Clinical decision-making in the care of older adults: practical insights for non-geriatricians

Clinical reasoning forms the cornerstone of medical practice and decision-making and directly determines the quality of healthcare services provided to patients. However, in recent years, increasing attention has been directed at strengthening clinical decision-making processes through educational pedagogy in recognition of a diagnostic and medical error epidemic. Amidst a rapidly ageing global population, there will undoubtedly be increasing challenges and complexities in the medical care of older adults with varying degrees of medical comorbidities, functional statuses, as well as differing care goals and needs. Although geriatric medicine as a specialty has developed over the years, with inter-disciplinary collaborations for optimal care of older adult patients, there remains a large proportion of these patients who will be cared for by non-geriatrician generalists and specialists. Therefore, in this article, we hope to provide practical insights in clinical decision-making when caring for older adult patients, specifically looking at common proclivities for cognitive errors in the form of bias and 'noisy' clinical judgements in real-world practice, and discuss multi-levelled strategies that could mitigate these challenges and strengthen the quality of care.