Elderly Care: When to say no to doctors

geriatric care omahaAn elderly person suffering from multiple chronic conditions likely sees several specialists on a routine basis. Oftentimes, these specialists — cardiologists, general practitioners, gastoenterologists, etc. — administer tests that end up confirming what everyone already knows: the patient is elderly and has multiple chronic conditions. Recent coverage from the New York Times’ New Old Age blog and the AARP blog reveal that many of these tests aren’t always necessary. And a patient has every right to tell his or his doctor “no.”

Both articles cite Choosing Wisely, an initiative by the American Board of Internal Medicine (ABIM) Foundation that aims to help doctors and patients understand when certain tests do or do not make sense. One recent list from Choosing Wisely is comprised of recommendations from geriatricians and palliative care specialists.

So what are some of tests and treatments to avoid?

For starters, both the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine agreed that feeding tubes should not be used for people suffering from advanced dementia. Research has shown that feeding tubes don’t prevent pneumonia or prolong a dementia patient’s life but they do cause bedsores and distress. The alternative is simple — spoon feed the patient instead.

Other questionable tests and treatments include prescribing medications to elderly diabetics to achieve “tight glycemic control” (i.e., control their blood sugar) and prescribing antibiotics when a test indicates a urinary tract infection but the patient shows no signs of discomfort.

The list from the palliative care doctors warns of delaying palliative care, as it can relieve pain and control symptoms in patients — patients who can still seek treatment for their diseases.

For more lists, visit the Choosing Wisely website.

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