title: Underrepresentation of individuals 80 years of age and older in chronic disease clinical practice guidelines.
abstract: OBJECTIVE
  To determine whether Canadian clinical practice guidelines (CPGs), and the evidence used to create CPGs, include individuals 80 years of age and older.
  
  
  METHODS
  Descriptive analysis of 14 CPGs for 5 dominant chronic conditions (diabetes, hypertension, heart failure, osteoporosis, stroke) and descriptive analysis of all research-based references with human participants in the 14 guidelines.
  
  
  METHODS
  To identify recommendations for individuals 65 years of age and older or 80 years of age and older and for those with multiple chronic conditions.
  
  
  RESULTS
  Although 12 of 14 guidelines provided specific recommendations for individuals 65 years of age and older, only 5 provided recommendations for frail older individuals (≥ 80 years). A total of 2559 studies were used as evidence to support the recommendations in the 14 CPGs; 2272 studies provided the mean age of participants, of which only 31 (1.4%) reported a mean age of 80 years of age and older.
  
  
  CONCLUSIONS
  There is very low representation of individuals in advanced old age in CPGs and in the studies upon which these guidelines are based, calling into question the applicability of current chronic disease CPGs to older individuals. The variety of medical and functional issues occurring in the elderly raises the concern of whether or not evidence-based disease-specific CPGs are appropriate for such a diverse population.
authors.affiliation: Faculty of Health Sciences, University of Western Ontario, Arthur and Sonia Labatt Health Sciences Bldg, Room 316, London, ON N6A 5B9. lcox2@uwo.ca
authors.forename: Lizebeth
authors.initials: L
authors.lastname: Cox
authors.forename: Marita
authors.initials: M
authors.lastname: Kloseck
authors.forename: Richard
authors.initials: R
authors.lastname: Crilly
authors.forename: Carol
authors.initials: C
authors.lastname: McWilliam
authors.forename: Laura
authors.initials: L
authors.lastname: Diachun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic