AGS updates guidelines for appropriate care among older adults

The American Geriatrics Society has updated their Choose Wisely guidelines to include more research regarding agitation, cancer, dementia and other conditions impacting older adults.

The Choose Wisely campaign is designed to promote discussions between physicians and patients regarding the safety and efficacy of tests, medications and procedures.

“Providing high-quality care to older adults means recognizing and responding to the specific, evolving challenges and opportunities that we all face as we age. Since 2012, the AGS and the ABIM Foundation have worked together through Choose Wisely to synthesize pressing updates from the geriatrics field in a format that is easy to understand — and apply — in everyday practice,” Wayne C. McCormick, MD, MPH, AGSF, president, AGS, said in a press release.

The AGS advises against the use of antipsychotics for the treatment of certain dementia symptoms, including behavioral and psychological. The risks may outweigh the benefits — including oversedation, cognitive worsening and increased risk for falls, strokes or mortality — and antipsychotics should only be used when patients pose a risk to themselves or others and when other nonpharmacologic treatments have failed. The authors noted that drug treatment may be unnecessary if the cause of behavioral changes is identified and addressed. Additionally, when dealing with dementia patients, the AGS warned against prescribing cholinesterase inhibitors without regular assessments to evaluate their cognitive efficacy and potential adverse gastrointestinal effects. Physicians who do not see cognitive improvements in patients within 12 weeks should consider discontinuing their use.

In patients with type 2 diabetes, physicians should avoid using medications other than metformin to moderately control hemoglobin A1c levels, as there is little evidence to recommend tight control to achieve glycemic targets. The authors note that the evidence supporting metformin continues to grow, and the harms associated with the drug are far less common than originally believed. Moreover, physicians should make realistic goal adjustments to factor in the patient’s life expectancy. Additionally, recommendations for breast, colorectal, prostate and lung cancer screenings should also consider associated risks and patient life expectancy to avoid unnecessary overtreatment. The guidelines also advise both physical restraints for hospitalized older patients with delirium and appetite stimulants and high calorie supplements for older adults with anorexia or cachexia be avoided, due to the lack of efficacy surrounding both.

“As the older adult population in the U.S. continues to grow, it’s so important that geriatrics care principles reflect the latest science, evidence, and advice supporting quality health care,” Paul Mulhausen, MD, MHS, FACP, AGSF, chair of the AGS Choosing Wisely Workgroup, said in the release.

Reference:

Choosing Wisely: Ten Things Physicians and Patients Should Question. Available at: http://geriatricscareonline.org/toc/choosing-wiselyreg-five-things-physicians-and-patients-should-question-an-initiative-of-the-abim-foundation/CL015/. Accessed April 28, 2015.

Editor's Note: On May 4, we corrected a phrase in the fourth paragraph to clarify that the risks of using antopsychotics may be greater than the benefits, according to the authors of the Choose Wisely guidelines. The Editors regret this error.

Editor's Note: On May 21, we corrected a phrase in the fifth paragraph to clarify that medications other than metformin should be avoided for the control of hemoglobin A1c levels, according to the authors of the Choose Wisely guidelines. The Editors regret this error.