22 Oct Medical care for older people – what evidence do we need?
National Academy of Science and Engineering (acatech) 2017
In Germany today, reaching a very old age is no longer an exception. About 4.5 million people (5.4 percent of the population) are 80 years of age and older, and their numbers continue to grow. In recent decades, the over 85-year-olds have been the group with the fastest and greatest gain in life span and many positive developments for this growing population group have been recorded. The increasing life expectancy and the improved health of older people over a longer period are also attributable to therapeutic and preventive measures, in addition to other factors. Sick old people, however, may possibly have entirely different medical needs than younger people; this is not sufficiently reflected in the German healthcare system.
The high standard in medicine, not only in relation to medical care, but also in research of diseases and the development of therapies, focuses typically on middle-aged patients with a single disease. Accordingly, knowledge gained from the treatment of middle-aged people is frequently also applied for older patients – although they differ both physically and mentally from younger people in terms of their medical care priorities and personal circumstances. This does not comply with good scientific practice, and often leads not only to inappropriate care, but may occasionally also actually endanger the concerned patients.
Older people, who frequently suffer from multiple chronic disorders, take many medications at the same time, each of which focuses on one individual ailment. This polypharmaceutical treatment does not at times correspond to the health targets of older patients and may even pose a considerable health risk. There is a lack of external evidence on how to improve treatment for multimorbid older and very old people. There is also a lack of guidelines that indicate the current knowledge gaps and risks. At the same time, important medications are often not offered. Therefore, research to provide specific scientific evidence specifically for older people is absolutely essential. New treatment objectives come to the fore and determine the indication for pharmacotherapeutic, surgical and other interventions: In younger patients cure, restoration of working ability or long-term prognoses determine the course of action. In older patients, these priorities are often replaced by independence, quality of life despite complaints, and the relief of symptoms.
The pressure for a quick and effective change to the healthcare situation of older people is growing continuously in line with the rapid demographic change. Physicians, therapists and carers alike must adjust to old and very old people in their daily work – particularly in hospital care. This also applies to basic, advanced and continuing staff training and the cooperation with other health care providers. At all points in the medical care chain, from the lack of scientific evidence to the implementation in practical care, the focus must be on older people and their specific needs.