Aging provides opportunity for the accumulation of signs and symptoms that could indicate a plethora of diagnoses. A common challenge in health care is deciding what “should” be done, which is more complicated than determining what “could” be done. This decision-making process involves analysis of potential benefit and risk of harm. Harm-benefit analysis is informed by clinical facts and “judgments about what constitutes an acceptable risk or an acceptable quality of life. (1)” Still complicated? Consider a multiple choice test in which the “best” answer may be different for each patient.
A recent initiative to promote informed medical decision-making is “Choosing Wisely® (2).” Organizations created evidence-based lists of “Things Providers and Patients Should Question” to “make wise decisions about the most appropriate care” for individual scenarios (2). I found it interesting to screen the 140-page summary list for aging wisdom. Here are some examples (2):
- “Don’t prescribe a medication without conducting a drug regimen review” (American Geriatrics Society).
- “Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment” (American Academy of Hospice and Palliative Medicine).
- “Don’t recommend screening for breast or colorectal cancer, nor prostate cancer (with the PSA test) without considering life expectancy and the risks of testing, overdiagnosis and overtreatment” (American Geriatrics Society).
- “Avoid physical restraints to manage behavioral symptoms of hospitalized older adults with delirium” (American Geriatrics Society).
- “Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia” (American Geriatrics Society, American Psychiatric Association).
- “Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding” (American Academy of Hospice and Palliative Medicine, American Geriatrics Society, AMDA – The Society for Post-Acute and Long-Term Care Medicine).
Physical therapists have now joined this initiative and one of the “5 Things Physical Therapists and Patients Should Question” directly addresses a key principle for effective geriatric rehabilitation:
“Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals” (American Physical Therapy Association) (3).
Have other health professions developed lists for “Choosing Wisely®?”
What tests/procedures/treatments do you think aging adults and their health providers should question?
This week’s Guest Blogger is Rebecca Galloway, PT, PhD, GCS, CEEAA, Assistant Professor, Department of Physical Therapy, UTMB School of Health Professions.
References
- Sokol D. “First do no harm” revisited. BMJ 2013;347:f6426 doi:10.1136/bmj.f6426.
- ABIM Foundation. Choosing Wisely: An initiative of the ABIM Foundation. http://www.choosingwisely.org/ . 2014. Accessed 11-6-2014.
- American Physical Therapy Association. APTA Releases Its Choosing Wisely List of What to Question. http://www.apta.org/Media/Releases/Consumer/2014/9/15/ . 9-15-2014. Accessed 10-9-2014.
Join us for a real-time discussion about ideas raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.
Image Source: Microsoft Office
Rodger Marion 
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