Author Archives: HIA Guest Blog

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?

 

Integrating Community Programs in Healthcare: A Personal Experience of Health Professionals Sharing a Lot More than Lunch!

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Michael Malone, MD
Professor of Medicine and Section Head of Geriatrics
University of Wisconsin School of Medicine and Public Health
Medical Director
Aurora Senior Services and Aurora at Home

Two years ago, members of Milwaukee’s Aurora Health Care geriatrics program where I work began doing something different for lunch. The geriatrics fellows (who are learning to be experts at caring for older persons with multiple chronic illnesses) started to share meals once a week with the nurses, social workers, and teaching doctors who also work with the patients we serve. The fellows and faculty enjoyed helping each other overcome struggles in providing “best care” for vulnerable older individuals. Over shared meals, physicians started reaching out to social workers and others at the table to get input, feedback, and recommendations. This was particularly helpful, as many of the challenges our doctors have encountered centered on the social aspects of a patient’s needs and where and how to find appropriate support.

Creating a Network to Achieve “Best Care”
Gradually, we started to use these lunches to discuss cases more formally. We would discuss patient needs in five specific areas: 1) medical needs, 2) medications, 3) social needs , 4) psychological needs, and 5) how patients understood and perceived their own illnesses. The in-person discussions have given our physicians, nurses, and social workers a chance to develop working relationships with one another. We’ve all developed a better understanding of programs provided by the ADRC, and our patients are better served as we work together.

Importance of the Older Americans Act
As I reflect on how our clinic serves older individuals in Wisconsin, I’m struck by the importance of integrating community programs into health care. The Older Americans Act (OAA), for example, provides for caregiver support, health promotion, meals, and transportation for vulnerable elders. Our sharing and learning together during lunch has resulted in a better understanding of the whole person (physical, mental, social needs), and how that person supports and is supported by a community shaped in one way or another by initiatives like the OAA. Reauthorizing the OAA represents an important opportunity to help modernize and improve the aging services network to meet the needs of our nation’s older adults.

Among other objectives, the bill aims to address

  • Elder abuse;
  • The importance of evidence-based care;
  • The effective coordination of services at the federal, state, and local levels; and
  • Several other challenges confronting older Americans and their health providers.

These are topics I hope to discuss at lunch with colleagues for many years to come not only because they are important but also because they can be addressed—effectively, reliably, and equitably—through sustained support of the OAA. I’d encourage you to do some digging of your own regarding legislation that supports older Americans—you might be surprised at just how expansive public support for healthy aging has become, but also how vital it will be to ensure this support not only remains constant but also shifts to reflect new realities as more and more of us turn 65.

The Older Americans Act Reauthorization Act of 2015 was approved by the U.S. Senate last week and has now been sent to the House of Representatives for a final vote.  You can help support swift passage of this important legislation by writing to your Representative to encourage her to stand behind the important services that the OAA provides.  Visit the Health in Aging Advocacy Center for more details.

About the Author
Dr. Malone is the Chair of the AGS Public Policy Committee.

Finally summer! Time to get some sunshine!

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Syed picQuratulain Syed, MD
Assistant Professor of Medicine,
Division of General Medicine and Geriatrics,
Emory University School of Medicine

Now that the long, harsh winter is over and the Sun has finally decided to shine on people living beyond Florida, it’s time to take advantage of the warm weather while it lasts. So ladies and gentlemen, let’s head out to lose the pounds you put on eating your favorite pies the last holiday season.

Outdoor activities have many health benefits, including helping your body make vitamin D, losing unwanted pounds, helping lower your blood pressure, and keeping your heart healthy. While outside, it’s important to take some precautions to avoid getting sick from excessive heat exposure. Here are some tips to help you enjoy the sun:

  • Walk in the early morning (before 10am) or late evening hours (2-3 hours prior to sunset) to avoid excessive heat exposure.
  • Keep a bottle of water with you and sip from it while you are out to avoid getting dehydrated.
  • Wear light colored, loose fitting, and lightweight clothing (such as cotton).
  • Get your hats out and wear them. You get to show them off and avoid the direct heat of the sun.
  • To prevent sunburns and skin cancer, buy sunblock lotion or spray from your local pharmacy and apply it liberally on all exposed parts of your body.
  • Choose pavement or a shaded trail in a park to walk on. Make sure to select a trail which is clean and even, to avoid stumbling on slippery stones and rocks. If you have been under trees and walked through grass, check for ticks on your skin and in skinfolds. Ticks prefer to be in hot moist areas. Also check your scalp after you get home. Have a healthcare provider remove the tick if you find one attached to your skin.
  • Try going to an indoor shopping mall to walk. However, if you love to shop, you might want to leave your credit card at home!
  • Be mindful of your surroundings and be sure to walk in well-lit, clean, and safe walking spaces. Let someone know where you are going and when you expect to return. Take your cell phone with you!
  • Water exercises are a great way to stay in shape for everyone, including people with joint aches and arthritis who can’t walk or run long distances. If there is a swimming pool available at the community center near you, ask about their water exercise schedule. If there are no water exercise classes, put your swimsuit on and walk from one shallow end to the other.
  • Pack some light snacks as low-salt crackers, vegetables (e.g., carrots, cucumbers etc.), and peanut butter to enjoy while you sit on a bench to rest during and after a long walk.
  • Make sure to wear comfortable walking shoes with good support and cushioning. No high heels!
  • If you have one, remember to bring your cane or walker with you. You might need it if you get exhausted from the exercise.
  • Keep your medicine list and emergency contact information in your wallet or handbag at all times.
  • If you experience a severe headache, nausea, spinning of your head, too much sweating, or your heart racing very fast, it may be signs of a condition called heat exhaustion. If this happens, do not wait. Alert your companion or asking people passing by to help you to a shaded place and call for help.

