Choosing wisely targets hyper-polypharmacy


15 Aug 2016

The latest Choosing Wisely lists from The Australian and New Zealand Society for Geriatric Medicine (ANZGM) and The Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) send a strong message on the appropriate use of medicines for older adults.

ASCEPT identified the following five recommendations:

  1. Recognise and stop the prescribing cascade
  2. Reduce the use of medicines when there is a safer or more effective non-pharmacological management strategy
  3. Avoid using a higher dose than is necessary for the patient to optimise the ‘benefit-to-risk’ ratio and achieve the patient’s therapeutic goals
  4. Stop medicines when no further benefit will be achieved or the potential harms outweigh the potential benefits for the individual patient
  5. Reduce use of multiple concurrent therapeutics (hyper-polypharmacy).

ANZGM identified the following five recommendations:

  1. Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia
  2. Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium
  3. Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present
  4. Do not prescribe medication without conducting a drug regimen review
  5. Do not use physical restraints to manage behavioural symptoms of hospitalised older adults with delirium except as a last resort.


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