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To the Editor: Drs Rochon and Gurwitz¹ document specific underuse of proven therapies and properly encourage application of effective agents for "seniors (65 years and older)." However, for purposes of pharmacological management, all elderly patients should not be grouped together because they fall roughly into 2 cohorts, those younger than 75 years and those of the rapidly increasing population aged 75 years or older. For the older group, reliable prospective studies are rare because they are complicated by multiple morbidities, frequent compromise of 1 or more organ systems, and substantial interindividual variability of general health. Because of these pathophysiological problems and sparse data, most decisions for older elderly patients will continue to be individualized and less accurately defined.

These issues are well illustrated in decisions for blood pressure management in persons aged 75 years or older. Rochon and Gurwitz point out that elevated blood pressure levels in this group are . . . [Full Text of this Article]

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RELATED ARTICLE

Prescribing for Seniors: Neither Too Much nor Too Little
Paula A. Rochon and Jerry H. Gurwitz
JAMA. 1999;282(2):113-115.
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