Table 7.

How clinical practice guidelines addressed barriers to implementation

CLINICAL PRACTICE GUIDELINE, BY DISEASE	HOW BARRIERS TO IMPLEMENTATION WERE ADDRESSED
Diabetes26	“Glycemic targets may be difficult to achieve in elderly” “Co-morbidity may prevent physical activities—known to improve glycemic control” Have caution with drugs (eg, sulfonylureas), as risk of hypoglycemia increases with age “Conventional insulin syringes may increase dose errors”
Hypertension27	Includes discussions on adherence issues and how to reduce them Advises caution to be exercised in patients, such as the elderly, who cannot tolerate diabetes target blood pressure measurements
Congestive heart failure28	Includes discussion on polypharmacy and adherence issues
Depression31	Acknowledges lack of levels of evidence I–IIa* for most recommendations pertaining to elderly
Dementia32–38	Includes discussions on knowledge gaps Advises providers to stop cholinesterase inhibitors if patients have comorbidities that make use of medications risky Includes warnings regarding the use of medications in patients with comorbidities

^*Levels of evidence are based on the categories used by the individual article.