When Less is More...
Welcome to Memory Care Support’s August 2015 newsletter!
When my husband and I clean out our closets and storage areas in our little house, it is always difficult to decide what to keep and what to donate. But it’s an annual event for us to take a hard look at what’s accumulated in the dark corners of our closets and storage shed. Our first criteria is – if we haven’t used it in a year, why do we need it? And the final question is – if we were to die today, is this anything any of our 5 children would want to keep? Almost always, the answer is a resounding “no” – and it gets added to the pile of donated items. And for a short time, we feel very luxurious having open space in our closets!
Having less can also be a desirable goal in good medicine – having less interventions, less medications, less tests done, and less hospitalizations. Having less doesn’t mean less care, it can mean more judicious and beneficial care and less exposure to unnecessary risks.
Following the “Less is More” theme, I want to introduce you to a wonderful initiative by the American Board of Internists– this initiative is called the Choosing Wisely Campaign.
Choosing Wisely aims to promote conversations between clinicians and patients by helping patients choose care that is:
As part of the Choosing Wisely Campaign, the American Geriatrics Society (AGS) has identified tests and procedures commonly used with older patients whose necessity should be questioned and discussed.
- Supported by evidence
- Not duplicative of other tests or procedures already received
- Free from harm
- Truly necessary
Many of their recommendations are directly related to good care for people living with dementia. A few of their recommendations include:
- Don’t put feeding tubes in patients with advanced dementia.
- Don’t use antipsychotic medications as the treatment for behavioral symptoms of dementia.
- Don’t use benzodiazepines or other sedative-hypnotics in older adults.
- Don’t prescribe cholinesterase inhibitors (i.e. Aricept) for dementia without periodic assessment of perceived benefits and adverse effects.
- Don’t use physical restraints to manage behavioral symptoms.
Many of these recommendations seem obvious but these are still medical practices frequently used throughout many areas of healthcare.
The full list will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments. You can read the entire list of recommendations by AGS at:
Thank you, I look forward to hearing from you,
Anne Ellett, N.P., M.S.N.
AANC Certified Gerontological Nurse
Founder, Executive Director - Memory Care Support
Ph. 949 933-6201