Abstract
BackgroundClinical care for older adults is complex and represents a growing problem. They are a diverse patient group with varying needs, frequent presence of multiple comorbidities, and are more susceptible to treatment harms. Thus Clinical Practice Guidelines (CPGs) need to carefully consider older adults in order to guide clinicians. We reviewed CPG recommendations for primary cardiovascular disease (CVD) prevention and examined the extent to which CPGs address issues important for older people identified in the literature.MethodsWe searched: 1) two systematic reviews on CPGs for CVD prevention and 2) the National CPG Clearinghouse, G-I-N International CPG Library and Trip databases for CPGs for CVD prevention, hypertension and cholesterol. We conducted our search between April and December 2013. We excluded CPGs for diabetes, chronic kidney disease, HIV, lifestyle, general screening/prevention, and pregnant or pediatric populations. Three authors independently screened citations for inclusion and extracted data. The primary outcomes were presence and extent of recommendations for older people including discussion of: (1) available evidence, (2) barriers to implementation of the CPG, and (3) tailoring management for this group.ResultsWe found 47 eligible CPGs. There was no mention of older people in 4 (9 %) of the CPGs. Benefits were discussed more frequently than harms. Twenty-three CPGs (49 %) discussed evidence about potential benefits and 18 (38 %) discussed potential harms of CVD prevention in older people. Most CPGs addressed one or more barriers to implementation, often as a short statement. Although 27 CPGs (58 %) mentioned tailoring management to the older patient context (e.g. comorbidities), concrete guidance was rare.ConclusionAlthough most CVD prevention CPGs mention the older population to some extent, the information provided is vague and very limited. Older adults represent a growing proportion of the population. Guideline developers must ensure they consider older patients’ needs and provide appropriate advice to clinicians in order to support high quality care for this group. CPGs should at a minimum address the available evidence about CVD prevention for older people, and acknowledge the importance of patient involvement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0310-1) contains supplementary material, which is available to authorized users.
Highlights
Clinical care for older adults is complex and represents a growing problem
Most Clinical Practice Guideline (CPG) focus on a single disease, the prevalence of comorbidities increases with age and studies in Australia [5] and Scotland [6] estimate that around 70 percent of people over 75 have two or more chronic conditions
Need for guidance primary CVD prevention in older people In this paper we focus on CPGs for primary cardiovascular disease (CVD) prevention in older people
Summary
Clinical care for older adults is complex and represents a growing problem. They are a diverse patient group with varying needs, frequent presence of multiple comorbidities, and are more susceptible to treatment harms. Clinical Practice Guidelines (CPGs) need to carefully consider older adults in order to guide clinicians. Clinical practice guidelines (CPGs) aim to support clinician decision making, CPGs may not always be straight forward to implement for older people for several reasons [1]. Most CPGs focus on a single disease, the prevalence of comorbidities increases with age and studies in Australia [5] and Scotland [6] estimate that around 70 percent of people over 75 have two or more chronic conditions. Applying CPGs for each condition leads to polypharmacy, increases treatment burden, and risk of adverse events [1]
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