Posted by ed_uk2010 on March 3, 2014, at 13:40:15
In reply to New Recomendations for over 65, testing, Mammo, Me, posted by Phillipa on March 3, 2014, at 11:50:01
> This is sad and disheartening to read.
I actually don't think it is, here's my interpretation...
>"Don't prescribe cholinesterase inhibitors for dementia without periodic assessment for perceived cognitive benefits and adverse gastrointestinal effects."....
Periodic assessments are vital. It wouldn't be appropriate to Rx cholinesterase inhibitors for dementia without reviewing the response. In many patients, the drugs cause adverse effects or are not effective.
>Don't recommend screening for breast or colorectal cancer, nor prostate cancer (with the [prostate-specific antigen] test) without considering life expectancy and the risks of testing, overdiagnosis and overtreatment.
If an elderly person has serious illness leading to a short life-expectancy, cancer screening will not be beneficial. Diagnosing cancer in someone with advanced heart failure, for example, will not improve anything for that patient. Cancer screening is useful for people with an otherwise good life expectancy.
>Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia or cachexia in older adults; instead, optimize social supports, provide feeding assistance and clarify patient goals and expectations.
High calorie supplements are often expensive and most taste unpleasant. Instead, elderly people need to be provided with support to eat normal healthy food.
>Don't recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral assisted feeding.
I cannot see any possible benefit in tube-feeding people with advanced dementia. It is essentially prolonging death, not life. Caregivers should assist feeding by mouth, using liquidised food where appropriate.
>Avoid using medications to achieve hemoglobin A1c <7.5% in most adults age 65 and older; moderate control is generally better.
Attempts to control blood glucose very tightly tends to cause adverse effects in elderly people, and may not be beneficial.
>Don't use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.
A lot of elderly people have asymptomatic bacteriuria (not UTI). In the absence of symptoms, treatment provides no benefit but leads to antibiotic resistance.
poster:ed_uk2010
thread:1061722
URL: http://www.dr-bob.org/babble/20140214/msgs/1061726.html