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Choosing Wisely Canada

Canadian Nurses Association & Canadian Gerontological Nursing Association

Continuous bed rest or limited ambulation during a hospital stay causes deconditioning and loss of muscle mass and is one of the primary factors for loss of walking independence in hospitalized older adults. Up to 65% of older persons who can walk independently will lose this ability during a hospital stay. Walking during the hospital stay is critical for maintaining this functional ability. Loss of walking independence increases the length of hospital stay, the need for rehabilitation ...

Choosing Wisely Canada

Canadian Nurses Association & Canadian Gerontological Nursing Association

Transfers to hospital for assessment and treatment of a change in condition have become customary. However, harms can outweigh benefit and may result in increased morbidity. In one Canadian study, approximately half of hospitalizations were considered avoidable. Transfer often results in long periods in an unfamiliar and stressful environment for the older person. Other hazards include delirium, hospital-acquired infections, medication side effects, lack of sleep, and rapid loss of muscle ...

Choosing Wisely Canada

Canadian Nurses Association & Canadian Gerontological Nursing Association

When antimicrobials are indicated and consistent with an older person’s plan of care, intravenous formulations should not be the first choice unless there is no other safe and effective route of administration. Many antimicrobials have excellent bioavailability and only in rare instances need to be administered intravenously. Use of oral formulations of these medications reduces the need for placement and maintenance of venous access devices and their associated complications. In addition, ...

Choosing Wisely Canada

Canadian Nurses Association & Canadian Gerontological Nursing Association

While antimicrobial treatments can be lifesaving, they are not without side-effects, particularly for an older person. Antimicrobial use is only appropriate if it aligns with the older person’s wishes and goals of care. Life-prolonging use of antimicrobials may be inconsistent with a patient’s wishes or a palliative approach to care. Talk with the older person and their family to ensure they understand the impact of antimicrobial treatment.

Choosing Wisely Canada

Canadian Society of Internal Medicine

Several non-opioid therapies (including both drug and non-drug alternatives) may achieve a similar magnitude of improvement in pain and function more safely without the potentially serious side effects of opioid therapy (e.g. harms related to dependence, addiction and overdose).