The American Geriatrics Society recently released a part 2 to “Five Things Physicians and Patients Should Question” in the on-going ABIM Foundation’s “Choosing Wisely” series. The first AGS “Five Things” focused a great deal on drugs and dementia and the second one builds on that. The AGS recommends that cholinesterase inhibitors, a class of drugs associated with low to moderate benefits in delaying memory loss in Alzheimer’s Disease for a few months, be carefully scrutinized and perhaps discontinued if results are not obtained after a 12-week trial or if the drug has been used for a year or more.
Cholinesterase inhibitors, like Namenda and Aricept, are often prescribed and then become part of the drug regimen for patients with dementia for years and years. In many cases, little attention is paid to whether they are providing any therapeutic value and, according to the AGS, can contribute to problems in other areas of health.
The AGS also recommends avoiding physical restraints in hospitalized older adults with delirium. Delirium often makes providers feel as though they have a free pass to use restraints, especially in hospitals. We hope the AGS recommendation encourages hospitals to review their patient restraint protocols with an eye toward using good comfort-focused care approaches over restraint-oriented approaches.