Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis
A complex decision path with a careful evaluation of the risk-benefit ratio is mandatory for drug treatment in advanced age. Enrolment biases in randomized clinical trials (RCTs) cause an underrepresentation of older individuals. In high-risk frail older subjects, the lack of RCTs makes clinical dec...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2015-01-01
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| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fmed.2014.00061/full |
| _version_ | 1819150762988535808 |
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| author | Alberto ePilotto Alberto ePilotto Daniele eSancarlo Julia eDaragjati Julia eDaragjati Francesco ePanza Francesco ePanza |
| author_facet | Alberto ePilotto Alberto ePilotto Daniele eSancarlo Julia eDaragjati Julia eDaragjati Francesco ePanza Francesco ePanza |
| author_sort | Alberto ePilotto |
| collection | DOAJ |
| description | A complex decision path with a careful evaluation of the risk-benefit ratio is mandatory for drug treatment in advanced age. Enrolment biases in randomized clinical trials (RCTs) cause an underrepresentation of older individuals. In high-risk frail older subjects, the lack of RCTs makes clinical decision-making particularly difficult. Frail individuals are particularly 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. |
| first_indexed | 2024-12-22T14:22:40Z |
| format | Article |
| id | doaj.art-8d2c37cbd4974eea9104fc81fd4db65c |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-22T14:22:40Z |
| publishDate | 2015-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-8d2c37cbd4974eea9104fc81fd4db65c2022-12-21T18:22:56ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2015-01-01110.3389/fmed.2014.00061127568Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and PrognosisAlberto ePilotto0Alberto ePilotto1Daniele eSancarlo2Julia eDaragjati3Julia eDaragjati4Francesco ePanza5Francesco ePanza6Geriatrics Unit Azienda ULSS 16 PadovaIRCCS “Casa Sollievo della Sofferenza”IRCCS “Casa Sollievo della Sofferenza”Geriatrics Unit Azienda ULSS 16 PadovaIRCCS “Casa Sollievo della Sofferenza”University of Bari Aldo MoroIRCCS “Casa Sollievo della Sofferenza”A complex decision path with a careful evaluation of the risk-benefit ratio is mandatory for drug treatment in advanced age. Enrolment biases in randomized clinical trials (RCTs) cause an underrepresentation of older individuals. In high-risk frail older subjects, the lack of RCTs makes clinical decision-making particularly difficult. Frail individuals are particularly 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.http://journal.frontiersin.org/Journal/10.3389/fmed.2014.00061/fullclinical decision-makingFrailtyOlder agePrognostic indicescomprehensive geriatric assessmen |
| spellingShingle | Alberto ePilotto Alberto ePilotto Daniele eSancarlo Julia eDaragjati Julia eDaragjati Francesco ePanza Francesco ePanza Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis Frontiers in Medicine clinical decision-making Frailty Older age Prognostic indices comprehensive geriatric assessmen |
| title | Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis |
| title_full | Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis |
| title_fullStr | Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis |
| title_full_unstemmed | Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis |
| title_short | Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis |
| title_sort | perspective the challenge of clinical decision making for drug treatment in older people the role of multidimensional assessment and prognosis |
| topic | clinical decision-making Frailty Older age Prognostic indices comprehensive geriatric assessmen |
| url | http://journal.frontiersin.org/Journal/10.3389/fmed.2014.00061/full |
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