How to Think Like a Geriatrician about Senior Medication
Leslie Kernisan, MD, shares an article about senior medication safety, and offers tips on how to be better prepared to ask your parents’ doctors the right questions.
Think Like a Geriatrician about Senior Medication
Everyone benefits when all of us are better informed about health. Likewise, everyone involved in the health care of older adults can benefit from learning to think a bit like a geriatrician.
This means keeping certain guiding principles in mind and watching for common pitfalls, when it comes to the medical care of seniors.
Problems in senior health are especially common when it comes to medications. So, geriatricians always pay attention to what drugs have been prescribed, and why. Then we often improve a senior’s health by suggesting changes to medications.
In this article, I’ll share five senior medication safety truths that I often find myself explaining to families. They are what I always keep in mind as I do my work, as they are the foundation for better prescribing in seniors, as well as for checking an older adult’s medications for safety and appropriateness.
I tell people these medication safety truths because I know that most older adults will not have their medications regularly reviewed by a geriatrician or geriatric pharmacist. But with the right knowledge, you’ll be better prepared to ask your parents’ doctors the right questions. This can help them address common oversights, and can improve the safety of your parents’ medications.
5 Things You Should Know about Your Parents’ Medications
Here’s what you should know, along with tips on what you can do about your older loved ones’ medications:
1. Fewer Medications is Often Safer
That’s because the more medications a senior takes, the greater the chance of side-effects, interactions, and emergencies due to adverse events. (A side-effect would be something like dry mouth from a depression drug. An adverse event is something like internal bleeding due to taking a blood-thinner.)
Fewer medications also means lower drug costs and pill burden, which means a senior is more likely to keep taking their medications in the long run. Now, after careful review we sometimes find that it’s not possible to reduce the number of medications. But it’s still a good goal to keep in mind.
What you can do: Periodically tell the doctors that your family would prefer for your parent to be on fewer medications if possible. Ask the doctors — or a pharmacist — to help you identify any medications that could perhaps be eliminated. In some cases it may be possible to treat a problem with non-drug therapies instead. (See below.)
2. Non-Drug Treatments are often Safer and can be Equally Effective
These include psychotherapy, exercise and social activities for depression, physical therapy for pain, watchful waiting for minor problems, or behavior management for dementia agitation. Although these may take more effort to implement initially, they often are better for seniors and families in the long run.
But many doctors are used to recommending prescription medication as a default. So don’t assume they will tell you about non-drug treatment options automatically; like all busy people they tend to fall back on their habits.
What you can do: Whenever a doctor proposes a prescription medication treatment for a given problem, be sure to ask about non-drug treatment options too. The doctor should be happy to review these once you’ve expressed your interest.
3. Medications Often Get “Forgotten”
When I review a senior’s medications, I often find medications that seem to have been “forgotten.” It might be a drug that was initially prescribed in the hospital but isn’t still needed. Or it might be a starter dose of a medication that perhaps should’ve been increased (or stopped, if a problem such as depression has improved).
This happens in part because seniors many medical visits are relatively short, which can make it hard for a clinicians to carefully review all medications to make sure they are all needed and at the right dosage. So don’t assume that a renewed prescription means a doctor has carefully thought through the need for the medication. It’s much better to plan on actively reviewing the need for every medication, on at least a yearly basis.
What you can do: If a medication was recently added during a hospitalization, make sure the primary care doctor checks up on it at a later follow-up visit. You can also request a comprehensive medication review, which usually means that all medications are re-evaluated for appropriateness and safety.
4. Check to See if the Medication is on the Beers List
Doctors often prescribe medications that are on the Beer’s list. This is a list of medications that older adults should avoid or use with caution.
Despite ongoing efforts to make sure that all doctors are trained to modify healthcare as needed for older adults, it still remains common for these medications to be prescribed, without documentation that the benefits and risks have been discussed with a senior.
In general, seniors and their families should not assume that their doctors have carefully thought through the risks of using these drugs in seniors. It’s much safer to plan on nudging the doctor to identify and reconsider these drugs. Pharmacists are also a good resource, for spotting these drugs.
What you can do: Check and see if any of your parent’s medications are on the Beer’s list. (It’s often easiest to open the Beer’s list on a computer and use the search function to see if any of your parent’s medications are on the list.) If you discover that your parent is taking medications that are on the Beer’s list, use this guide from the American Geriatrics Society: What to Do and What to Ask Your Healthcare Provider if a Medication You Take is Listed in the Beers Criteria for Potentially Inappropriate Medications to Use in Older Adults.
5. Weigh the Pros and Cons of Each Medication
When considering a particular medication, the goal is to properly weigh the pros and cons. In geriatrics, we often call this “balancing the benefits and burdens.”
Burdens include consistent downsides (like cost or hassle) which definitely affect a senior, as well as the risks (like side-effects or interactions) which will only affect a minority of seniors.
Risks can often be reduced with a lower dosage of a medication. For instance, studies suggest that for most people a medium dose of cholesterol medication is almost as beneficial as a high dose, but it causes problems less often. Also, bear in mind that doctors may not understand how much cost, hassle, or burden a medication causes, unless you tell them.
What you can do: When considering starting or continuing a medication, plan on asking the doctor to clarify the likely benefit, along with the risk. The likely benefit is often smaller than people realize, as is explained in this excellent article about medication.
Remember, healthcare works best when it’s a partnership between patients, family caregivers and doctors.
By understanding best practices in prescribing for seniors, and by learning about common pitfalls in medication safety, you’ll be better able to help your parents get the medications they need, and avoid the medications they don’t need.
What questions do you ask your parents’ doctors, that can help other caregivers improve the safety of their parents’ medications? Share your questions with us in the comments below.
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