Abstract
A complex decision path with a careful evaluation of the risk–benefit ratio is mandatory for drug treatment in advanced age. Enrollment biases in randomized clinical trials (RCTs) cause an under-representation of older individuals. In high-risk frail older subjects, the lack of RCTs makes clinical decision-making particularly difficult. Frail individuals are markedly susceptible to adverse drug reactions, and frailty may result in reduced treatment efficacy. Life expectancy should be included in clinical decision-making paths to better assess the benefits and risks of different drug treatments in advanced age. We performed a scoping review of principal hospital- and community-based prognostic indices in older age. Mortality prognostic tools could help clinical decision-making in diagnostics and therapeutics, tailoring appropriate intervention for older patients. The effectiveness of drug treatments may be significantly different in older patients with different risk of mortality. Clinicians need to consider the prognostic information obtained through well-validated, accurate, and calibrated predictive tools to identify those patients who may benefit from drug treatments given with the aim of increasing survival.
Highlights
Reviewed by: Marco Inzitari, Parc Sanitari Pere Virgili, Spain Ding-Cheng (Derrick) Chan, National Taiwan University Hospital, Taiwan
Older adults remain underrepresented in clinical trials of patients hospitalized with an acute coronary syndrome [2] or in ongoing randomized clinical trials (RCTs) regarding heart failure [3], while a very recent systematic review found that no RCTs of statin or any other hypocholesterolemic medication included persons older than 82 years at baseline [4]
While the exclusion of older subjects from RCTs is often understandable from the standpoint of completing a study safely and efficiently, the results of studies that include a very narrow, highly selected subset of subjects and exclude most of the older high-risk patients may be less generalizable to patients cared outside of the context of clinical trials
Summary
Reviewed by: Marco Inzitari, Parc Sanitari Pere Virgili, Spain Ding-Cheng (Derrick) Chan, National Taiwan University Hospital, Taiwan.
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