Who hasn’t worried about doing too much when trying to do the right thing? The concern around overtreatment in frail older adults is gaining traction, especially with new guidance from leading geriatric experts. In a recent commentary, Dr. Joseph G. Ouslander—Editor-in-Chief of the Journal of the American Geriatrics Society and board member of the American Geriatrics Society’s Foundation for Health in Aging—warns that “overtreatment of diabetes mellitus and hypertension resulting in iatrogenic hypoglycemia and hypotension are especially common in vulnerable older adults and can result in excess morbidity, mortality, and health care costs.”
Dr. Ouslander is calling for “urgent change” in how chronic conditions are managed among seniors. And we all know why: managing blood glucose and blood pressure can be tricky at any age, but it’s even more complicated in frail residents. While the SPRINT Study from the National Heart, Lung, and Blood Institute highlighted benefits of aggressive blood pressure control, it’s worth noting that the study didn’t include medically vulnerable older adults, the very population at risk of harm from this type of intensive management. The urgency of this issue is also echoed in an EurekAlert! article urging providers to rethink treatment goals for frail seniors with diabetes and hypertension.
Despite this, some providers still feel compelled to follow aggressive protocols, even when clinical guidelines suggest a more relaxed approach for seniors. The good news is, there are practical ways to adjust course without compromising care.
First, make sure your physicians are working from up-to-date recommendations and understand the limitations of studies that guide practice. The McKnight’s Long-Term Care News commentary breaks this down clearly, offering insight into the pitfalls of overly intensive diabetes and blood pressure care.
Next, identify residents at risk for medication-related complications and ensure regular medication reviews are taking place. Document the reasoning behind all dosage decisions—whether it’s continuing, adjusting, or discontinuing a medication. When appropriate, collaborate with your pharmacist to track trends and measure outcomes. The Journal of the American Geriatrics Society offers useful strategies to reduce iatrogenic hypoglycemia and hypotension, which could serve as a great foundation for quality improvement.
To prevent overtreatment in frail older adults, it’s essential to personalize every care plan. One-size-fits-all doesn’t work in senior living communities. Knowing your residents, their risks, and their history makes all the difference—and can help you do less, while doing more of what matters.
Stay well and stay informed!
