Have you ever felt like your rheumatologist either advocated for or discouraged you away from a certain medication or surgical option because of your age? Age bias in medical research means that older patients are not as likely to receive medical as younger patients with comparable disease severity. Evidence of age bias in the treatment of disease has been show in several areas of medicine including both oncology and cardiovascular disease and recently in rheumatoid arthritis.
Studies of utilization of DMARDs (disease modifying drugs such as methotrexate) have sometimes shown that while the benefits of the drugs are not age related, older people tended to receive less DMARDs than younger people and time before initiating this therapy was longer. For example, one study found that patients who were diagnosed after age 60 were less likely to receive biological drug therapy or combination drug therapy than patients whose disease began between 40 and 60. However, lower utilization can also be attributed to patients’ treatment preferences. For example, older patients may be less likely to take risks with treatment, avoiding aggressive treatment because of potential side effects.
A study published online in the December issue of Rheumatology, studied age bias in the treatment of patients with RA. Surveys were sent to rheumatologists around the country asking them about their treatment recommendations for one of two patients. The vignettes of the patients were identical except their ages. One “patient” was 28 and the other 82.
The results showed that the 204 rheumatologists responding were more likely to recommend aggressive treatment for the young RA patient compared with the older patient even though they had the same level of disease activity and comorbidities. Their results also found that women physicians tended to have “fewer systematic biases towards the elderly” than male physicians, concluding that male physicians showed stronger age bias. Also, younger physicians were more likely to prefer aggressive treatment for older patients than older physicians were.
While some rheumatoid arthritis treatment decisions may be due to age bias, other treatment options arguably should be weighed with age as a factor, such as joint replacement surgery. I remember years ago when I had my big toe fused, the physicians actively discouraged me from having that joint replaced. The doctors were first concerned that available technology at that time had poor long-term effectiveness rates. Secondly, because I was in high school, the surgeon and rheumatologist wanted to limit the number of future surgeries for revisions and replacement of the joint that I would likely have to endure.
More recently, when Vioxx and Bextra were taken off the market, I remember asking my rheumatologist whether I should continue taking Celebrex. The dosage I had been taking for several years had also been linked to cardiovascular problems. Her response to me was “Don’t worry about it, you’re young. Only older people with heart disease and other heart risk factors need to worry about it.” When I questioned whether it was possible for Celebrex to be damaging my young, healthy heart in the long-run, I was met with a shrug and a flip, “I wouldn’t worry about it.” I was not relieved. I have concerns that I have expressed in past blogs that young people are often overlooked in longitudinal studies of drug safety.
- Has a doctor recommended a different course of treatment because you were a certain age? Share your story by leaving a comment below or posting it on the RA message boards.
Published On: January 05, 2007