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:
- Recognise and stop the prescribing cascade
- Reduce the use of medicines when there is a safer or more effective non-pharmacological management strategy
- 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
- Stop medicines when no further benefit will be achieved or the potential harms outweigh the potential benefits for the individual patient
- Reduce use of multiple concurrent therapeutics (hyper-polypharmacy).
ANZGM identified the following five recommendations:
- Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia
- Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium
- Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present
- Do not prescribe medication without conducting a drug regimen review
- Do not use physical restraints to manage behavioural symptoms of hospitalised older adults with delirium except as a last resort.