New clinical guidelines in Age and Ageing journal
David Stott is Professor of Geriatric Medicine at the Institute of Cardiovascular and Medical Sciences at the University of Glasgow and is Editor in Chief for Age and Ageing journal.
Clinical guidelines are intended to help health care practitioners adopt best practice. Good guidelines have the potential to reduce variations to practice and improve patient outcomes while ensuring efficient use of health-care resources.
There are however a plethora of guidelines, often with contradictory advice and of variable quality.
Importantly, for care of older people, guidelines have often lacked relevance due to restricted focus on single-organ disease, ignoring the realities of frailty with multi-morbidity, cognitive impairment (acute and chronic) and disability. However this is gradually changing, and guidelines now are emerging that are directly relevant for care of frail older people.
Given the increasing importance of guidelines in clinical decision making, this year Age and Ageing has added clinical guidelines as a new category of article. The journal is now publishing both ‘stand-alone’ guidelines (3000 words) and commentaries (1500 words). Already two papers have been published; the best practice guidelines for the management of frailty by Turner and Clegg give advice on the management of frailty in community and outpatient settings. The summary of the National Osteoporosis Society Vitamin D guideline by Aspray et. al. charts a rational approach to the confusing topic of when to measure 25-hydroxy vitamin D, and when and how to treat. I am keen to encourage further submissions of high-quality guideline articles to Age and Ageing.
Must clinical guidelines be followed for all patients? Obviously not! Here we can follow the logic of Margaret Thatcher (Scott Enquiry) who said ‘…Guidelines are for the guidance of officials to be consistent. Of course they have to be followed, but they are not strict law. That is why they are Guidelines and not law and, of course, they have to be applied according to the relevant circumstances.’ Therefore guidelines should be seen as important in informing practice but not in dictating it.