Clinical Practice Guidelines for Geriatric Pharmacotherapy

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Application of clinical practice guidelines to older adults presents unique challenges. The first few references shown below highlight these challenges and offer insights into the application of guidelines to older adults. These references are followed by a list of disease-specific guidelines that have particular relevance to older adults.

Clinical practice guidelines and older adults

Boyd and colleagues reviewed clinical practice guidelines (CPGs) for diseases common in older adults, and evaluated implications of applying recommendations from these CPGs to older adults with multiple morbidities. Their review suggests that adhering to current CPGs in caring for an older person with several co-morbidities may have undesirable effects. Basing standards for quality of care and pay for performance on existing CPGs could lead to inappropriate judgment of the care provided to older individuals with complex co-morbidities and could create perverse incentives that emphasize the wrong aspects of care for this population and diminish the quality of their care.

Link to abstract

Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716-724.

In 2012, Cynthia Boyd was co-chair of a panel sponsored by the American Geriatrics Society. The panel developed Guiding Principles for the Care of Older Adults with Multimorbidity. These guidelines and related resource materials are very helpful and are available as open access documents on the AGS Web site.

Pharmaco-epistemology for the prescribing geriatrician

With the emphasis today on evidence-based prescribing, this excellent article helps the clinician caring for older adults to understand common mistakes that are made with interpretation and application of clinical trial evidence.

Link to abstract (full text can be downloaded free)

D. Le Couteur and H. Kendig. Australasian Journal on Ageing 2008; 27(1):3-7.

National Guideline Clearinghouse

This compilation of clinical practice guidelines is made available by the Agency for Healthcare Research and Quality.

AHRQ Effective Health Care Program

The Agency for Healthcare Research and Quality maintains a Web site with a variety of useful resources, including guidelines, literature reviews and comparative effectiveness reviews.

Department of Veterans Affairs

The VA has developed clinical practice guidelines on a variety of topics.

Adult Immunization Schedule

Here is the link to the schedule on the CDC Web site.

Alzheimer’s disease

Practice guideline for the treatment of patients with Alzheimer's disease and other dementias. This guideline from the American Psychiatric Association was updated in 2007.

Antithrombotic and thrombolytic therapy‑CHEST Guidelines, 2012

View the guidelines here.

Atrial fibrillation -- Management of patients with atrial fibrillation

2011 update from the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
Link to full text guidelines

2011 ACCF/AHA/HRS Focused Update on the Management of Patients with Atrial Fibrillation (Update on Dabigatran).
Full text is available

Benign prostatic hypertrophy (BPH) -- Guidelines from the American Urological Association, 2010.
Full text is available

Cardiovascular disease prevention in women -- Guidelines from the American Heart Association, 2011.
Full text is available

Cardiovascular risk assessment in asymptomatic adults -- Guidelines from the American Heart Association and the American College of Cardiology Foundation, 2011.
Full text is available

Chronic Kidney Disease -- Treatment of stages 1-3 CKD, systematic review by U.S. Preventive Services Task Force, April 2012.
Full review is open access

Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA).
Link to full text

COPD Guidelines -- GOLD
View the guidelines here.

Diagnosis and management of stable COPD-August 2011, from ACP, ACCP, ATS, ERS.
Link to full text guidelines (PDF)

Diabetes -- Standards of medical care in diabetes-January 2010, American Diabetes Association.
Link to full text guidelines (PDF)

Management of hyperglycemia in type 2 diabetes: a patient-centered approach (PDF). Position statement of the American Diabetes Association and the European Association for the Study of Diabetes (ADA/EASD), April 2012.

Oral pharmacologic treatment of type 2 diabetes mellitus, February 2012, American College of Physicians:
Link to abstract

Guidelines for developing comprehensive care plans for patients with diabetes mellitus -- April 2011, clinical practice guideline from the American Association of Clinical Endocrinologists.
Link to full text guidelines (PDF)

Treatment of painful diabetic neuropathy, April 2011, American Academy of Neurology guideline.
Link to full text (PDF)

Falls -- American Geriatrics Society clinical practice guidelines on prevention of falls in older persons, 2010.
Link to full text guidelines

Framingham Risk Calculator -- see Ten-Year ASCVD Risk Estimator Tools

Gout -- American College of Rheumatology Guidelines for Management of Gout, 2012
Link to guidelines

Heart Failure -- Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines-2009.
Link to full text guidelines

Management of Chronic Heart Failure in Adults-Synopsis of the National Institute for Health and Clinical Excellence Guideline, 2011. Annals of Internal Medicine
Link to full text synopsis (PDF)

HIV/AIDS -- Use of antiretrovirals in adults with HIV infection, from the International AIDS Society‑USA; full text of guidelines are available free on the JAMA Web site.

Hyperlipidemia -- American College of Cardiology and American Heart Association recommendations on detection, evaluation, and treatment of high cholesterol were last updated in 2013.
Full text of these guidelines

Triglycerides and cardiovascular disease: A scientific statement (PDF) from the American Heart Association, 2011

Hypertension -- NOTE: JNC 8 (Joint National Committee hypertension guidelines, 8th revision) were released in 2013. Full text of these guidelines

2012 Annual Canadian Hypertension Education Program Recommendations. This Web site has full text of guidelines, along with summary and other resources and tools.

The National Institute for Health and Clinical Excellence in the United Kingdom released updated guidelines on management of hypertension in adults in primary care, August 2011.

Hypertension in the Elderly -- ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly.
Link to full text guidelines (PDF)

Hyperthyroidism -- American Thyroid Association and American Association of Clinical Endocrinologists Guidelines for Thyrotoxicosis and Other Forms of Hyperthyroidism, 2011.
Link to full text guidelines

Ischemic Heart Disease - ACP/ACCF/AHA/AATS/PCNA/STS Clinical Practice Guideline for Management of Stable Ischemic Heart Disease, November 2012.
Link to text guidelines.

Methicillin-resistant Staphylococcus aureus -- Clinical practice guidelines for the treatment of MRSA infections in children and adults, from the Infectious Diseases Society of America, January 2011.
Link to full text guidelines (PDF)

Migraine Headache -- Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults : Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society, May 2012.
Link to full text (PDF).

Osteoporosis -- Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society.

Clinical practice guidelines for diagnosis and treatment of postmenopausal osteoporosis, from American Association of Clinical Endocrinologists, 2010.
Full text is here (PDF).

Pharmacological Management of Persistent Pain in Older Persons -- This 2009 guideline is available free from the American Geriatrics Society.

Practice Guidelines for Chronic Pain Management -- An Updated Report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. April 2010.

Renal Dosing -- Consensus Guidelines for Oral Dosing of Primarily Renally Cleared Medications in Older Adults (PDF), 2009. National Institutes of Health

Stroke Prevention -- Guidelines for Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack, 2011. American Heart Association and American Stroke Association.
Full text available here.

Guidelines for the Primary Prevention of Stroke, 2010. American Heart Association and American Stroke Association. Full text available here.

Ten-Year ASCVD Risk Estimator Tools -- To estimate a person’s risk for cardiovascular events. Note that these web sites use the Pooled Cohort Equations for risk calculation. This calculator is used in conjunction with the new Hyperlipemia guidelines and replaces the Framingham Risk Calculator. American Heart Association and/or American College of Cardiology 

Urinary Tract Infection, Catheter-associated
The Infectious Diseases Society of America has released 2010 guidelines on diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults, including those who are institutionalized.
The full text of these guidelines is available here.

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