Evidence-Based Medicine in Geriatric Patients
Although evidence-based and expert consensus clinical practice guidelines have improved clinical care, the applicability to the patient requires clinical judgment by the clinician. Moreover, the clinician must weigh the possible benefits to the patient’s quality of life (63). When it comes to the geriatric patient, an approach of conservative prescribing is best. Examples of this behavior on the part of clinician would include a preference for nondrug therapies, vigilance for monitoring for medication adverse effects, skepticism about new drugs to the market until they have proven themselves to be safe and effective for the elderly, and shared decision-making with patients about treatment plans (64).
Unnecessary medication use is a common problem in rehab medicine. Patients with chronic medical conditions may continue to take the same medication(s) for years without assessment of necessity or new medications may be initiated during a hospitalization and continued indefinitely when they were intended for short-term use only. Some commonly identified unnecessary medications at transitions of care are proton-pump inhibitors, CNS medications and vitamin and mineral supplements (65). In rehabilitation, careful consideration for the continued use of opioid analgesics, muscle relax- ants, and NSAIDs should be given; medications deemed unnecessary can be safely discontinued utilizing a systematic approach (66).