Caring for Patients in an Evidence-Limited World

Evidence-based medicine (EBM) integrates three elements: scientific evidence, clinician’s expertise, and patient’s goals and values. The practice of EBM requires a clinician to ask questions, acquire best evidence, appraise literature for validity and applicability, and apply it at the bedside. Specific to EBM in older adults, there is a relative lack of valid therapies and tools for decision-making. Most clinical trials have limited inclusion of older adults, particularly the oldest old and those with comorbidities, so results may be less applicable. This makes eliciting patients’ values and preferences more critical in decision-making. Knowledge of key EBM concepts and terminology and the ability to utilize the limited available evidence to treat older patients and to communicate decisions at the bedside are core competencies for geriatrics practitioners.