As we age, especially after the age of 65, many people pay more attention to their health management, frequent visits to medical institutions, seek chronic disease management, or pay attention to their overall health. The problem of over-diagnosis and treatment should not be overlooked, especially in the elderly group, where some routine screening and treatment may not be necessary or even cause harm.
A recent study suggests that measures are needed to prevent over-treatment of older patients, including unnecessary prostate cancer (PSA testing), urinary tract infections (UTIs), and diabetes screening. The results of the study showed that decision support tools, such as electronic alerts and reminders, could help healthcare professionals reduce 9% of unnecessary PSA tests and 5.5% of UTI screenings, while also making them aware of when tests may be unnecessary for patients.
The risks of overtreatment to older patients include but are not limited to potential health hazards, but also additional financial burden, time consumption, and mental stress. For example, routine screening for urinary tract infections is a test used to initially identify the presence of a urinary tract infection. Screening usually includes the following steps and tests:
Urine Routine Examination: This is the most basic screening method that analyzes a urine sample to detect abnormalities, including but not limited to white blood cells (reflecting inflammation), red blood cells (indicating possible urinary tract bleeding), proteins, bacteria, crystals, casts, etc. Leukocyturia and pyuria are common manifestations of urinary tract infections and mean an increased number of white blood cells in the urine.
Nitrite Test: A type of rapid urine test strip screen used to detect the presence of nitrate reduction to nitrite in the urine, some bacteria (such as E. coli) can produce this change, but not all urinary tract infections cause a positive result.
Many older women have bacteria naturally present in their urethra that can lead to a positive test result, but if they don't actually have any symptoms, they are likely not to be in an active infection. Such misdiagnosis can lead to unnecessary antibiotic prescribing, which can lead to side effects such as nausea, diarrhoea, dizziness, and, in the long term, exacerbate the growing problem of antibiotic resistance worldwide.
Prostate cancer screening is another common example, with studies showing that PSA tests in men over the age of 69 tend to have false-positive results, leading to unnecessary invasive treatments and consequent treatment side effects. For these reasons, the U.S. Preventive Services Task Force (USPSTF) recommends that men age 70 and older should not be screened for PSA.
In addition, the treatment of older people with diabetes also needs to be treated with caution. Tight blood sugar control is important, but as we age and our body functions change, the criteria for blood sugar control should be relaxed. Medical screening and screening programs for older adults should weigh the pros and cons against the individual's health history, current physical health, and life expectancy. In asymptomatic older adults, many of the common screenings and tests may not be necessary without clear concern for the disease. For example, procedures such as colonoscopy, mammography, cervical smear, anxiety screening, and type 2 diabetes screening may be considered for adjustment or omission in some older patients.
Older people still need to have the necessary regular medical check-ups and vaccinations
For example, blood pressure, cholesterol levels, vision and hearing tests, bone density scans (DEXA scans), flu vaccines, COVID vaccines, pneumococcal vaccines, etc.
In order to deal with the problem of over-diagnosis and treatment, researchers have strengthened geriatric education when training providers, and embedded the alert function in the electronic medical record system, when the provider prescribes treatment for elderly patients that is not recommended, the warning message will automatically pop up. Studies have shown that these interventions significantly reduce the number of elderly patients receiving medical interventions with no clear benefit.
参考文献——Persell SD, Petito LC, Lee JY, et al. Reducing care overuse in older patients using professional norms and accountability: a cluster randomized controlled trial. Ann Intern Med. Published online February 6, 2024. doi:10.7326/M23-2183