Older people are undertreated as much as they are overtreatedBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1200 (Published 23 March 2009) Cite this as: BMJ 2009;338:b1200
- David Oliver, senior lecturer, geriatric medicine1
As a geriatrician, I see daily the iatrogenic effects of overtreatment of older patients that is partly driven by a box ticking, target oriented culture.1 People are taking drugs they no longer need or may never have needed or that haven’t been meaningfully reviewed for some time, despite the quality and outcomes framework.
However, common, serious, and debilitating conditions largely affecting older people tend to be under-recognised and poorly managed while services and research tend to be underfunded and education and training of professionals inadequate. In hospitals older patients with legitimate and treatable medical problems (often manifesting with loss of physical function or impaired cognition) are written off as “social” or “acopia.”
Although ageing should not be routinely medicalised, danger lies in having treatable problems in older people “socialised.” Patients over 65 already account for around 70% of bed days in NHS hospitals, but priorities and values have yet to catch up with the fact that frailty, ageing, and long term conditions are core to health. Many patients don’t present in “textbook” fashion, and much of medicine is about maintenance or palliation rather than cure, about the commonplace and not the rare and diagnostically challenging, and about low tech rather than high tech interventions. So we have the bizarre paradox of general practitioners being given incentives to treat, say, hypertension or cardiac failure aggressively, while conditions such as continence, osteoporosis, dementia, delirium, and falls are far down the pecking order.
Cite this as: BMJ 2009;339:b1200
Competing interests: None declared.
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