Analysis

Preventive health care in elderly people needs rethinking

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39241.630741.BE1 (Published 09 August 2007) Cite this as: BMJ 2007;335:285
  1. Dee Mangin, senior lecturer in general practice1,
  2. Kieran Sweeney, honorary clinical senior lecturer in general practice2,
  3. Iona Heath, general practitioner3
  1. 1Christchurch School of Medicine, University of Otago, Christchurch New Zealand
  2. 2Peninsula Medical School, Royal Devon and Exeter Hospital, Exeter EX2 5DW
  3. 3Caversham Group Practice, London NW5 2UP
  1. Correspondence to: D Mangin derelie.mangin{at}chmeds.ac.nz
  • Accepted 28 May 2007

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

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 service. In rapidly ageing populations, we urgently need to reappraise the complex and uncomfortable relations between age discrimination, distributive justice, quality, and length of life.

The epidemic of cardiovascular disease

In the richer countries of the world, improved social conditions combined with immunisations and antibiotics have rapidly reduced the rates of death from infectious diseases. People saved from these epidemics now live long enough to face the new “epidemic” of cardiovascular disease, which is the focus of huge investment and endeavour in health promotion. The national service framework for cardiovascular disease aims to reduce the number of people dying from coronary heart disease by 40% by the year 2010 with advice that standards set out in this framework apply to all people, irrespective of age.1 But …

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