Choosing Wisely Campaign Geriatrics Mary Timiras M D

Choosing Wisely Campaign: Geriatrics Mary Timiras, M. D. , FACP Confluence Health February 10, 2016

AMDA (American Medical Directors Association) • No blood pressure treatment for sys bp <150 or diastolic bp <90 in those over 60 years of age • No hospital level care for a frail elder without understanding individual’s goals of care and possible benefits and burdens • Don’t get C. Dif toxin of symptoms resolve

American Academy of Nursing • Don’t use physical restraints with older hospitalized patient • Don’t let older adults lie in bed or just get up to a chair during their hospital stay

American Geriatrics Society • Don’t prescribe medication without conducting a drug regimen review • Don’t use appetite stimulants or high calorie supplements for anorexia/cachexia; instead, provide social supports, discontinue meds that interfere with eating, provide appealing food and feeding assistance, clarify patient goals and expectations

American Geriatrics Society • Don’t recommend screening for breast, colorectal, prostate or lung cancer without considering life expectancy and risks of testing, overdiagnosis and overtreatment • Don’t prescribe cholinesterase inhibitors for dementia without periodic assessment of benefits versus adverse effects

6 ‘I’s of Geriatrics Iatrogenesis Instability Incontinence Immobility Impaired mental function (dementia and delirium) • Immortality (lack thereof) • • •