01.04.2016 | main topic
Choosing wisely in case of hypertension, diabetes and hyperlipidemia in older patients
Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 5-6/2016Einloggen, um Zugang zu erhalten
The Choosing WiselyTM campaign was created by the American Board of Internal Medicine, it asks medical specialty societies to indicate five diagnostic and/or therapeutic interventions in their specialty to be avoided in specific cases. The aim of this campaign is to stimulate discussion between patients and their doctors about the usefulness of each procedure and also to avoid unnecessary, possibly wasteful measures. Hypertension, diabetes and hyperlipidemia are the most common conditions seen in primary care. The feasibility of applying the principles of Choosing Wisely in these cases was the target of this mini-review.
A PUBMED query based on entering the terms “choosing wisely”, “elderly”, “hypertension”, “diabetes” and “hyperlipidemia” was performed. The search was limited to studies in human subjects using original articles and reviews in English and German that were published in the period of 1982–2015. In addition, a manual search from all relevant references and screened articles was performed.
Using the up to date knowledge of precise indication for the pharmacological treatment of hypertension, diabetes and hyperlipidemia in older patients protects them from adverse effects and avoids interventions of low value.
Additional tests of functionality like a frailty score or the comprehensive geriatric assessment can improve decision making for starting of medical interventions and for adjusting the intensity of treatment. Based on current literature they can help to withdraw or to abstain from unnecessary medical interventions.