In 2013, Consumer Reports and the Choosing Wisely Initiative put together a list of medical tests, procedures, interventions and medications to question before having because they don’t always make sense for seniors. They recommended that we all become more thoughtful and educated before accepting what would be the “normal” procedure for a younger patient.
As intelligent consumers, we are careful that our loved ones are taking medications properly. We watch that certain medications are not taken with others, and that all the medications come from one pharmacy so that interactions between medications are monitored.
But we don’t often question a medication being prescribed to the senior.
For seniors, benzodiazepines such as Xanax or Valium are not good first choices for insomnia or agitation because they increase fall risk and can cause dependency long term.
Evidence suggests that antipsychotic medications do little for behavior problems in dementia patients and can cause stroke and early death in these clients. Non-chemical approaches have been much more successful.
Elderly clients who have bacteria in the urine but no symptoms of a urinary tract infection should not always be treated with antibiotics.
Interventions considered right for the younger adult patient might not always be the best choice for the over 65 client. Feeding tubes placed in patients with advanced dementia caused agitation, requiring these patients to be medicated, which in turn caused inactivity causing a higher number of bed sores.
Caregivers were much more success-ful hand feeding the patients, which allowed less medication and more movement.
Routine screening and tests are often unnecessary for patients over 75. A colonoscopy, for example, is costly and carries many risks such as infection.
Prostate screening, if positive, often results in unnecessary aggressive treatments that can be damaging to the quality of life. Only in special circumstances, such as a history of prostate cancer, should a man over 75 be tested.
Women over 70 do not benefit significantly from aggressive breast cancer treatment. Therefore, routine mammograms over 70 are not recommended.
If your loved one is admitted to the hospital, there are some basic hospital practices that can be especially harmful to the older patient.
Bedrest sounds harmless but in fact, the longer the older person stays in bed, the weaker they become. They might get dizzy upon standing and become a fall risk. Some become so weak they require a costly rehabilitation stay.
The hospital staff works 24/7, but having sleep interrupted can slow healing and make it harder to fight infection. This is especially true for the older adult. Ask the staff to “cluster” nighttime interruptions or have the doctor write an order to skip them altogether. And be sure the patient is pain free at night.
Question whether you need a procedure or not. Watch for side effects with medications.
The website www.choosingwisely.org is written for the average consumer. It contains information for all ages about many medical subjects.
Sally Wogsland, RN, BSN is co-owner of ComForCare Home Care and is also a certified senior advisor. SWogsland@ ComForCare.com
