Polypharmacy and Deprescribing

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WebDoes the number of medications you’re taking sometimes seem too high? Maybe it’s time for you and your healthcare provider to give your medication list a check-up by taking a closer look at the prescription and over-the-counter (OTC) treatments you take.

As you grow older, you’re more likely to develop health conditions that require taking multiple medications—some of which you may take for a long time. Many older people also take OTC medications, vitamins, or supplements as part of their routine care. As a result, older adults have a higher risk of overmedication, also known as “polypharmacy”—the medical term for taking four or more medications at the same time. Polypharmacy can increase your chances of unwanted reactions (also called “adverse drug reactions”) due to medications taken on their own or together.

To address this increasingly common problem, healthcare providers are focusing on how to reduce the number of medicines older adults are using through a practice called “deprescribing.” Dr. Michael Steinman, a member of the American Geriatrics Society (AGS) and a geriatrician at the University of California, San Francisco, recently appeared on WPUR—Boston’s NPR News Station—to discuss deprescribing with Dr. Barb Farrell, a pharmacist from Bruyère Geriatric Day Hospital in Ottawa, and Laura Landro, assistant managing editor at the Wall Street Journal. Hear what they had to say.

Want access to more tips and tools to help you manage multiple chronic conditions or multiple medications? We’ve got you covered.

 

Have you scheduled your Medicare wellness visit yet?

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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 we are almost through 2016, I hope you haven’t all lost track of your healthy lifestyle New Year resolutions.  The Medicare annual wellness visit can help you achieve those goals.

If you enrolled in Medicare plan B within the past 12 months, you are eligible for a Welcome to Medicare preventive visit. If you have had Medicare for more than a year, you are eligible for an annual wellness visit every year (at least 11 months after the previous wellness visit).  These visits include a review of your medical history, social history related to your health and education, and counseling about preventive services, including certain screenings, shots, and referrals for services, if needed.

Here is how to prepare for the visit:

  • These visits are free of cost. However, you may have to pay Medicare a deductible or co-insurance if your healthcare provider performs additional tests or services during the same visit and those services aren’t covered under these preventive benefits.
  • Even if you are seeing your current primary care provider, remember to bring any prior medical information, including immunization records, to make sure nothing is overlooked.
  • Gather information about your family’s health history before your appointment. This will help guide discussion on the screenings you should get and the pros and cons of these tests.
  • Bring an updated list of all prescription drugs, over-the-counter drugs, vitamins, and supplements that you currently take.
  • Do you have advance directives? If you don’t have any, or if you wish to update them, write down your preferences and goals in life in order to discuss them with your healthcare provider.
  • Write down your current level of physical activity and your activity goals. Physical activity can prevent/reduce falls and improve physical strength. Having notes will allow you to have a conversation with your provider about available resources that can help you achieve these goals.
  • Be prepared to discuss any home safety concerns. If your home is in need of rails or grab bars or other modifications to meet your physical needs, you can discuss them at this visit.

Call your healthcare provider today to schedule your annual wellness visit!

The Inextricable Link between the Eldercare Workforce and Family Caregiving

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TF-cropped-photo-by-andy-camp-webTerry Fulmer, PhD, RN, FAAN, AGSF
President, The John A. Hartford Foundation

(This post also appeared on the blogs for the Eldercare Workforce Alliance and The John A. Hartford Foundation.)

Are you a caregiver? Sooner or later, caregiving touches us all.

According to a new report by the National Academies of Sciences, Engineering, and Medicine, Families Caring for an Aging America, nearly 18 million individuals currently provide care to an older family member, spouse, or friend. Millions more anticipate serving in a caregiving role in the future. Most of us, as we age, will eventually become care recipients.

For individuals and for society as a whole, the preparation of our nation’s workforce to address caregivers’ needs should be of paramount concern.

Family caregivers are a large and absolutely critical component of our health care workforce. They are the primary providers of care for our nation’s older adults, yet they remain almost invisible. While they perform a host of vitally important activities, from meal preparation and house cleaning to complex medical tasks like wound care, they often do so with no training, limited support, and little recognition.

