I read Drs Mazowita and Kozak’s article “First do no harm: Reflections on the application of consensus guidelines for diabetes and other chronic conditions in residential care” [BCMJ 2013;55:80-84] with great interest, and I strongly agree with their message that guidelines must be applied in the frail elderly in a more mindful fashion.
As an emergency physician in a city with a sizable geriatric population, I frequently assess and treat frail elderly patients from nursing homes. These patients are commonly on statin therapy, sometimes (amazingly) even for primary prevention. It is not unusual to see people on statins who have terminal cancer or chronic illnesses and who have a life expectancy of less than a year. This is clearly irrational and inappropriate on many levels. These drugs are costly and have potential adverse effects. I cannot see what possible benefit statins could have for, say, a 90-year-old nursing home patient with dementia, but this is something I see frequently.
It is time for more family physicians as well as many specialists to apply clinical practice guidelines in a more mindful fashion, especially in the frail elderly population.
—Jeffrey Eppler, MD, FRCPC
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