Older patients often receive less care than they should

Today's Boston Globe reports that older people with chronic illness receive less aggressive treatment than younger patients, and that age bias is often the cause. A few reasons are given:

• Older people are often excluded from drug trials. As a result there isn't good information on appropriate dosing or efficacy
• Doctors assume older people won't be able to tolerate aggressive treatments
• Older people often confuse chronic conditions with the normal aging process. And doctors apparently share this view to some extent. The Globe cites a survey in the Journal of Gerontology indicating that 35 percent of doctors believed increased blood pressure was a normal consequence of aging, although it is not

I've seen some evidence of this problem recently:

• In my consulting work on clinical protocol development, physicians conducting studies on behalf of pharmaceutical companies complained that the studies insisted on too many exclusion criteria (which would tend to knock out older people taking multiple medications). These criteria contribute little to the outcome of the trials, but severely limit the generalizability of the results
• An older relative of mine was initially denied chemotherapy due to his age. When the family pushed hard for it, the doctors went along and he responded well to the chemo

One of the advantages of Mark McClellan's leadership and the new Medicare drug benefit is that we are already seeing a push at the Federal level for treatments to be tested on older people.