Defining 'elderly' in clinical practice guidelines for pharmacotherapy

Area of Science:

• Gerontology
• Clinical Pharmacology
• Health Policy

Background:

• Australian clinical guidelines for pharmacotherapy frequently use the term 'elderly' without clear definition.
• Existing guidelines often lack specific criteria for defining older patients, impacting treatment recommendations.

Purpose of the Study:

• To investigate how 'elderly' patients are defined and considered in Australian clinical guidelines for pharmacotherapy.
• To analyze the implications of these definitions on clinical decision-making for older individuals.

Main Methods:

• A qualitative analysis of 20 Australian clinical guidelines focused on National Health Priority Areas.
• Guidelines were systematically reviewed for definitions and considerations of 'elderly' persons regarding pharmacotherapy.

Main Results:

• Only 3 out of 20 guidelines defined 'elderly' by chronological age; the rest provided no definition.
• Guidelines often used age-based dosage recommendations without clear rationale, indicating a generalized approach.
• Thematic analysis revealed perceptions of 'elderly' as frail with altered pharmacology, alongside limited evidence bases.

Conclusions:

• Current clinical guidelines offer insufficient definitions and guidance for treating older patients with pharmacotherapy.
• There is a need to move beyond chronological age and generic definitions, focusing on individual patient characteristics and their relationship to medication.
• Guidelines must provide practical descriptions of age-related changes relevant to pharmacotherapy and assessment methods for individual patients.