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The Benefits of Going for Broke

Research: Studies find that older patients, even with numerous health problems, can react well to aggressive treatment.


Got an ache, pain or condition that's not being addressed by your doctor? Don't take "aging" for an answer. Contrary to conventional wisdom, two new studies show that older adults, even those with a number of health problems, can benefit from aggressive treatment.

The very group of patients that doctors are often reluctant to treat for high blood pressure--older adults with multiple risk factors for cardiovascular disease--have the most to gain from treatment, reported researchers from Wake Forest University Baptist Medical Center in a recent issue of Circulation, the medical journal of the American Heart Assn.

An international team of researchers reviewed medical records of more than 4,000 patients age 60 and older with high blood pressure. They found that treating these high-risk older adults with anti-hypertension drugs was four times more effective at preventing heart attacks, strokes and heart failure than treating those with lower levels of risk.

"This is a real breakthrough in geriatric medicine, because high blood pressure is one of the most prevalent and least adequately treated cardiovascular conditions in older people," said Dr. Marco Pahor, professor of geriatrics at Wake Forest.

Doctors may have several reasons for not aggressively treating hypertension in older adults who have multiple risk factors for heart disease, including smoking, diabetes and high cholesterol, said Pahor. They may be concerned about drug interactions, believe there is little that can be done to alter the natural progression of blood vessel disease or worry that lowering blood pressure could be more risky than beneficial.

"Most of the time, doctors think treating systolic hypertension is useless in older patients if they have additional risk factors," Dr. Luigi Ferrucci, the study's lead researcher from the National Institute for Research and Care for the Elderly in Florence, Italy, said in a statement when study results were released. "We have demonstrated very clearly that this is not true."

In another study led by the North Central Cancer Treatment Group, a clinical trials group based at the Mayo Clinic in Rochester, Minn., scientists found that older patients diagnosed with mid-stage colon cancer benefit as much from chemotherapy after surgery as younger patients with the disease. The study results, based on data from more than 3,000 patients and published in the New England Journal of Medicine, conclude that age alone should not determine whether an older patient is offered chemotherapy after surgery for treatment of stage II or III colon cancer.

"We found that patients age 70 and older who were judged by their physicians to be fit enough to undergo chemotherapy had the resiliency to successfully withstand the side effects," said lead researcher Dr. Daniel J. Sargent.

A lack of geriatrics education in medical school is to blame for much of the underdiagnosis and undertreatment of older patients, says James Nyberg, director of government relations at the International Longevity Center, a New York City think tank on aging issues. Better training of physicians and the public and research such as these studies, he says, can help alleviate misconceptions. Also, older adults should advocate for themselves by questioning their doctors or seeking second opinions if they feel treatment is being determined simply on the basis of age.


Korky Vann is a reporter for the Hartford Courant, a Tribune Co. newspaper.

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