Five Tips to Improve Medication Management

The greatest challenge for all who practice geriatrics is reducing polypharmacy, the addition of medications that either provide no benefit or cause harm to seniors.  Millions of seniors end up on many medications that are not helping them and could be causing side effects.  Geriatricians are the experts in what we call de-prescription, cutting down on unnecessary medications.        The key reasons seniors end up on too many medications are the following.  First, all physicians, including young geriatricians (as I was 30 years ago), have hope that newer medications will actually benefit our seniors.  The four medications we have used to treat dementia turn out to provide no benefit at all.  We cant appreciate this until we have been in practice for decades and know how to review all of the studies that suggest there might be some marginal benefit.  Also, one must practice for many years to understand how all medications, including over-the-counter medications, can cause difficult to diagnose side effects.  For the dementia medications, we had hoped that they either alleviated symptoms, delayed the onset of dementia, or slowed the progression of dementia.  It takes years of practice and experience to realize that these medications fail to help our seniors.      Second, many primary care clinicians (say, family medicine physicians) and specialists (say, cardiologists) tend to overvalue medical benefit for medications used for the most common conditions.  The best example would be blood pressure medications.  All geriatricians know that we approach frail seniors differently than we approach a robust 70-year-old or a healthy 45-year-old.  Many clinicians will treat everyone the same, such as trying to keep the systolic blood pressure around 120 and the diastolic pressure around 80.  Often, these pressures are simply too low for frail seniors and even for some robust seniors.  The medications can cause lightheadedness, falls, and fractures (to name just a few side effects).      Third, clinicians in traditional medicine often fail to appreciate the value of alternative healing and the value of the placebo effect.  Lets return to medications for dementia.  In recent years, we havent seen any commercials for the four medications I referred to above.  Weve seen many advertisements for Prevagen and Neuriva.  These medications have not been studied extensively like the four that required many studies and FDA approval.  If seniors feel more comfortable on these OTC medications, its probably from the placebo effect.  That is, they feel that they are at least doing something to counter the onset or progression of dementia.  The cost is affordable, and these individuals dont need a prescription from their doctor.  If the individual thinks Prevagen isnt helping, or may be causing side effects, he or she can stop it at any time.  They dont need permission from their physician.        Fourth, the pharmaceutical industry has specialized in direct-to-consumer advertising.  These are entertaining and convincing ads.  It doesnt matter what disease condition we are considering.  Every expert in marketing knows that these creative, subliminal messages get through.and result in more prescriptions.        Before sharing my suggestions for cutting down on your medications, let me share a story about Elsie, a 90-year-old woman I took care of in 1992.  She was feisty and funny.  She was on the 6 medications our team had prescribed for her.  Benign positional vertigo was one of her conditions.  One of my most memorable clinic visits was the one when Elsie reported that she followed that Harvard newsletter you gave me, Dr. Murphy, and it worked.  She did this complex maneuver all on her own, and it eliminated her dizziness.  Then she added, oh, and by the way, doctor, I threw all those doggone pills in the garbage.and I feel great now. So be it.  This approach worked well for Elsie, but I dont recommend it for others.  Here is what I suggest.       First, find the courage to question your clinicians.  Its not easy when you have put so much trust in your doctors recommendations.  Try the soft approach.  For example, you could say, Doctor, Im on a lot of medications and I worry that one of them might be causing some problems. You could mention a symptom youve been wondering about.  Then you ask, could I cut down on the dose of one of these medicines to see how I do?  If your physician agrees with this trial of dose reduction, you could ask which medication he or she would select to reduce the dose.        Second, you continue with the honest communication you have established.  You dont need to let your doctor know how you are doing a week or two later.  However, you should report that you are doing fine by calling the office staff that can document your success with the dose reduction.  Believe it or not, you are educating your primary care office about the value of dose reductions.        Third, when you have more confidence in the dose reduction approach, you can specify which medication(s) you would eventually like to discontinue.  You can share feedback youve received from family members and friends or from the research you or they have done.         Ever since the 1950s we have been moving from a paternalistic approach to health care (i.e., the doctor decides everything for your health) to a more patient-centered approach to health care.  This makes sense.  You know whats best for your overall health, including physical, psychological, social, spiritual, and any other dimensions of health.  Your clinicians job is to reflect your preferences.  Dose reductions of useless or harmful medications is just part of this evolution in health care.     Dr. Don Murphy, MD, FACP The article was written by Dr. Don Murphy, Geriatrician and Hospice Physician who plans to run for Governor of Colorado. He can be reached at murphdoc@comcast.net, or calling 720-490-6757, or his main YouTube channel, TheCrazyMurphys5560.  

