Sometimes “Less is More” when it comes to good medicine and I’d like to tell all of you about a wonderful initiative by the American Board of Internists– this initiative is called the Choosing Wisely Campaign.
Having less can be a desirable goal in good medicine – having less interventions, less medications, less tests done, and less hospitalizations. Having less doesn’t mean less care, it can mean more judicious and beneficial care and less exposure to unnecessary risks.
Choosing Wisely aims to promote conversations between clinicians and patients by helping patients choose care that is:
• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary
As part of the Choosing Wisely Campaign, the American Geriatrics Society (AGS) has identified tests and procedures commonly used with older patients whose necessity should be questioned and discussed.
Many of their recommendations are directly related to good care for people living with dementia. A few of their recommendations include:
• Don’t put feeding tubes in patients with advanced dementia.
• Don’t use antipsychotic medications as the treatment for behavioral symptoms of dementia
• Don’t use benzodiazepines or other sedative-hypnotics in older adults
• Don’t prescribe cholinesterase inhibitors (i.e. Aricept) for dementia without periodic assessment of perceived benefits and adverse effects
• Don’t use physical restraints to manage behavioral symptoms
Many of these recommendations seem obvious but these are still medical practices frequently used throughout many areas of healthcare.
The full list of “Things Providers and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments. You can read the entire list of recommendations by AGS.
If you are caring for an elder parent, discuss these topics together – plan for quality care but minimal intervention!
Have a great day!
Anne Ellett, N.P., M.S.N.