Lifestyle medicines and the elderly

Lifestyle medicines are those used to meet patient aspirations rather than traditionally defined medical need. However, in many cases, the boundary between the two is ill defined and a matter of degree or cultural expectation. Such medicines are not yet widely used by the elderly, but this may change in an increasingly consumerist society. There are ethical, clinical and financial issues to be considered around these drugs, which are not independent. The ethical issues relate mainly to the rising consumerism in medicine, and whether these and other medicines are consumer goods available almost on demand. The clinical issues concern the balancing of risk and benefit for these medicines, and how we inform patients of these issues. The financial issues are who should pay and whether third party payers can and should ration these medicines and, if so, how. Lifestyle medicines may provoke a debate on the whole issue of rationing. These issues are not confined to the use of these medicines by the elderly and their resolution will depend on a broader societal debate, in which the elderly need to be active.