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Medicine in Older Patients: Evidence Based?

  • Simon P. Mooijaart
Chapter

Abstract

Increasingly, medical doctors are supposed to treat their patients according to clinical guidelines—a synthesis of existing literature, translated into standardized advice with respect to treatment of patients in a given situation. The implementation of such clinical guidelines has had great success: stringent cardiovascular risk management in combination with early revascularization therapies has resulted in a decreased risk of cardiovascular disease and associated complications including death in the last decades. In some Western countries, cardiovascular disease is no longer the number one cause of death, with cancer being the leading cause. However, despite the clinical guidelines, in older patients the risk of cardiovascular has not decreased. Rather, older patients often have multiple diseases, and implementation of all clinical guidelines for these individual diseases in one patient is burdensome, not effective or may even be harmful [1].

References

  1. 1.
    Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294(6):716–724CrossRefGoogle Scholar
  2. 2.
    Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312(7023):71–72CrossRefGoogle Scholar
  3. 3.
    Mooijaart SP, Broekhuizen K, Trompet S, de Craen AJ, Gussekloo J, Oleksik A et al (2015) Evidence-based medicine in older patients: how can we do better? Neth J Med 73(5):211–218PubMedGoogle Scholar
  4. 4.
    López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G (2013) The hallmarks of aging. Cell 153(6):1194–1217CrossRefGoogle Scholar
  5. 5.
    Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB et al (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 12(4):249–256CrossRefGoogle Scholar
  6. 6.
    Rockwood K, Mitnitski A (2007) Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 62(7):722–727CrossRefGoogle Scholar
  7. 7.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156CrossRefGoogle Scholar
  8. 8.
    Hofman CS, Makai P, Boter H, Buurman BM, de Craen AJ, Olde Rikkert MG et al (2015) The influence of age on health valuations: the older olds prefer functional independence while the younger olds prefer less morbidity. Clin Interv Aging 10:1131–1139CrossRefGoogle Scholar
  9. 9.
    Broekhuizen K, Pothof A, de Craen AJ, Mooijaart SP (2015) Characteristics of randomized controlled trials designed for elderly: a systematic review. PLoS One 10(5):e0126709CrossRefGoogle Scholar
  10. 10.
    Dodd KS, Saczynski JS, Zhao Y, Goldberg RJ, Gurwitz JH (2011) Exclusion of older adults and women from recent trials of acute coronary syndromes. J Am Geriatr Soc 59(3):506–511CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  1. 1.Department of Internal Medicine, Section of Gerontology and GeriatricsLeiden University Medical CenterLeidenNetherlands

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