Note: this is not medical advice and should not replace a discussion with your own treating physician. This document was created after compiling helpful over the counter and home remedies from patients and colleagues.Winter is a beautiful time of the year, but it also brings along various illnesses. With the constant change in temperature and dry air, it's easy to catch a cold or flu. However, being sick doesn't have to be miserable. Here are some tips to help you through your winter sickness.First off, make sure you are getting enough rest. Your body needs time to fight off the illness, so getting plenty of sleep is essential. Drinking lots of fluids is also crucial to staying hydrated. Warm liquids such as tea or soup can help soothe your throat and loosen congestion. Second, take over-the-counter medication to relieve your symptoms. Decongestants can help relieve nasal congestion, and pain relievers such as acetaminophen or ibuprofen can help reduce fever and body aches. However, be sure to read the instructions carefully and consult with a doctor if you have any doubts.Lastly, try to avoid spreading your illness to others. Cover your mouth and nose when you cough or sneeze, and wash your hands frequently with soap and water. Stay home if you're feeling unwell to prevent spreading the illness to others, and mask up if you need to leave the house. Reminder that we are fortunate enough to have vaccinations against flu, COVID and RSV which cause significant respiratory illness.In conclusion, being sick during the winter can be tough, but with plenty of rest, hydration, and medication, you can make it through. Ive gathered up some of the most common remedies used by myself, my patients, and my followers on social media and shared them below. Remember to take care of yourself and stay warm during the chilly winter weather.  Straight Off the ShelfNote: if you take other medications, its important to talk with your physician or pharmacist about how these over the counter meds may interact with your prescribed meds       Cough o   Vicks Vapo Rub on the chest and bottoms of feet o   Coricidin (good for those with cough and high blood pressure) o   Delsym Cough Medicine: dextromethorphan containing cough meds help with cough suppression, for dry coughs o   Mucinex: guaifenesin containing meds help to loosen up mucus in your though to help you cough it up, for wet coughs o   Sudafed: pseudoephedrine is a decongestant and can make you pretty wired/awake. caution if you have high blood pressure o   Dimetapp for kiddos 6 and older       Congestion/sore throat o   Afrin nasal spray: temporary congestion relief o   Flonase nasal spray: great for post nasal drip that causes sore throat o   Saline nasal rinses       General cold/flu symptoms o   Dayquil/Nyquil: remember, these contain acetaminophen aka Tylenol. so dont mix with additional tylenol unless instructed by your physician Know your meds! acetaminophen is also known as Tylenol; ibuprofen is also known as Motrin and is the same class of medications as naproxen aka Aleve  Home/Herbal RemediesNote: if you take other medications, its important to talk with your physician or pharmacist about how these remedies may interact with your prescribed meds      Nin Jiom Pei Pa Koa-Chinese herbal throat and cough syrup       Green tea       Ginger tea       Boom boom inhaler stick       Lemon, honey, and chamomile tea       Sleep      Epsom salts baths       Oscillococcinum       Black elderberry syrup       Raw garlic with honey       Mullein tincture       Electrolyte rich drinks like liquid IV, LMNT, pedialyte-- monitor sugar content       Fermented foods       Reishi       Ashwaghanda       Foods high in vitamin C (citrus!)  