The American Geriatrics Society has identified some commonly used treatments that may either lack benefit or even be harmful to long-term care residents. The five specific items are: 1) If you are going to treat dementia with cholinesterase inhibitors, perform periodic cognitive assessments. 2) When you consider screening tests (e.g., mammography, colonoscopy, PSA), consider the likely life expectancy of your patient, as well as the potential consequences of overdiagnosis. 3) Instead of relying on appetite stimulants to enhance waning appetite, consider behavioral and social factors affecting appetite, such as support for eating at mealtime. 4) Don’t prescribe a new medication without confirming other currently prescribed medications to avoid duplication and adverse interactions. 5) When possible, do not use physical restraints in the face of delirium since they have been associated with injury and even death; instead treat the underlying cause(s), promote a physiologic sleep-wake cycle, and consider options to manipulate the environment to enhance orientation.
Remembering to include these five issues in managing long-term care residents will hopefully improve outcomes and reduce medical misadventure.
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