our dying

The first 150 words of the full text of this article appear below.

Summary points

* Single disease models should not be applied to preventive treatments in elderly people
* Preventive treatments in elderly people may select cause of death without the patient’s informed consent
* Preventive use of statins shows no overall benefit in elderly people as cardiovascular mortality and morbidity are replaced by cancer
* A more sophisticated model is needed to assess the benefits and harms of preventive treatment in elderly people

Preventive health care aims to delay the onset of illness and disease and to prevent untimely and premature deaths. But the theory and rhetoric of prevention do not deal with the problem of how such health care applies to people who have already exceeded an average lifespan. In recent years, concerns about equity of access to treatments have focused on ageism. As a result, preventive interventions are encouraged regardless of age, and this can be harmful to the patient and expensive for the health . . .

[Full text of this article via paid subscription only] The full text is now available.
http://www.bmj.com/cgi/content/short/335/7614/285?etoc

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Tolstoy’s bicyclist scholars, Phylliss Turner, MSc, nonagenarian

Phylliss Turner, MSc graduate
Photos aren’t allowed in comments, 😦
https://theelderlies.wordpress.com/2007/05/01/tolstoys-bicyclists-nola-ochs-95/#comment-19820

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Ralph White, MD nonagenarian

This was a nice surprise in my E-mail, an article about Dr White. Not only is he still contributing to his community (well, duh 😉 ) but he is one of the unique Orange County residents who have seen southern California’s orchards, onion farms, and dairies.

Retired 97-year-old O.C. doctor is still in the game
By GREG HARDESTY, The Orange County Register

…White, two weeks after suffering a minor stroke he diagnosed himself, is touring the $203 million Patient Care Center at St. Joseph Hospital, where he began mending bodies in 1939, in the old hospital building that now houses administrative offices.

… The sleek operating rooms inside the new St. Joe’s facility, opening in October, have ceiling-mounted surgical lights and voice-activated surgical equipment, flat-screen computer monitors and tiny video recorders to transmit live feeds of procedures… White used to make $15 house calls at a time when Orange County’s population was 130,000 (Irvine alone today has more than 200,000 residents).

He’s delivered more than 1,500 babies….

One former patient takes him to lunch every year … on his birthday (June 30, 1910). White diagnosed her breast cancer in the early stages, when she was in her 40s. She’s in her 60s now. Perhaps these connections explain why, after retiring as a family practitioner 31 years ago – the year Jimmy Carter became president – White still hasn’t had his fill of St. Joe’s. Since retiring, White has volunteered more than 11,000 hours at the hospital – the equivalent of working for more than five years, every day, without a day off. […]

Dr Ralph White, nonagenarian

http://www.ocregister.com/ocregister/life/themorningread/article_1803814.php

Read the rest, especially his list of the changes he’s seen in healthcare over the years, White titles his list, “From Cradle to Grave Practice.” That would make an exciting oral history or blog. Especially for eldercare from the participant/observer point of view.

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