AGS Updates Choosing Wisely Recs for Elderly Patients

AGS Updates Choosing Wisely Recs for Elderly Patients
AGS Updates Choosing Wisely Recs for Elderly Patients

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.

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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.

AGS expanded its guidance for avoiding prescription appetite stimulants and high-calorie nutritional supplements for older patients with anorexia or cachexia and now endorses discontinuing medications that may interfere with eating while providing appealing food and feeding assistance, measures for optimizing social supports, and means to clarify patient goals and expectations.

The recommendation not to use physical restraints to management the behavioral symptoms of hospitalized older adults who are delirious was strengthened based on scarce evidence that physically restraining these older adults is an effective solution. The new rationale for AGS guidance states that physical restraints should only be employed as a last resort, in the least-restrictive manner, and for the shortest possible time.

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While guidance for selecting alternatives to benzodiazepines and other sedative-hypnotics as initial treatment options for insomnia, agitation, or delirium in older adults is unchanged, it is now supported by recent research and evidence that points to significantly elevated risks associated with these medications in older adults. AGS suggests that these drugs may be better suited for alcohol withdrawal or severe generalized anxiety unresponsive to other therapies.

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