An article in the British Medical Journal (BMJ) is calling for a more sophisticated way of assessing the pros and cons of preventive treatment in elderly people – seeing that possibly all that preventive treatments are doing is changing the cause of death, rather than prolonging life.

Preventive treatment is there to delay the onset of disease and illness and prevent premature deaths, write Dr. Dee Mangin and team. As concerns about the fairness of treatments have grown, interventions are being put forward without taking into account the age of the patient – a move which is both costly for the health service and possibility detrimental to the patient, they say.

As a country’s population ages rapidly, an urgent reappraisal is required of the complex and awkward relations between age discrimination, distributive justice, quality and length of life, they say.

The article gives as an example the preventive use of statins. All it seems to do is replace the cause of death from a cardiovascular disease to cancer – it does not prolong life.

The writers wonder whether all that is being achieved, as preventative treatments are introduced for the elderly, is that the cause of death is changing, but nothing else – without the patient’s informed consent.

This weakens the principle of respect for autonomy and is basically unethical.

Doctors receive guidelines which contain financial incentives to persuade patients to accept these preventive treatments. However, might not the best interests of the elderly lie in investing this money in procedures that improve quality of life, such as cataract operations, joint replacement surgery, and providing for people with dementia.

It is not right to continue extrapolating figures from younger populations and using linear models that utilize absolute risk of disease, rather than all causes of mortality and morbidity, they add. Otherwise, the only ones to really gain will be the drug companies, making more and more money from a growing number of older people who are consumed by epidemics instead of enjoying the benefit of a longer life, they conclude.

“Preventive health care in elderly people needs rethinking”
BMJ Volume 335 pp 285-7

Written by: Christian Nordqvist