Mike Steinman recently published a paper in JAMA about sensible medication managment in older adults. I've had the opportunity to see him speak about this issue on a couple of occassions. I wanted to share a few take home "GeriPal" pearls, leading with the title of the post:
- Any symptom in an older adult is a medication side effect until proven otherwise
- Review medication lists and sort by indication. Most older adults are on at least one unnecessary medication, or one where the harms outweigh the benifits in light of the patient's goals, social and clinical circumstances, and life expectancy.
- If you taper it up, taper it down
- When starting a medication, start low, and go slow
- Warfarin, hypoglycemic agents, and digoxin account for one-third of all adverse drug event related emergency department visits by older adults. Doesn't mean don't prescribe them, just prescribe thoughtfully and monitor for adverse side effects.
- Most adverse drug events are due to a failure of monitoring, not prescribing innapropriate medications
Comments
Thank you!
Pratima
I do want to also share something that I've been struggling with as I teach on the inpatient wards and in the clinic - there is also a pervasive syndrome of undertreatment - as in, "I can't give them an anti-depressant, they're OLD" -- or "We shouldn't, start warfaring, because they're OLD and they MIGHT FALL". So, although I absolutely agree that caution is needed, we may need to remind our learners that caution doesn't mean absolute avoidance...
Great post!
Kate.
-start low and go slow, but GO! Advanced age does not mean "do not treat."
Thank you!
Lindy Swain, PharmD
www.pharmacyadvocates.com