Yearly Archives: 2015

The 2015 Updated AGS Beers Criteria: What’s New

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Donna-Fick headshotTodd-Semla headshot

Donna M. Fick, PhD, RN, GCNS-BC, FGSA, FAAN

Todd P. Semla, PharmD, MS, AGSF

Co-Chairs of the 2015 Updated AGS Beers Criteria Expert Panel

 

 

 

Today, the American Geriatrics Society (AGS) released its 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. For more than 20 years, the Beers Criteria have served as a valued resource for healthcare professionals about the safety of prescribing medications to older adults. In fact, the AGS Beers Criteria have become one of the most frequently used reference tools in the field of geriatrics. The AGS Beers Criteria were previously updated in 2012.

How We Updated the Beers Criteria
The 2015 Updated AGS Beers Criteria reflect work done by a panel of 13 geriatrics experts convened by the AGS. The panel searched for clinical trials and research studies since the 2012 AGS Beers Criteria were issued, and found more than 20,000 results! From this pool, our team reviewed more than 6,700 studies. From there, we were able to identify more than 40 potentially problematic medications or classes of medications, which we organized into five lists. While these lists aren’t exhaustive, they can be very helpful as conversation-starters between older adults and their healthcare providers about what treatment options work best from one individual to the next.

What’s New?
In addition to updating two lists of medications that may be potentially harmful for people aged 65 and older who are not receiving palliative or hospice care, the 2015 Updated AGS Beers Criteria now contain:

  • Separate guidance on avoiding 13 combinations of medications known to cause harmful “drug-drug interactions.” Some medications may be inappropriate when prescribed together because they can increase an older adult’s risk for falls, fractures, or urinary incontinence, for example.
  • A list of 20 potentially problematic medications to avoid or for which doses should be adjusted depending on an older person’s kidney function. These medications could raise risks for problems such as nausea, diarrhea, bleeding, problems affecting the brain and nervous system, and changes in mental well-being and bone marrow toxicity (a condition in which bone marrow makes fewer blood cells).
  • Three new medications and two new “classes” of medications added to the Criteria. An example of a new class of medication includes the proton-pump inhibitors that some people take for acid reflux or stomach ulcers. Recent studies have linked these medications to an increased risk for bone loss, fractures, and serious bacterial infections, which is why they were added to the 2015 AGS Beers Criteria.

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It’s Baaack! The Flu Season, That Is…

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Shah headshot

Krupa Shah, MD, MPH
Assistant Professor
University of Rochester School of Medicine & Dentistry

Like it or not, the flu season is back. Everybody should take notice, especially older adults. This blog post will give you some tips on how to prevent getting the flu.

 

 

Why is it especially important for older adults to be extra careful about the flu?

  • In general, older adults have weaker immune systems compared to younger adults. This is a result of the aging process. In fact, people 65 years or older are at the greatest risk of complications from the flu.
  • Older adults become sick more frequently, which often results in hospitalization.

What are some of the more common flu symptoms?

  • Fever
  • Cough
  • Runny nose
  • Sore throat
  • Body aches
  • Headaches
  • Chills
  • Fatigue

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Walking is the Best Medicine!

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Lacing up your shoes and getting out the door is one of the best things older adults can do for their health and mood.

Barb Resnick HeadshotBarbara Resnick, PhD, CRNP
Professor
Sonya Ziporkin Gershowitz Chair in Gerontology
University of Maryland School of Nursing

The Surgeon General’s new “Call to Action on Walking” is a perfect opportunity to celebrate the many physical and mental health benefits of walking. In fact, if the benefits of walking came in pill form, I’m convinced it would be the best-selling pill on the planet! Walking is a scientifically proven, simple way to dramatically improve your well-being. No matter how old you are, when you walk regularly, you can enjoy benefits like these:

  • You can lower your blood pressure and cholesterol
  • You will start feeling happier, less anxious, and less stressed
  • Your sleep can become sounder and more restful
  • You may be able to lessen your risk of falling and reduce your fear of falling
  • You can prevent gaining weight
  • Your mental sharpness can improve

Recently, researchers from Johns Hopkins University discovered that for older women (but not older men), a low-intensity daily walk might enlarge the part of the brain responsible for memory. Known as the hippocampus, this section of the brain is linked to memory loss when it shrinks due to aging. [Varma et al. Low-Intensity daily walking associated with hippocampal volume in older adults. Hippocampus. 2015 May;25(5):605-15] 

Although we know that there is little risk associated with walking, many older adults are afraid that walking might worsen conditions such as arthritis. But the good news is that the opposite is true. In fact, when you walk just 3,000 steps a day, you can prevent the pain of knee arthritis from getting worse. And people who walk 6,000 steps a day (about 3 miles) can reduce their chances of becoming disabled by arthritis.

