Thursday, December 01, 2011


Many of us take care of senior citizens, some as old as 80-90 years old. I often see cases for second opinion and I find that there are some very enthusiastic ( read young newly graduated ) doctors, who will push drug doses high in these group of seniors, in an attempt to get excellent control of their disease states. Well, an article in the Nov 24th issue of the New England Journal of Medicine is timely. In this article by Dr Daniel Budnitz of the Center for Disease Control ( CDC ), he and his colleagues looked into the need for emergency admissions in the US from 2007-2009. They found 100,000 emergency admissions. 48% of these admissions were for patients 80 years or older. Two thirds of these emergency admissions in senior citizens were for adverse drug events from 4 medications, namely warfarin, anti-platelet agents ( bleeding ), insulin and other oral hypoglycemics. Looks like enthusiatic doctors were pushing warfarin doses to get optimal PT-INR for warfarin, adding clopidogrel to aspirin, or using prasugrel, using high doses of insulin and hypoglycemics to get normal blood sugars.
I must say that to my understanding, the trial data for drug doses for senior citizens, especially those 80 years and above is so sparse that sometimes I wonder if treating this group of patients is evidence based or not. Are we just doing something because we have to, and aiding the pharmas in the process. I suppose, if you are in USA where patients are never allowed to die ( guess why their Medicare budget is so high, you must or face litigation.
I personally feel, and I have often explained to my senior patients relatives, in treating senior citizens, "perfection may be the enemy of good".

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