Honour thy older patients, for although they often have the highest risk, they may also have the highest risk of harm from treatment

Age increases the risk of cardiovascular disease and most cancers. This amplifies the apparent effect of risk-reducing treatments, but these can only postpone rather than avert death. The quality of remaining life may often be more important than the duration.
For these reasons it is particularly important with older people to take account of individual preferences in the light of NNTs, possible harms, and the absolute prolongation of life offered by each treatment.
Information from randomised controlled trials is often derived from populations without major comorbidity who are younger than most patients with the condition. Therapeutic decision making in older people with multiple conditions and on multiple drugs is fraught with difficulty, and there is often little evidence on which to base combinations of treatment. So it is essential to establish a clear understanding of what individuals are experiencing while on treatment, and what they would like to achieve; and to be honest about possible benefits, harms, and uncertainties.

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Key Papers

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B.
Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012

Frank C, Weir E.
Deprescribing for older patients. CMAJ 2014