As the Academies’ report documents, our fragmented health care system and the demands it places on families often result in physical, emotional, and financial challenges for these heroic caregivers, which puts their loved ones at risk. This is unsustainable, dangerous, and wrong.

The good news is that health and social service professionals, as well as direct care workers such as home health aides and nursing assistants, are in a unique position to support family caregivers. To make that possible, we must work to create a health care system that is not just person-centered, but also family-centered, as called for in the report. The entire care workforce needs to be equipped with training and systems that support this transformative approach. Continue reading →

National Strategy Needed to Support Invisible Heroes of Health Care—Family Caregivers of Older Adults

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TF-cropped-photo-by-andy-camp-webTerry Fulmer, PhD, RN, FAAN, AGSF
President, The John A. Hartford Foundation

(This post also appeared on The John A. Hartford Foundation blog.)

For far too long, the nearly 18 million family caregivers of older adults in the United States have been largely invisible to policymakers and our health care system, despite filling an absolutely essential role. The contributions these modern-day heroes make to the care of older adults is indispensable, and often comes at a significant cost to their own health, well-being, and financial security.

Families Caring for an Aging America, the sweeping new report from the blue-ribbon committee convened by the prestigious National Academies of Sciences, Engineering, and Medicine, offers a clear, comprehensive, and compelling rationale for creating a national strategy to elevate the position of family caregivers within our health care system.

As the report indisputably documents, we have a growing population of older adults living longer than ever before with greater needs for assistance.  We have family members and friends performing increasingly complex care tasks for their older relatives and friends with little or no training.  We largely marginalize and ignore caregivers, which puts them and their loved ones at risk for harm.

If we are truly to reform health care, we must expand the idea of “person-centered care” to “person and family-centered care.” As a geriatric nurse, I have seen the need for a family-centered approach first-hand.  Too often family members, with little or no training or support, are thrust into the position of being responsible for everything from navigating the labyrinthine health care system to performing complicated medical tasks. This might be medication management and wound care, tasks that are normally provided by trained doctors and nurses.

Ensuring that caregivers not only receive the support and training they need, but have a role and a valued voice in decisions affecting their loved ones, are critical to improving care for older people. Continue reading →

Regaining Physical Resilience After Serious Illness

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

I’ve been blogging here about my difficult recovery following months of cancer treatment. One thing I’ve learned: To fully recover, you must fight to regain your physical endurance and strength, also known as your physical resilience (see this earlier blog post about another important factor in your recovery, emotional resilience).

The advice I’m offering applies to you if you’re the one who’s experiencing the illness, and it’s also relevant if you’re a caregiver for someone living with a serious condition.

Getting Yourself Started

To regain your energy and strength, begin to resume daily activities as soon your healthcare team gives you the green light. Then, slowly but surely, you can increase the time you spend each day doing some form of physical activity. That can be easier said than done, especially when you’re coping with symptoms such as pain or fatigue. Here’s my advice: Start small and begin with the basics. As soon as you’re able, start bathing and dressing yourself. If these tasks are too challenging, talk with your healthcare provider and caregiver about small steps you can take to stay active given your own situation.

Walking is also a great way to recondition. I found during my own recovery that keeping up my usual routine, which involved getting up and exercising every morning, was helpful. Even when I needed to go to the hospital for intravenous hydration, I would consider that my morning walk. Over time, I was able to walk more and more, and I found that walking at 6:00 or 6:30am worked well—even on days when it was hot and humid. Walking is a great way to start the day and can help ease symptoms such as pain and a low mood.

Depending on the weather, the time of year, and the availability of safe walkable space in your community, you may have to be a bit creative. In the summer, for example, early morning walking might be the best—especially if drinking sufficient fluids for hydration is difficult. If outdoor walking isn’t an option but walking is still something you’re able to do safely, consider climbing up and down the stairs, walking in the hallway if you live in an apartment building or institutional setting, or just marching in place while you’re sitting or standing. When it’s safe to do so, putting on headphones and listening to a book or music can help make the time pass more quickly and pleasantly. Continue reading →