HJNO Jul/Aug 2019

Healthcare Journal of new orleans I  JUL / AUG 2019 41 In a study of older Medicare beneficiar- ies, 92 percent reported being willing to stop taking one or more of their medicines if their physician said it was possible, and 66.6 percent wanted to reduce the number of medicines that they were taking. In the end, physicians should be reassured that most older patients are open to deprescribing their medications within the framework of patient-centered care and shared decision making. When considering the number of medi- cations and benefit/risk information, as well as using the Beers List, a review with the patient can lead to less polypharmacy and fewer Potentially Inappropriate Medicines (PIMs).Agoodmedication review is essential because discrepancies are common between what patients think they should be taking and what doctors record on their medica- tion lists. One particular method of review is commonly called a brown bag review, in which patients are asked to bring in all of their medicines (including all prescription and over-the-counter medicines, vitamins, supplements, and herbal preparations). This can provide a useful snapshot of the patient’s current medication use. The clini- cian can review each medication brought in the brown bag one at a time and inquire about how the patient takes it. Brown bag column  Senior Health reviews often present a good time to review the effectiveness of medications, as well as their adverse effects. Unfortunately, patients often do not report drug-related symptoms to their physicians. It is true that seniors with many health problems need to take several medications to control multiple medical conditions. While thesemedications individuallymay be warranted, there are times when the number of drugs prescribed for a given condition is more than is necessary. There are a variety of other reasons polypharmacy can occur as well, including: Prescribing cascades If a patient has several health conditions, you may encounter what is described as a prescribing cascade, in which the pa- tient is given a prescription to counteract side effects of another medication, or to counteract an interaction between two or more other prescribed medications. Disconnected medical care This is more likely to occur if a patient is cared for by several doctors, including specialists or physicians who may only see them for a short period of time, such as during an urgent hospitalization. One doctor may prescribe a medication that compounds or counteracts the effect of a medication already taken, particular- ly when the patient is receiving care at Polypharmacy and the Ever-Growing Pile of Pills multiple healthcare sites. Pharmacy changes If your patient is filling their prescriptions at multiple pharmacies, none are likely to have a complete list of their medication regimen (unless they utilize multiple lo- cations of a pharmacy chain). Interactions between medications may go unnoticed when the combination would have raised a red flag if patients were getting all their prescriptions from the same place. The average senior is taking more medi- cations than ever before. It is imperative to empower older adults as they navigate the complexities related to polypharmacy. But it appears the best approach is a multi-dis- ciplinary one. Professionals, caregivers, and the patient all play a vital role in caring for seniors as they tackle their pile of pills. n Carrie Mercer has over 20 years of experience in healthcare marketing. She holds a B.A. in market- ing/communications. Her previous work experi- ence includes positions as marketing director of Women & Children’s Hospital in Lake Charles, marketing director for River Parishes Hospital in LaPlace, and director of geriatric services develop- ment for Tulane Medical Center. Ms. Mercer joined the Lambeth House marketing team in 2012. She left in 2014 to work for Wunderman, a global ad agency specializing in healthcare marketing. In June 2016,Ms.Mercer returned to LambethHouse as marketing director for independent living. It is all too customary for older adults to be prescribed multiple medications for several illnesses. The use of numerous medicines, com- monly referred to as polypharmacy, is common in the older population with multimorbidity, as one or more medicines may be used to treat each condition. While there are almost always good intentions behind this, polypharmacy is associated with adverse outcomes, including mortality, falls, adverse drug reactions, and increased length of stay in hospitals. The risk of adverse effects and harm rises with increasing numbers of medications. Carrie A. Mercer Marketing Director Lambeth House