Optimizing medical care for geriatric patients in Austria: defining a top five list of “Choosing Wisely” recommendations using the Delphi technique

Abstract

PurposeInappropriate use of diagnostic and therapeutic medical procedures is common and potentially harmful for older patients. The Austrian Society of Geriatrics and Gerontology defined a consensus of five recommendations to avoid overuse of medical interventions and to improve care of geriatric patients.MethodsFrom an initial pool of 147 reliable recommendations, 20 were chosen by a structured selection process for inclusion in a Delphi process to define a list of five top recommendations for geriatric medicine. 12 experts in the field of geriatric medicine scored the recommendations in two Delphi rounds.ResultsThe final five recommendations are concerning urinary catheters in elderly patients, percutaneous feeding tubes in patients with advanced dementia, antipsychotics as the first choice to treat behavioral and psychological symptoms of dementia, and screening for breast, colorectal, prostate, or lung cancer, and the use of antimicrobials to treat asymptomatic bacteriuria.ConclusionsThe selected recommendations have the potential to improve medical care for older patients, to reduce side effects caused by unnecessary medical procedures, and to save costs in the health care system.

A Choosing Wisely top-5 list to support general practitioners in Austria

“…Our search on websites of international Choosing Wisely initiatives resulted in 147 reliable recommendations. We excluded 44 duplicates (identical recommendations from various medical societies), 24 recommendations with similar content, and seven recommendations that were already covered by the top‑5 list of the Society of Geriatrics and Gerontology [ 17 ]. From the remaining pool of 72 recommendations, a team of ten experts from the Austrian Society of General Practice and Family Medicine selected those that were most relevant for general practitioners.…”

O uso de fármacos anticolinérgicos e fatores associados em adultos de meia-idade e idosos

“…Reconhecendo a utilidade dos fármacos, bem como os riscos que envolvem sua utilização, especialmente em populações mais suscetíveis, cresce o número de estudiosos que se ocupam desse assunto. Choosing Wisely 4 , critérios de Beers 5 e Stopp/Start 6 são exemplos de movimentos e ferramentas desenvolvidos pela comunidade científica no sentido de promover o uso desses insumos de maneira mais racional.…”