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Comparative Study
. 2011 Jul;57(7):e263-9.

Underrepresentation of individuals 80 years of age and older in chronic disease clinical practice guidelines

Lizebeth Cox  1 , Marita Kloseck, Richard Crilly, Carol McWilliam, Laura Diachun
Affiliations
Comparative Study

Underrepresentation of individuals 80 years of age and older in chronic disease clinical practice guidelines

Lizebeth Cox et al. Can Fam Physician. 2011 Jul.

Abstract
in English, French

Objective: To determine whether Canadian clinical practice guidelines (CPGs), and the evidence used to create CPGs, include individuals 80 years of age and older.

Design: Descriptive analysis of 14 CPGs for 5 dominant chronic conditions (diabetes, hypertension, heart failure, osteoporosis, stroke) and descriptive analysis of all research-based references with human participants in the 14 guidelines.

Main outcome measures: To identify recommendations for individuals 65 years of age and older or 80 years of age and older and for those with multiple chronic conditions.

Results: Although 12 of 14 guidelines provided specific recommendations for individuals 65 years of age and older, only 5 provided recommendations for frail older individuals (≥ 80 years). A total of 2559 studies were used as evidence to support the recommendations in the 14 CPGs; 2272 studies provided the mean age of participants, of which only 31 (1.4%) reported a mean age of 80 years of age and older.

Conclusion: There is very low representation of individuals in advanced old age in CPGs and in the studies upon which these guidelines are based, calling into question the applicability of current chronic disease CPGs to older individuals. The variety of medical and functional issues occurring in the elderly raises the concern of whether or not evidence-based disease-specific CPGs are appropriate for such a diverse population.

Objectif: Déterminer si les directives de pratique clinique (DPC) canadiennes et les données probantes qui servent à les créer portent aussi sur les personnes de 80 ans et plus.

Type d’étude: Analyse descriptive de 14 DPC pour 5 conditions chroniques majeures (diabète, hypertension, insuffisance cardiaque, ostéoporose, accident vasculaire cérébral) et analyse descriptive de tout article de recherche avec des participants humains cité dans ces 14 directives.

Principaux paramètres à l’étude: Identifier les recommandations visant les personnes de 65 ans et plus ou de 80 ans et plus, ou celles avec plusieurs affections chroniques.

Résultats: Même si 12 des 14 directives contenaient des recommandations visant spécifiquement les sujets de 65 ans et plus, seulement 5 en contenaient pour les individus frêles de 80 ans et plus. Un total de 2559 études ont servi de preuve pour appuyer les recommandations des 14 DPC; sur les 2272 études qui mentionnaient l’âge moyen des participants, seulement 31 (1,4 %) ont indiqué un âge moyen de 80 ans et plus.

Conclusion: Les personnes très âgées sont très peu représentées dans les DPC et dans les études sur lesquelles ces directives sont basées, ce qui soulève un doute sur l’applicabilité aux personnes âgées des DPC actuelles pour les maladies chroniques. Étant donné la variabilité des problèmes médicaux et fonctionnels qui affectent les personnes âgées, on peut se demander si les DPC pour des maladies particulières fondées sur des preuves s’appliquent à une population aussi diversifiée.

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References

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