CHOOSING WISELY CANADA
5 things
geriatricians and patients should question
By the Canadian Geriatrics Society *
1
Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary
tract symptoms are present.
Cohort studies have found no adverse outcomes for older
men or women associated with asymptomatic bacteriuria.
Antimicrobial treatment studies for asymptomatic bacteriuria in older adults demonstrate no benefits and show
increased adverse antimicrobial effects. Consensus criteria has been developed to characterize the specific clinical
symptoms that, when associated with bacteriuria, define
urinary tract infection. Screening for and treatment of asymptomatic bacteriuria is recommended before urologic
procedures for which mucosal bleeding is anticipated.
ics. The number needed to treat with a sedative-hypnotic
for improved sleep is 13, whereas the number needed to
harm is only 6. Older patients, their caregivers and their
health care providers should recognize these potential
harms when considering treatment strategies for insomnia, agitation or delirium. Use of benzodiazepines should
be reserved for alcohol withdrawal symptoms/delirium tremens or severe generalized anxiety disorder unresponsive
to other therapies. Prescribing or discontinuing sedativehypnotics in hospital can have substantial impact on longterm use. Cognitive behavioural therapy, brief behavioural
interventions and benzodiazepine-tapering protocols have
proven benefit in sedative-hypnotic discontinuation. These
non-pharmacologic interventions are also beneficial in improving sleep.
3
Don’t recommend percutaneous feeding
Don’t use benzodiazepines or other sedtubes in patients with advanced demenative-hypnotics in older adults as first tia; instead offer oral feeding.
Careful hand-feeding for patients with severe dementia is
choice for insomnia, agitation or delirium.
2
Large scale studies consistently show that the risk of motor
vehicle accidents, falls and hip fractures leading to
hospitalization and death can more than double in older
adults taking benzodiazepines and other sedative-hypnot-
at least as good as tube-feeding for the outcomes of death,
aspiration pneumonia, functional status and patient comfort. Food is the preferred nutrient. Use of oral nutritional
supplements may be beneficial. Tube-feeding is associated
with agitation, increased use of
physical and chemical restraints
and worsening pressure ulcers.
4
Don’t use antipsychotics as first choice
to treat behavioural and
psychological symptoms
of dementia.
People with dementia often exhibit aggression, resistance to
care and other challenging or
disruptive behaviours. In such instances, antipsychotic medicines
are often prescribed, but they
provide limited benefit and can
SMA NEWS DIGEST | SUMMER 2014
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