Soothing Tea RecipeIn a saucepan, bring the following to a boil, then remove from heat and enjoy: tips and enjoy:       8 oz water       1 tbsp apple cider vinegar      1 tbsp honey       1 cinnamon stick       1 clove of peeled and smashed garlic       small piece of peeled ginger             Tips & Tricks From a PCP:      after a viral infection, cough can last 4-6 weeks in some cases. if you have fever with the cough or its getting worse, talk with your doctor as it could indicate a bacterial infection       never underestimate the power of sleep and resting your body       a fever is technically a temperature over 100.4 degrees F       the symptoms of COVID, flu, and RSV overlap significantly. getting tested for these infections may be helpful in determining if you need further intervention       your gut health is key to your immune system. you may not be able to fully prevent getting sick, but a healthy mind and body will help you with resilience and recovery. focusing on fiber, mindfulness, sleep and regular exercise can help your gut stay strong!       most viral infections last about 5-7 days. but if you are experiencing shortness of breath, chest pain, high fevers, difficulty swallowing, dizziness, or wheezing, contact your physician immediately

As the summer heat intensifies across the country, dehydration becomes a common and potentially dangerous concern. This condition can have severe implications, particularly for seniors who are more vulnerable due to several physiological factors. Seniors face unique challenges, especially when it comes to the impact of their medication on hydration. Why Are Seniors More Prone to Dehydration?Seniors are at an increased risk for dehydration for several reasons:     Reduced Thirst Signal: As people age, their bodies lose their ability to recognize thirst, making it harder to drink fluids.      Lower Body Water Volume: Older adults generally have a lower total volume of body water, meaning they have less fluid to lose before dehydration sets in.      Kidney Function Decline: Kidneys become less efficient at conserving water with age, further contributing to fluid loss.     Chronic Illnesses: Conditions such as diabetes can worsen the risk of dehydration since they affect the body's ability to control water. In addition to these factors, medication plays a significant role in influencing fluid balance in seniors.The Impact of Medication on DehydrationAs a clinical pharmacist, I've seen firsthand how medications can contribute to dehydration, especially in older adults. One of my clients, an active senior, nearly passed out while cycling in the summer. As it turned out, he was on a diuretic medication, commonly referred to as a "water pill." Diuretics are a class of drugs that increase urination, leading to reduced fluid levels in the body. These medications, often prescribed for conditions like hypertension and heart failure, can inadvertently lead to dehydration if fluid intake isn't carefully managed. Some commonly used diuretics include bumetanide, chlorothiazide (Diuril), hydrochlorothiazide, and furosemide (Lasix). But diuretics aren't the only medications that can cause dehydration. Other drugs like these can also affect your body's water balance.     Antihistamines: Often used for allergies, these can cause dry mouth and reduced fluid intake.     Blood Pressure Medications: Certain blood pressure medications can increase urine output.     Laxatives: They can cause fluid loss through increased bowel movements.     Chemotherapies: These treatments often lead to side effects like vomiting and diarrhea, contributing to dehydration.Managing Dehydration RisksIt's important to be aware of dehydration risks, particularly for those taking medications that impact fluid balance. Regardless of whether one feels thirsty, its important to drink water throughout the day. Staying alert to the signs of dehydrationsuch as increased thirst, dry mouth, dark urine, fatigue, and dizzinesscan also help address the issue early. These symptoms are early warning signs that the body may need more fluids.  Finally, anyone concerned about dehydration should consult a healthcare provider. They can adjust medication and advise seniors on managing fluid intake to prevent dehydration.   At Deeper Dive Horizons, one of my priorities is to guide you and your loved ones through the complexities of medication management to improve your well-being. With over 22 years of experience, my goal is to dive deeply into your health and ensure you maintain a balanced and healthy life, even in challenging conditions like extreme heat. Schedule a consultation today to get started 888-984-8895.