Frequency of clinical questions per ageing factor
| Aging factor | Frequency | Definition | Examples |
|---|---|---|---|
| Special considerations when choosing optimal treatment | 18 (26%) | Selection of an optimal individualised treatment considering ageing factors such as risk/benefit and comorbidities. Successful outcome is more difficult because of underlying ageing issues | What is the preferred A1c goal in the ageing population? What is the best treatment choice for diabetes when the patient also has heart failure? |
| Special prescribing considerations | 13 (19%) | Medication prescription needs to be adjusted to maximise compliance, and minimise side effects/organ damage (eg, by adjusting medication dose) | What is the geriatric dose of buspar for depression? What is the CrCl cut-off for alendronate? |
| Complex management of side effects | 9 (13%) | Consideration of side effects. Issues such as polypharmacy and lower medication tolerance contribute to a higher incidence of and more complexity in managing side effects | Is hallucination a side effect of rivastigmine? Is there adjunct treatment of depression that does not cause drowsiness? |
| Condition prevalence | 8 (11%) | Condition related to the questions is much more prevalent in the elderly. Questions related to these conditions would be less common in non-ageing patients | What is the best treatment choice for cognitive dysfunction? |
| Understanding other provider’s rationale | 6 (9%) | Unable to interpret rationale of other providers due to lack of enough information (eg, prescription without reason, diagnosis without explanation). Complex ageing patients are often cared for by multiple providers | What are these eye drops used for? What are the indications of concomitant use of aspirin and warfarin? |
| Dx testing considerations | 4 (6%) | Ageing risk factors need to be considered in the choice of diagnostic intervention | Is contrast indicated for chest X-ray to assess aspiration in a patient with GERD? |
| Access to health services | 4 (6%) | Health services that are more commonly needed or that have special requirements in elderly patients | Where should I refer this patient for mental health? |
| Difficult diagnosis | 4 (6%) | Difficult diagnosis due to underlying ageing factors (eg, multiple comorbidities, different presentation). Difficult to interpret new set of symptoms/signs/findings in light of the overall patient’s picture | Why is this patient osteopaenic? What is the cause of this patient's weight loss? |
| Gender considerations | 1 (1%) | Decisions in the elderly that are affected by gender (eg, different statin dose, different osteoporosis treatment) | How do I manage cardiovascular risk in elderly women? |
| Need for geriatric tool | 1 (1%) | Need for tools (eg, assessment tools) that are specific for geriatrics | Where can I find a template for haematology–oncology assessment |
| No ageing factor | 2 (3%) | Question not motivated or mediated by ageing and answer is not ageing-specific | Where can I find patient education information on cholesterol diet? |
GERD, gastroesophageal reflux disease.