Part Two of Medication Use in the Elderly

The following represents the second in a two-part series on medication use in the elderly. In my previous installment, I discussed my process for evaluating elderly patients and their individual pharmaceutical regimens. My ABCDs of geriatric polypharmacy and compliance includes ASK and BEERs (as in Beers criteria for potentially dangerous medications). To further this discussion, we look at C and D.
C: Complications and Cost – Is my blood pressure therapy contributing to worsening constipation in Mrs. Jones? Would it be worthwhile to use another agent? Will medication X potentially act adversely with medication Y? Physicians need to be aware of a host of intervening factors that ultimately drive effective management of a disease process. Often these are not decisions based on medical knowledge but rather on knowledge of insurance formularies, patient feelings and expectations regarding their care, and cost issues. Does my 96 year old patient with heart disease really need clodiprogrel (plavix) as compared to simple aspirin at pennies a day? This may effectively decrease cost by over hundred dollars a month or more. Further, can I substitute a four dollar generic medication over a sixty dollar brand name when they have the same proven efficacy? Again, careful consideration of these factors will decrease polypharmacy and improve compliance, both of which will improve outcomes.
D: Discuss and Discontinue – Patients appreciate concern over medications and costs. In turn, this drastically improves trust within the doctor-patient relationship. Trust equals compliance. We are all guilty of so-called clinical inertia – a failure to act. There are many suggested reasons for clinical inertia – time constraints, cost, and drug coverage or simply, the patient looks good and has no complaints on their current regimen. To combat this, there must be an open discussion with patients to assess medical needs, risk of adverse effects and expectations of therapy etc. in order to determine the best course. Then, after all is said and done, axe some medicines. Though by no means exhaustive, this list of geriatric ABCDs can be utilized on a daily basis with minimal effort. As the elderly population sky-rockets and the number of available pharmacological agents rises, such efforts become critical in maintaining the health and welfare of this most important patient group.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.