Guidelines Help with Difficult Medical Decisions


Guidelines Help with Difficult Medical Decisions

medical_decisionsI often talk with family caregivers about difficult decisions they face as their family member declines because of a chronic illness or disability. A physician or medical team presents the family caregiver and other family members with treatment recommendations, leaving the family caregiver to wonder: “How in the world do I know which option is the right option?”

Now, family caregivers have a go-to resource which offers insights about the appropriateness of treatments and tests: ABIM Foundation’s Choosing Wisely campaign, which aims to spark conversations between patients and physicians about what care is really necessary. The campaign recently released a list of 90 test and procedures to question and includes the following recommendations for older adults:

  • Don’t use feeding tubes in patients with advanced dementia. Studies show that percutaneous feeding tubes do not result in better outcomes for these patients. The recommendation states that assistance with oral feeding is a better, evidence-based approach. (American Academy of Hospice and Palliative Medicine; American Geriatrics Society)

  • Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia. People with dementia often exhibit aggression, resistance to care and other challenging or disruptive behaviors. In such instances, antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm, including stroke and premature death. Use of these drugs should be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others. Identifying and addressing causes of behavior change can make drug treatment unnecessary. (American Geriatrics Society)

  • When prescribing medication for most people age 65 and older with type 2 diabetes, avoid attempting to achieve tight glycemic control. The recommendation states that there is no evidence that using medicine to tightly control blood sugar in older diabetics is beneficial. In fact, using medications to strictly achieve low blood sugar levels is associated with harms, including higher mortality rates. (American Geriatrics Society)

The complete list from the specialty societies, available at, includes additional detail about the recommendations and evidence supporting them. Consult the list when a physician recommends a treatment or a procedure for yourself, your family members and your caree.


  • Consumer Reports has partnered with Choosing Wisely to create a website which features information to help you make appropriate decisions about treatments and offers help in choosing prescription drugs. You can visit the site here.

  • Medical Waste: 90 More Don'ts for Your Doctor

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