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 [10]] 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
Kelowna