BMJ  2007;335:361-362 (25 August), doi:10.1136/bmj.39311.447407.3A

Letters

Prevention in elderly people

Later life's complexity needs a scalpel rather than an axe

The key features of ageing are increased inter-individual variability, complexity, and comorbidity, which is why indicators of quality of care based on single disease models work less well among older than younger people. However, it is a far cry from this position to the nihilism of Mangin et al.¹

Individualised health promotion for older people is highly effective² and is likely to be among the reasons for falling disability among older Americans,³ to the point of stabilising healthcare expenditure on older people. Health promotion among older people embraces a far wider repertoire of manoeuvres than the prescription of statins, and sadly, evidence is abundant that old age is associated with a failure of doctors to provide health promotion to older people in a range of settings.^{4 5}

Rather than systematically withholding preventive options for older people, clinicians should capitalise on other hallmarks of later life, wisdom and common sense, to develop a partnership approach whereby older people can choose whether or not to take up the different elements of an individualised health promotion programme. Using these gerontological principles effectively will help to ensure that health promotion in later life is sculpted with a scalpel rather than an axe.

Centre for Ageing, Neurosciences and the Humanities, Adelaide and Meath Hospital Dublin, Dublin 24, Republic of Ireland

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Competing interests: None declared.

References

1. Mangin D, Sweeney K, Heath I. Preventive health care in elderly people needs rethinking. BMJ 2007;335:285-7. (11 August.)[Free Full Text]
2. LIFE Study Investigators, Pahor M, Blair SN, Espeland M, Fielding R, Gill TM, et al. Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci 2006;61:1157-65.[Abstract/Free Full Text]
3. Manton KG, Gu X, Lamb VL. Change in chronic disability from 1982 to 2004/2005 as measured by long-term changes in function and health in the U.S. elderly population. Proc Natl Acad Sci U S A 2006;103:18374-9.[Abstract/Free Full Text]
4. Arber S, McKinlay J, Adams A, Marceau L, Link C, O'Donnell A. Influence of patient characteristics on doctors' questioning and lifestyle advice for coronary heart disease: a UK/US video experiment. Br J Gen Pract 2004;54:673-8.[ISI][Medline]
5. Maguire CP, Ryan J, Kelly A, O'Neill D, Coakley D, Walsh JB. Do patient age and medical condition influence medical advice to stop smoking? Age Ageing 2000;29:264-6.[Abstract/Free Full Text]

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Relevant Article

Preventive health care in elderly people needs rethinking

Dee Mangin, Kieran Sweeney, and Iona Heath
BMJ 2007 335: 285-287. [Extract] [Full Text] [PDF]