The American Geriatrics Society (AGS) has released updates to its recommendations for the ABIM Foundation’s Choosing Wisely campaign to reflect new research on conditions affecting older adults, such as agitation, certain types of cancer, delirium, dementia, and others. The AGS expanded earlier guidance on seven specific tests, treatments, or procedures in this recent update.
AGS added to its rationale for recommending against the use of cholinesterase inhibitors (CIs) without periodic evaluations to determine mental health benefits and gastrointestinal problems associated with treatment. It is advised that clinicians, patients, and their caregivers discuss treatment goals and the likelihood of adverse effects before initiating treatment, and that therapy is adjusted if the desired effects are not met within 12 weeks.
Lung cancer screenings have been added to the list of oncological screenings (which include breast, colorectal, and prostate cancer screenings) that should not be recommended for older patients without first considering life expectancy and the risk associate with testing, over-diagnosis, and over-treatment.
In recommending “moderate” (instead of “tight”) blood glucose control for older adults with diabetes, medications other than metformin should be avoided, based on evidence that metformin improves patient outcomes and the harms associated with its use are less common than prior research has indicated.
AGS continues to recommend avoiding antipsychotics as first-choice treatment for behavioral and psychological symptoms associated with dementia. The rationale for this guidance has been expanded to include new data on nonpharmacologic management of the condition.