Dr. Robert Hoel, an Instructor in Pharmacy and Faculty in Geriatric Medicine Fellows program at Mayo Clinic in Rochester, MN, reviews his article appearing in the January 2021 issue of Mayo Clinic Proceedings, where he shares the risks and benefits of common medications in the older adult patient and offers guidance for safely deprescribing said medications. He notes it is key to provide an explanation for the recommended changes in order to gain concurrence by the patient with the recommended changes. Available at:
The term polypharmacy holds connotations about the practice of medicine but the term has little meaning about the understood specifics i think providers recognize polypharmacy when we review a long list of medications for a patient or see a bag of bottles the patient carries into the office we might even ask how did we get here my name is bob howell i’m an
Instructor in pharmacy in the mayo clinic college of medicine and faculty in the geriatric fellows program here in rochester minnesota my co-authors and i have been graciously asked to address our article entitled polypharmacy management in older patients which will be appearing in the january 2021 issue of the mayo clinic proceedings it is part of a thematic
Review on aging and geriatric medicine series we successfully treat our patients diseases and improve their overall health but as they age our patients often no longer achieve the same benefits in the same way from all of their medication treatments over the years the purpose of this thematic review is to understand a path out of the plethora of drug therapy
Problems that can occur we don’t want to simply focus on the numbers of drugs as that doesn’t necessarily tell us much but instead we want to focus on using the right medications for our patients that have them have the best medica medication outcomes or the best medication experience we recognize that medication problems become more common the more medications
Our patients take and the more high risk medications they take you will note from our references that unintended medication problems are very well published and include more care visits hospitalizations and morbidity and of course higher costs of healthcare to all i want to refer you to our outline for de-prescribing or reducing therapy whenever possible the
Wheel diagram in our article points to the nature and the type of medication problems that can occur your assessment of these will be valuable in deciding what changes to make in medication therapy some of our patients cannot adhere to all their medicines due to barriers like cost or side effects and almost every patient would be overwhelmed taking medications
Four or five times a day keeping up with medication schedules filling their pill boxes ordering refills and they will need help we suggest a purposeful consultation to address medications with a provider or perhaps a clinical pharmacist we need a better way to understand why our patients aren’t benefiting from their medication regimen and look for ways to
Simplify and improve the medication experience as we look to improve the regimen we also need to gain the confidence of our patient and their family advocates who really need to buy into looking at a better medication regimen people do want to hear that simple simplification is usually possible for most patients they like to hear providers say that by making
Changes we reduce risks like falling and continue to have more benefits versus risk in our patient therapy often simplification of the regimen helps overcome current problems like adherence problems and all these will help future therapy educating the patient and advocates includes to help them understand that most of the supplements that they have accumulated
Adds to the burden and complexity of their medication regimen and it does so with possible side effects and interactions and unnecessary cost with very little measurable benefit in summary identifying therapy problems and a plan to de-prescribe should be workable not only in just a clinic setting but in long-term care settings or in a palliative care patient
Setting we want to keep in mind that changes in medication plans need to align with the ongoing health care objectives for each patient as they age we hope you’ll find this article helpful in improving your patients regimen so that they have the best medication experience they can thank you we hope you found this presentation from the content of our website
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Polypharmacy Management in Older Patients By Mayo Proceedings
