A comment on the extrapolation of clinical trials and guidelines to complex geriatric patients

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Dominik Alex Nowak


commentary, geriatrics, complex, elderly, uncertainty, underrepresentation, polypharmacy, comorbidity, multi-morbidity, extrapolation


Sample first paragraph -

Uncertainty abounds in medicine. While the development of evidence-based medicine gives clinicians some degree of probabilistic comfort in decision-making, there still exist extensive grey zones in clinical practice. The management of complex geriatric patients is one such grey zone. It is understood that the elderly are underrepresented in clinical trials. Factors such as multi-morbidity and polypharmacy, however, compound the problem. In complex geriatric cases, that is, it is unclear whether we can justifiably generalize the typical randomized controlled trial (RCT) or clinical practice guideline. We must remember, then, that the management of these patients often depends more on clinical acumen than on good evidence.