Overtreatment refers to using medical interventions that are unlikely to provide meaningful benefit to an individual and are highly likely to cause more harm than good. There are various reasons overtreatment may be common in the treatment of older adults.
There are various reasons why overtreatment of older adults may be an issue. These include:
- Older adults are more likely to have multiple conditions and take multiple medications.
- Healthcare professionals may have a fear of litigation if they don’t treat people in a certain way.
- There may be individual or family expectations for treatment.
- Healthcare professionals may be under the influence of training or from the pharmaceutical and medical device industry to use more aggressive treatments.
There are ways that can help reduce the overtreatment of older adults, including using proper age-related assessments, implementing a shared decision making process for treatment, and offering more education and awareness to healthcare professionals and the public.
Overtreatment can be defined as overly intensive therapy or treatment course for an older adult, where the harms of the treatment outweigh the benefits, or are not expected to prolong life expectancy.
This overtreatment of older adults can cause various harms to the individual, both physical and societal. This may include lower quality of life, frequent admissions to the hospital, and a high risk of adverse effects.
Vs. undertreatment
Undertreatment means using less than the recommended therapy or treatment in an older adult who would benefit from more intensive treatment with or without worse outcomes. It can also imply the deprivation of non-cancer-related treatments in certain geriatric domains, regardless of therapy choice.
Did you know?
Medicare will generally cover a second opinion. If you have Original Medicare, this is covered under Part B. Medicare Advantage (Part C) plans will also provide coverage if you need or desire a second opinion.
To receive Medicare coverage for a second opinion, you just need to be sure the second doctor accepts Medicare. If you have Medicare Advantage, you may need to be sure the second doctor is in your plan’s network.
There are various reasons why overtreatment in older adults may be more common. However, some of the most common reasons include:
- multimorbidity and polypharmacy
- individual and family expectations
- fear of litigation
- outside influence
Multimorbidity and polypharmacy
Multimorbidity refers to when a person has multiple conditions at the same time. Polypharmacy is when a person is taking multiple medications.
According to a 2016 study, polypharmacy is a global public health issue. This is especially true in the older population, as they are typically more likely to take medications.
Individual and family expectations
Technological and medical advances can sometimes make it difficult for individuals and their families to accept that medication has limitations. As a result, individuals and their families may pressure or demand that healthcare professionals initiate or continue a treatment course even if it may not be clinically viable.
Fear of complaints or litigation
Most complaints tend to focus on what a healthcare professional didn’t do, rather than overtreatment. However, the fear of complaints or even litigation can lead healthcare professionals to carry out extra tests and procedures that may not always be completely necessary. This is known as defensive medicine.
Outside influence
Healthcare professionals are often influenced by outside sources, such as the pharmaceutical and medical device industries. The marketing and promotion of new treatments can create pressure for healthcare professionals to use them, even if they are not appropriate for everyone.
Overtreatment of older adults can have various consequences. Some of these consequences include:
- increasing the cost of care
- increasing the workload of doctors and other healthcare professionals
- causing wastage
- diverting healthcare away from other people who may need it
- threatening the sustainability of the healthcare system
- increasing the risk of adverse drug effects
- increasing the risk of harmful effects on the quality of life and health of older adults
- prolonging discomfort at the end of life
Examples of overtreatment
There are many ways overtreatment in older adults may occur. A few examples are:
- overuse of antibiotics
- overtreatment for cancer
- overtreatment at the end of life
- overly intensive glucose management for people with diabetes
- unnecessary hospital readmissions
There are various ways that have been recommended to help avoid the overtreatment of older adults.
Geriatric assessment
Geriatric assessments are multidimensional processes that are designed to assess the following in older adults:
- functional ability
- overall health, including physical, cognitive, and mental
- socioenvironmental situation
These assessments have many benefits, including:
- increased identification of conditions
- decreased use of nursing homes and acute care hospitals
- reduced mortality
- improved functional and mental status
- greater satisfaction with care
Advance care planning
Advance care planning is
One of the most important parts of advance care planning is having a discussion with your loved ones about your wishes. However, many people also choose to put these decisions in writing using legal documents called advance directives.
Other ways to avoid overtreatment
A few other ways to potentially avoid overtreatment of older adults include:
- shared decision making
- education and awareness
- value-based care
Overtreatment is common when caring for older adults. There are various reasons for this, including that older adults are more likely to have multiple conditions and take multiple medications.
Healthcare professionals using geriatric assessment and individuals using advance care planning can help reduce the overtreatment of older adults.