Caring for older adults: What physicians, patients should question and what reporters should look at

Hospital patient

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The American Geriatrics Society (AGS) today published the results of its examination of care to determine the top five things patients and physicians should question when caring for older adults. 

  • Recommending percutaneous feeding tubes in patients with advanced dementia; instead of offering oral-assisted feeding.
  • Using antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.
  • Using medications to achieve hemoglobin 7.5 percent in most adults age 65 and older; moderate control is generally better.
  • Use of  benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation, or delirium.
  • Use of antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.

AGS partnered with the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign to evaluate information from ABIM societies and AGS members. They looked at whether physician-ordered tests and procedures were sufficiently evidence-based, whether the potential health benefits were worth any risks they might pose, if they were redundant or medically necessary. The goal of the campaign is to pinpoint and eliminate unnecessary health spending.

The AGS report points out that while life expectancy of Americans is increasing, so is incidence and burden of chronic disease. At least half of the over-65 population has at more than one chronic condition. Current practice guidelines focus treatment on individual disorders, but may not be relevant to those with more than one condition. This may result in adverse medication interaction, duplication of tests and services and procedures that may ultimately provide little benefit.

This assessment is supported by a 2013 Robert Wood Johnson Foundation report describing the challenges and wasted spending resulting from overuse of services: “Of the estimated $765 billion of health care dollars wasted in 2009, a quarter – $210 billion – was spent on the overuse of services.”

The AGS stressed that their list is intended only to help facilitate discussions between older adults and their providers, and is not a substitute for professional judgment or patient-provider consultation. The full article is available in the April 2013 issue of the Journal of the American Geriatrics Society.

This report offers local journalists several jumping off points. For example, hospital admission data of older adults with multiple co-morbidities can lead to questions about costs or multiple billings under the same DRG codes (more about DRG codes). What are some of the Medicare billing trends in your area? Several tools and databases listed in the aging core topic area can help with analysis and trending. Are patients or families told of treatment alternatives?

Let us know in the comments if you publish an article so we can feature it!

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