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“The Four M’s” of Caring for an Older Adult with Dementia

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Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio

Your older relative has just been diagnosed with dementia. Your head is spinning with questions, concerns, fears, and yes, disbelief.  Still, you want to know all you can. If you are going to be a caregiver, you want to be a good one. So, where to start?

Start with the things that, if not managed well, have the greatest chance of getting your relative into trouble! Start with “The Four M’s.”

 

Meals
From planning to shopping to preparing, meal preparation is a very complicated task—for someone with a memory problem. You may notice that the older person is losing weight, that they eat little at home but eat well when they go out to eat, or that there is spoiled food in the refrigerator.

Try: Have simple foods – especially your relative’s favorite ones – around the house, such as sandwiches, soup, and cereal. Bring in ready meals that just need to be microwaved. Consider arranging for home delivered meals. Try to make meal time a social time when possible. Ask friends, church and family members to stop in and stay during meals.

Medicine
Medication management can also be overwhelming and older adults are often taking 10 or more medications, including over-the-counter ones.

Try: Discuss simplifying the regimen with the primary healthcare provider. Are all medications still necessary, and how many can be given just daily? Set up the medicine in a “days of the week” pill box and monitor if they are being taken. Call daily to remind. Consider hiring help for in-person reminders. Take over the refill tasks. Continue reading →

Medication Adherence: A Tough Pill to Swallow

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KIM MOON - KimPick1 - webresKimberly Moon, PharmD
Clinical Pharmacist
Blue Cross Blue Shield of Michigan David2


David Dadiomov
Doctor of Pharmacy Candidate
University of Michigan
College of Pharmacy

 

The number of Americans with chronic medical conditions is increasing, which means that chronic medication use is playing a larger role in their lives. The World Health Organization estimates that 157 million Americans will require medications for at least one chronic disease, such as high blood pressure, high cholesterol, or diabetes. Luckily, treatments exist for these diseases that prolong life and improve quality of life as well. Medications can help improve medical conditions when they are taken as prescribed.

Taking medications improperly not only affects people who take these medications, but is also costly for our entire health care system. Medication non-adherence leads to 1/3rd of all medication-related hospitalizations and about $300 billion in avoidable costs. It is clear that medication non-adherence is a huge problem; several common concerns may be responsible for this issue.

“I’m worried about cost”
Cost is an important factor for those that take medications. When people first get placed on medications it is a relatively unexpected cost that they must now budget for. Luckily, many oral medications for management of blood pressure, cholesterol or diabetes are available as affordable generic medications. These medications are on the most affordable level of co-payment on most health plans, but even those without insurance may still benefit from pricing at various pharmacies that offer these medications at a low cost. For those who are prescribed expensive medications, most drug manufacturers have patient assistance programs to help with medication costs for those who qualify. Also, taking a long-term perspective is important. The daily cost of most medications is certainly less than the cost of a hospitalization due to a heart attack, stroke, or dialysis due to kidney damage.

“I’m concerned about the side effects”
No drug is without side effects. Luckily, for most people, side effects are minimal and medications are generally well tolerated. Sometimes certain side effects may prevent people from taking their medications as prescribed. Often a pharmacist’s recommendation on medication use or management of side effects can help alleviate concerns. For instance, certain medications should be taken with food, or at a certain time of day. Other medications may have side effects for the first few weeks, but then go away. It is important to ask questions when being prescribed a new medication and calling the pharmacist with questions about the medication or how to take it. Keeping a clear line of communication is important to medication adherence.

“I take too many pills”
Taking several medications is often discouraging for people, and may make it hard to remember to take them at the correct times. A pill box for each day of the week can help manage medications and at the very least, help see how many doses were missed during the week. Many medications are available in a once-daily formulation or even in a combination with another routine medication to reduce the total number of pills taken per day. Again it is important to talk with your prescribing healthcare provider and pharmacist.

“I don’t feel I need my medications”
People with conditions such as high cholesterol don’t have symptoms, so they could feel medications for this condition are not needed. It is important to remember that medications that lower cholesterol are important in reducing the 10-year-risk of developing a heart attack or stroke. People may not “feel” the medicine working, but research studies show taking medications as prescribed can help reduce risk of heart attack or stroke. Remember: Having high blood pressure or diabetes may not always make you feel like there is anything wrong with you, but these diseases can damage your kidneys and lead to kidney disease that may require dialysis.

Questions to ask the pharmacist:

  • How am I supposed to take this medication?
  • What is this medication used for?
  • How does this medication work?
  • What can I expect with this medication?
  • How will I know this medication is working?