From the Guidelines
For a 133-year-old patient, the primary focus should be on preserving quality of life and alleviating distressing symptoms, rather than solely on prolonging survival, as the benefit-risk balance of treatments may be limited in this age group. When considering treatment, it's essential to take into account the patient's comprehensive individual geriatric risk assessment, including health habits, cardiovascular risk factors, multimorbidity, physical and cognitive status, life expectancy, time to benefit or harm, and goals of care 1.
Given the advanced age of the patient, the decision to initiate or continue treatments should be based on the potential to improve quality of life, rather than solely on disease-specific targets. The current literature suggests that optimal prescribing in older people with limited life expectancy remains an unmet need, and many patients can start or continue to receive some recommended drugs for secondary prevention and treatment of chronic diseases until death, but this may not always be the best approach to optimize care 1.
In patients with limited life expectancy, multimorbidity, functional impairments, and frailty, the concept of time to benefit (or to harm) of treatments must be incorporated into therapeutic decisions, and treatment of chronic diseases until death may no longer be beneficial or appropriate, particularly when they can produce adverse drug reactions early in treatment 1.
Therefore, a comprehensive geriatric assessment and individualized treatment approach, prioritizing quality of life and symptom management, is recommended for a 133-year-old patient. This approach should consider the patient's remaining life expectancy, time to benefit, and goals of care, and may involve deprescribing long-term medications that are no longer beneficial or are causing harm 1.
It's also important to note that clinical practice guidelines (CPGs) are needed to inform decision-making around deprescribing long-term medications in patients with limited life expectancy, and that physicians must prioritize which long-term medications are most likely to produce benefit and least likely to harm the patient, using their best clinical judgment in their attempts to adhere to prescribing guidelines 1.
In terms of specific treatment recommendations, the focus should be on managing symptoms and improving quality of life, rather than on disease-specific targets, and treatment decisions should be made on an individual basis, taking into account the patient's unique needs and circumstances 1.
From the Research
Treatment for a 133-year-old Patient
There are no research papers to assist in answering this question as the provided studies do not mention patients of such an advanced age.
General Treatment for Hypertension
- The initial pharmacologic therapy for hypertension includes low-dose thiazide diuretics, beta-blockers, and ACE inhibitors 2.
- Combination therapy is indicated for patients with uncontrolled hypertension or cardiovascular risk factors 3.
- A fixed combination of an ACE inhibitor and a calcium channel blocker is an optimal combination for the treatment of hypertension 3.
- The combination of amlodipine and lisinopril has a marked additional effect on blood pressure compared with either given as monotherapy 4, 5.
Factors Affecting Treatment Response
- The response to lisinopril is related to baseline plasma renin activity 5.
- The response to amlodipine tends to be greater the higher the initial blood pressure 5.
- Black patients tend not to respond to monotherapy with lisinopril as well as Caucasian patients, although they respond similarly to the combination of amlodipine and lisinopril 5.