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Wednesday, April 09, 2014

Choosing Wisely Canada: 5 Things Physicians and Patients should question

For the past 2 years, the American Choosing Wisely campaign (see previous posts about Choosing Wisely here and here) has achieved tremendous success, and last week the initiative moved to Canada.  The first ever Choosing Wisely Canadian campaign includes a list of 5 things physicians and patients should question, produced with the assistance of the Canadian Geriatrics Society.  This list is specifically targeted to physicians working with older adults and to elderly patients.  It was compiled by a small group of council members from the Canadian Geriatrics Society, who reviewed the best available evidence and made recommendations to ensure delivery of high-quality medical care.  This years’ list includes the following recommendations:
1.       Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.
2.       Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.
3.       Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral feeding
4.       Don’t use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia.
5.       Avoid using medications known to cause hypoglycemia to achieve hemoglobin A1c <7.5% in many adults age 65 and older; moderate control is generally better.
For more information on these recommendations and to learn more about the Canadian Choosing Wisely campaign, please visit

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