You can have too much of a good thing when it comes to medicine for older adults

January 2021 blog post written by Dr. John Muscedere

Prevailing wisdom states that more is better — and it is no different when it comes to our expectation of medical treatments. With the help of the Internet, patients and their families have come to expect intensive tests, treatments and therapies at every life stage.

But sometimes, too much treatment can do more harm than good. This is true at all ages, but it is especially relevant for older adults living with frailty, who are much more likely to receive medical treatments that pose a higher risk of adverse outcomes.

Older adults with frailty are much more likely to be administered life support therapies but are much less likely to benefit from them when used. Of the older patients who survive, only a small percentage of those on mechanical ventilation return to their pre-illness level of function.

Yet even when the use of life support in late life offers little chance for benefit, it is commonly done resulting in needless suffering and reduced quality of life.

So, what can be done to address the potential overtreatment of older adults living with frailty?

First, we need to have frank end-of-life conversations with our loved ones, especially those living with frailty. Knowing their preferences in advance is crucial, since these discussions may not be possible during a health crisis. Secondly, we need to stop frailty in its tracks though healthy aging strategies such as the AVOID Frailty-Take Control public health campaign. Staying active and getting enough sleep, adhering to a vaccination schedule, staying on top of medications, maintaining social relationships, and maintaining a healthy diet are all important ways that older adults can reduce their risk of frailty and increase their chances of recovering from a health crisis.

As our population ages and many are living longer than ever before, let’s make sure that as a medical community we are helping older adults add good quality years to life instead of being concerned about adding more years to their lives by not presuming more is better when it comes to medical interventions for older adults.