Evidence-based medicine has focused on improving the chance of receiving the most appropriate medicine, treatments, and testing for each individual. Physicians from the University of Michigan advocate for more attention to the best time to stop medical treatments. In an article published in the Journal of the American Medical Association, Internal Medicine’s “Less is More” feature, they note that much of medical care prevents or treats chronic conditions. Stopping these services when the evidence changes or if the benefits no longer outweigh the risks is equally important, but may be overlooked.
The authors set up a system for making recommendations on when to reduce medical care with an initial set of 37 specific instances where physicians could “deintensify” care safely for certain patients. For example, a blood test for prostate specific antigen to identify prostate cancer is not necessary for most men over the age of 69 (unless you are at high risk). A press release about the publication explains the process used. See below for a list of the topics covered in the recommendations.
So be sure to discuss the pros and cons of all medications and treatments with your physician at regular intervals to stay on top of changes that occur with age, health, or lifestyle.
Summary of recommendations on deintensifying medical treatments
See the original publication (supplementary table e6) for specific information on the recommendations and patient population to which they apply.
Medication in older adults, when to stop or decrease the use of:
- insulin, sulfonylureas, and/or thiazolidinediones
- benzodiazepines or other sedative-hypnotics
- estrogen or combined estrogen/progestin therapy
- skeletal muscle relaxants
- single or combined antidepressants (tricyclics)
- antihypertensive medications
Medication in all adults, when to stop or decrease the use of:
- alternate antiplatelet therapy
- all but 1 class of the renin-angiotensin system agents
- non-statin medications
- testosterone therapy
- aldosterone receptor antagonists
- lipid lowering therapy
Cancer screening, if and when to schedule:
- prostate cancer screening using prostate specific antigen
- colorectal cancer screening
- cervical cancer screening
- lung cancer screening
- 25-OH-Vitamin D screening
- DEXA scans
- carotid artery stenosis screening
- screening with stress electrocardiography, stress echocardiography, or stress myocardial perfusion imaging
Other medical treatments, when to stop or decrease:
- prescribed glucose test strips