Beta-blocker balancing act in the elderly

Prescribing beta-blockers in elderly people with acute MI reduces their risk of dying but it can also hasten functional decline, research shows.

A three-year study of almost 16,000 nursing home residents found that beta-blockers were associated with a 26% lower rate of death but 14% higher odds of functional decline.

Functional harms were particularly pronounced in people with substantial cognitive or functional impairment, but not in those with relatively preserved mental and functional abilities, note the researchers.

“For nursing home residents with intact cognition or mild dementia and in those with nonsevere levels of functional dependency, we found substantial mortality benefit and no functional harms,” they write in JAMA Internal Medicine.

“Therefore, treatment is appropriate for most such patients.”

In contrast, for patients with extensive functional dependency or moderate to severe dementia, the researchers suggest it’s a trade-off between reduced mortality and increased risk for functional decline.

For many people, avoiding treatment may be preferable, they say.

“In this highly vulnerable group, understanding the importance that individual patients place on avoiding death and on avoiding functional decline will be critical to guiding decision making about use of these medications.”

Commenting on the study, Dr Jennifer Tjia, an associate professor of medicine at the University of Massachusetts, notes that good prescribing is a balancing act that is as much an art as a science.

“The present study adds to the science part,” she says.