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Choosing Wisely Australia

Australian and New Zealand Society for Geriatric Medicine

People with dementia may exhibit aggression, resistance to care and other challenging or disruptive behaviours. In such instances, the modest effectiveness of atypical antipsychotics may be offset by the higher risks for adverse events and mortality. Non-pharmacological interventions can be an effective substitute for antipsychotic medications. Use of these drugs should therefore be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves ...

Choosing Wisely Australia

Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists

Polypharmacy — defined as five to nine medications taken regularly — is common among elderly patients. However, patients who are prescribed with multiple, concurrent therapeutics (i.e. hyper polypharmacy) may be on ten or more drugs at time. Research has confirmed a significant association between polypharmacy and adverse outcomes among older people living in the community because the toxicities and side effects associated with prescribed drugs are accrued over many years. Polypharmacy in ...

Choosing Wisely Australia

Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists

Pharmacological treatments should cease when there are no further benefits to be achieved from the treatment, or when the potential harms from the treatment start to outweigh the potential benefits. This is particularly pertinent for elderly patients with a limited life expectancy where the treatments are unlikely to prevent disease events, and may in fact lead to adverse effects that reduce quality of life. These patients are at an increased risk of polypharmacy and increased drug events. For ...

Choosing Wisely Australia

Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists

Therapeutic dosage should be adjusted to optimise the benefit-to-risk ratio of the treatment. Dosage should be no higher or lower than needed to achieve the patient’s therapeutic goals. As patients become more frail, potential harms usually increase and potential benefits usually decrease for a given dosage of pharmacological treatment. For example, carefully assessing the risk and benefits when initiating non-steroidal inflammatory drugs in elderly patients is important, because of the ...

Choosing Wisely Australia

Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists

Pharmacological treatments should be avoided or minimised if safer or more effective nonpharmacological alternatives are available. Pharmacological treatments may become a panacea for chronic lifestyle-related problems, and may detract from behaviour management tools that have proven effective in managing these same problems. There is also a risk of adverse effects from particular pharmacological treatments which may be avoidable by using non-pharmacological management strategies. For instance, ...