Prevention 'may not help elderly'

Use of medicines to prevent disease may not prolong or improve life in elderly people, say doctors. Drugs such as statins, prescribed to combat heart disease, may simply switch the cause of death to cancer or dementia in older people, they warn. Writing in the British Medical Journal they said fear of discrimination meant doctors were offering preventive treatment regardless of age. Experts agreed more evidence on such treatments in the elderly was needed. Statins are the mainstay of the government's goal to cut rates of heart disease by 40% by 2010.

Around 40 million statins are prescribed annually in the UK, a figure that is rising. GPs are offered financial incentives through their contract to prescribe them to as many high-risk patients as possible. But Dr Dee Mangin, a GP in New Zealand, and London GP Dr Iona Heath said it was worrying that there was no upper age limit for assessing the risk of heart disease. And if the aim is to prevent untimely death, what effect is it having in people who have already lived longer than the average, they questioned. Cause of death One large study of statins in people aged 70-82 years old found that illness and deaths from heart disease fell in those treated with pravastatin but overall there was no difference in mortality as rates of cancer illness and death increased. Changing the cause of death without the patient's informed consent, is unethical, they argue. Dr Heath said: "If you said I can give you this drug and it will reduce your risk of dying from a heart attack, people would have a different reaction to if you said I can give you this drug which will reduce your risk of a heart attack but increase the risk of you being diagnosed with cancer or dementia."

Bonnie - this is such a compelling issue and one that has disappointed me greatly for a long time. When I see elderly clients on countless medications, many just to counterbalance the medications' side effects, the first issue we discuss is quality of life. Do they want to continue down this path or do they want to alter their diet and lifestyle, which has proven to improve quality of life, and reduce their medication intake? Usually if they are seeing me, they are so miserable that they will try anything. In many instances, improvement in quality of life is dramatic, even at an advanced age.

The financial incentives offered to GPs in the UK for prescribing statins is shocking!