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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3 Responses to “Preventive health care in elderly people needs rethinking”


  1. 1 Anonymous 2007 August 10 at 2:12 am

    Its now available free…

  2. 2 vuee 2007 August 10 at 8:06 am

    Thank you, quyana, kia ora, to whoever released it. This would make an interesting discussion with friends.

    The BBC has an article about the study. But please read the original BMJ article. If your life would not be lengthened with a prescription but a prescription medicine meant no cataract surgery, is this OK? if it were your decision? if it were your doctor’s decision? What other factors should be considered? How does this fit in with an advanced life directive (living will)? ____????

    Drugs such as statins, prescribed to combat heart disease, may simply switch the cause of death to cancer or dementia in older people, they warn.

    …Around 40 million statins are prescribed annually in the UK, a figure that is rising. GPs are offered financial incentives through their contract to prescribe them to as many high-risk patients as possible. [In the US, see the interconnection between prescribers and pharma http://www.nytimes.com/2007/08/04/us/04drug.html ] …

    Changing the cause of death without the patient’s informed consent, is unethical, they argue. […]


  1. 1 Older, more able « O’Folks Trackback on 2007 December 11 at 8:46 pm
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