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Eur Geriatr Med. 2018;9(6):783-793. doi: 10.1007/s41999-018-0105-8. Epub 2018 Sep 27.

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

Author information

1
Department of Internal Medicine and Acute Geriatrics, Geriatric Health Centres Graz, Albert Schweitzer Hospital, Graz, Austria.
2
2Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Krems an der Donau, Austria.
3
3Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria.
4
Department of Acute Geriatrics, Social Medical Center East, Vienna, Austria.
5
Department of Acute Geriatrics and Remobilisation, Hospital of Salzkammergut, Gmunden, Austria.
6
Department of Acute Geriatrics, Hospital of Klagenfurt, Klagenfurt, Austria.
7
Department of Geriatrics, Christian-Doppler University Hospital Salzburg, Private Medical University Paracelsus, Salzburg, Austria.
8
Department of Internal Medicine 2, General Hospital West-Styria, Voitsberg, Austria.
9
Department of Acute Geriatrics and Remobilisation, General Public Hospital of the Order of Saint Elisabeth, Klagenfurt, Austria.
10
House of Mercy, Long Term Care Hospital, Vienna, Austria.
11
Private Practice for General Medicine, Rankweil, Austria.
12
Institute for General, Family and Preventive Medicine, Private Medical University Paracelsus, Salzburg, Austria.
13
13Pharmacy Department, Hospital Hietzing with Neurological Centre Rosenhügel, Vienna, Austria.
14
14Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.

Abstract

Purpose:

Inappropriate 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.

Methods:

From 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.

Results:

The 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.

Conclusions:

The 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.

KEYWORDS:

Choosing Wisely; Consensus; Delphi process; Geriatric medicine; Recommendations

Conflict of interest statement

The authors declare that they have no conflict of interest.The local ethics committee at Medical University of Graz stated that this study does not need any approval as no personal data are required.For this type of study, formal consent is not required.

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