April 24, 2014
Overlake Senior Health Clinic Guards Against Patient Overmedication
Reducing 92-year-old patient’s medications from 20 to five prescription medications serves as stark reminder of risks of overmedication and severe side-effects
Bellevue, Wash. April 24, 2014 – A striking reduction of a 92-year-old grandmother’s medications from 20 to five routine prescription medications serves as a stark reminder of why medication management is a critically important health issue for older patients. Before the team at the Overlake Senior Health Clinic intervened, the patient’s condition had declined to a point where her family was considering hospice care.
Now this 92-year-old patient’s health is back on track. She still takes medications, but only the ones she needs, say her health care provider team at Overlake Senior Health Clinic.
“Overmedication and serious drug reactions can quickly turn into significant health and safety concerns for older patients,” said Dr. Priyanka Duggal, who saw the patient on her visit to the clinic.
This grandmother’s story, and others like it, is why Dr. Duggal, a geriatric specialist, and her colleagues want to spread the word about the need for heightened awareness and management of medications with older adults.
The 92-year-old patient’s first visit to the Overlake Senior Health Clinic proved incredibly beneficial. Dr. Duggal and her pharmacist colleague Trang Le immediately halted 12 medications, including multiple medications that the patient simply should not have been taking. Two medications carry serious side effects including drowsiness, blurred vision, increased risk of falls and confusion. Another pair of medications identified by the team increase the risks of mental decline, delirium, falls and fractures.
While stroke-related dementia prevents the patient from speaking clearly for herself, her granddaughter has seen an improvement in her grandmother’s health as a result of her treatment at the clinic. She’s more alert and engaged in the life of her family. Her condition has improved to a point where she is no longer eligible for hospice care.
“Working with the clinic has been wonderful,” said Janene Davis-Webley, granddaughter of the 92-year-old patient. “They’re really informative.” She’s hoping other older adults and their family members can learn from her grandmother’s story.
Said Dr. Duggal, “As patients get older, the changes their bodies go through increase the chances of side effects and adverse reactions to medications. It’s critically important that patients have active and regular conversations with their primary care physicians about the medications they are taking.”
An estimated one in three adults 65 or older will experience an adverse or harmful reaction to a medication or medications, according to the American Geriatrics Society (AGS), the professional organization for physicians that specialize in the care of older adults.
Dr. Duggal and her colleagues use the Beers Criteria, a medication reference published by AGS, when assessing patients. The criteria identifies medications that are potentially inappropriate or should be used with caution with older people. Four of the medications the 92-year-old patient was taking are on the AGS Beers list.
“Every new patient who comes into our clinic sees a physician and pharmacist at their first visit,” says Duggal. “Patients first have a 30-minute medication management appointment with a licensed pharmacist followed by a 60-minute appointment with one of our physicians.” A physician-pharmacist team inventory and evaluate the medications they discover during a patient’s initial visit. Of particular concern are medications that should be avoided altogether with older patients.
According to Dr. Duggal, older patients, like Davis-Webley’s 92-year-old grandmother, can end up on too many medications when the following situations occur:
Prescriptions are added to manage side-effects of other medications,
Different medical specialists write prescriptions for the same patient,
Prescriptions for older adults are filled at multiple pharmacies,
Older adults combine prescription medicine with the healing strategies of another culture, and
There is a patient and caregiver misunderstanding of dosages, timing and/or the purpose of various medications.
Overlake Senior Health Clinic physicians recommend that patients keep an updated list of all of the medications that they take—both non-prescription and prescription. This includes any supplements, such as vitamins and herbal products. If patients are seeing multiple physicians for their care, they should make sure each provider is aware of the complete list of medications.
When visiting a doctor, patients should make sure to ask if any of the medications are known to cause side effects. And if so, ask what they are—so they can watch for them. For more information about the Overlake Senior Health Clinic or to make an appointment, call 425-688-5234.
Published on April 24, 2014