Methodology for senior-proof guidelines: A practice example from the Netherlands.
Evidence-based guidelines constitute a foundation for medical decision making. It is often unclear whether recommendations in general guidelines also apply to older people. This study aimed to develop a methodology to increase the focus on older people in the development of guidelines.



The methodology distinguishes 4 groups of older people: (1) relatively healthy older people; (2) older people with 1 additional specific (interfering) comorbid condition; (3) older people with multimorbidity; and (4) vulnerable older people.



The level of focus on older people required may be determined by the prevalence of the disease or condition, level of suffering, social relevance, and the expectation that a guideline may improve the quality of care. A specialist in geriatric medicine may be involved in the guideline process via participation, provision of feedback on drafts, or involvement in the analysis of problem areas. Regarding the patient perspective, it is advised to involve organisations for older people or informal carers in the inventory of problem areas, and additionally to perform literature research of patient values on the subject. If the guideline focuses on older people, then the relative importance of the various outcome measures for this target group needs to be explicitly stated. Search strategies for all the 4 groups are suggested. For clinical studies that focus on the treatment of diseases that frequently occur in older people, a check should be made regarding whether these studies produce the required evidence. This can be achieved by verifying if there is sufficient representation of older people in the studies and determining if there is a separate reporting of results applying to this age group.
Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.|Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands.
Barbara C
0000-0001-6056-7795
BC
van Munster
Department of internal medicine and oncology, Hagaziekenhuis, Den Haag, The Netherlands.
Johanna E A
JEA
Portielje
Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.|Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Andrea B
AB
Maier
Dutch Geriatrics Society (Dutch abbreviation: NVKG), Utrecht, The Netherlands.|Department of Geriatrics, Havenziekenhuis, Rotterdam, The Netherlands.
Arend J
AJ
Arends
Guide2Guidance, Utrecht, The Netherlands.
Johannes J A
JJA
de Beer
D000368:Aged; D000066491:Clinical Decision-Making / Q000379:methods*; D000068456:Clinical Studies as Topic / Q000379:methods / Q000592:standards; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards; D006299:Health Services for the Aged / Q000592:standards*; D006304:Health Status; D006801:Humans; D009426:Netherlands; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D011787:Quality of Health Care