Enjoy the summer and stay safe!

About the Author
Dr. Syed is a member of the American Geriatrics Society’s Public Education Committee.

Alzheimer’s & Brain Awareness Month

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Brangman,Sharon27resized

Sharon A. Brangman, MD
Professor of Medicine
Division Chief, Geriatrics
Director, Central New York Alzheimer’s Disease Assistance Center
SUNY Upstate Medical University

Summer is definitely in full swing: the temperatures are rising, the days are getting longer, and the world is looking a bit more…purple. That may sound strange, but it’s part of a new initiative championed by the Alzheimer’s Association to commemorate the first Alzheimer’s and Brain Awareness Month this June.

In the spirit of Alzheimer’s and Brain Awareness Month, it’s important to understand what Alzheimer’s disease really is (and what it isn’t) and what you can do if you’re concerned about the condition, already living with it, or supporting someone who has been diagnosed.

Dementia and Alzheimer’s: What’s the Difference?
Alzheimer’s disease and dementia are often lumped together, but they aren’t the same thing. Dementia is the umbrella term that covers a wide range of symptoms related to loss of memory and thinking skills severe enough to affect a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of all dementia cases. Vascular dementia, which can follow a stroke, is the second most common type. Additionally, many other, often-reversible conditions like thyroid problems or vitamin deficiencies can cause dementia-like symptoms.

Despite what many people think, dementia isn’t a normal part of aging. Many people have memory loss issues—but that doesn’t mean they have dementia or Alzheimer’s. Those two conditions mean something very different, which is why it’s so important to get a check-up from a healthcare professional if you’re concerned about your cognitive abilities and the potential for developing Alzheimer’s disease. Continue reading →

National Nurses Week 2015: Celebrating Profiles of Geriatrics in Nursing—Terry Fulmer

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TF-cropped-photo-by-andy-camp-webTerry Fulmer, PhD, RN, FAAN, AGSF
President, The John A. Hartford Foundation
University Distinguished Professor and Dean
Bouve College of Health Sciences, Northeastern University

The field of geriatrics relies on so many different healthcare professionals to provide expert, high-quality, patient-centered care for older adults. In honor of National Nurses Week 2015 (May 6-12), we’re celebrating the commitment of nurses committed to elder care by helping them share their stories in their own words. Here’s what Terry Fulmer—the new president of The John A. Hartford Foundation and a professor of Public Policy and Urban Affairs at Northeastern University—had to say about her career as a gerontological nurse practitioner.

It was her first experience as a nurse that convinced Terry Fulmer the best part of nursing was caring for older patients. Fresh from Skidmore College, where she earned her BS in Clinical Nursing in 1975, Dr. Fulmer had just started working as a staff nurse at Boston’s Beth Israel Hospital, one of Harvard’s teaching hospitals.

“I discovered in the midst of this remarkable teaching hospital that I had this incredible autonomy and authority when working with the older patients,” says Dr. Fulmer, whose mother was a nurse and who decided (at age five) that no other profession could possibly be more exciting or satisfying. “Older adults often need help with activities of daily living, and when they’re very ill, they often need help with geriatric syndromes such as incontinence, confusion, and falls, and that’s all in the domain of nursing care,” she continues. “A physician might diagnose those problems but it’s the nursing practice that creates a care plan to address them. With older patients, the most important component of care, by far, is nursing care. It’s very motivating.”

After recognizing that geriatric nursing was for her, Dr. Fulmer’s first step was to go back to school. While working at Beth Israel, she earned her Master’s degree at Boston College and started her doctorate. Before she’d even finished her PhD she was offered and accepted a position as assistant professor of nursing at the college, where she both taught and began doing research into the detection and prevention of elder abuse and neglect. Dr. Fulmer, who was soon promoted to associate professor, also headed the Beth Israel Hospital Elder Abuse Committee.

Elder abuse remains a focus of Dr. Fulmer’s research and is among several areas in which her work has had considerable impact. In addition to publishing scores of papers, sitting on key panels, and training healthcare professionals to detect abuse and neglect, Dr. Fulmer also played a key role in the development of the Elder Assessment Instrument, a screening checklist now used nationwide.

“I’ve had families call and say that because of our work in this area, they recognized elder abuse in their families,” says Dr. Fulmer. “I’ve also had nurses tell me they’ve been able to help patients because of our work. And I’ve heard from promising young scientists in nursing, medicine and other disciplines that they’ve been impressed by the work and want to carry it on. That’s even better.”

Along with clinical care and research, teaching and training have always been Dr. Fulmer’s passions. “Working with students, every day there’s an ‘Aha!’ moment when they know they’re improving the quality of life for their patients,” Dr. Fulmer says. “You might show a student nurse how to provide excellent mouth care for an older adult who, as a result, is able to eat more nutritiously. It’s amazing. All of a sudden there’s this profound moment when you help them understand how pivotal their work is.”

“You know, I have the same passion today that I had when I started,” adds Dr. Fulmer.” I can’t imagine anything I’d rather do than care for older patients and teach others to do the same.”