Primary Care for Seniors

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.  

When temperatures rise, so do the risks associated with heat, especially for older adults.Older individuals may not adjust as well to sudden changes in temperature, and with possible chronic health conditions or certain medications, extreme heat may cause negative health outcomes.Kavod Senior Life is well aware of these potential issues, sharing four best practices to protect people in the second half of life against the heat. Here are some tips we've learned from our 50+ years of housing and supporting older individuals in aging well!Stay HydratedWhy It Is Important: Older adults are at a higher risk of dehydration because they may not feel thirsty as often as younger people, and as mentioned above, certain medications can increase the risk of dehydration.Tips:Drink water even if you dont feel thirsty.Eat water-rich foods like fruits (e.g., watermelon, cucumbers) and vegetables.Avoid alcohol and caffeinated beverages, as they can lead to dehydration.How Kavod Responds: Hydration stations are set up in the lobbies of each building during the hottest days to give residents, staff and visitors easy access to ice cold water (with lemon and cucumber, even!)Create a Cool EnvironmentWhy It Is Important: A cool living space is crucial to preventing heat-related illnesses.Tips:Use fans or air conditioning. If air conditioning is not available, consider spending time in public places like libraries, shopping malls, or community centers that are air-conditioned.NOTE: Do not rely on fans as your main cooling source when temperatures are extreme for heat.Keep blinds or curtains closed during the hottest parts of the day to block out the sun.Use light-colored, loose-fitting clothing made of natural fibers like cotton, which are more breathable.Try to avoid using the stove or oven to cook it will make your home hotter.Take cool showers or baths to cool down.How Kavod Responds: A cooling center is set up on campus where the temperature stays at 72 degrees. Residents can get out of their apartments and socialize there without having to go outdoors, helping abate social isolation. Dietary AdjustmentsWhy It Is Important: Certain foods can help keep the body cool and hydrated.Tips:Encourage smaller, more frequent meals that are easier to digest.Include hydrating foods like soups, smoothies, and salads.Limit heavy, hot foods and opt for lighter fare like yogurt, salads, and chilled fruits.How Kavod Responds: Kavod staff serves residents cold lemonade and fresh watermelon over the weekend in the cooling center, both terrific ways to stay hydrated.Educate and EquipWhy It Is Important: Knowledge and preparation are key to preventing heat-related issues.Tips:Educate yourself about the risks of heat and the importance of staying cool.Be aware of the signs and symptoms of heat-related illnessHave access to emergency numbers and know what to do in case you experience these symptomsHow Kavod Responds: The management team reviews, prepares and hand-delivers updates to residents to best ensure everyone is educated and can take appropriate actions against the heat.ConclusionBy following these four important steps, older individuals can stay healthy and safe while enjoying all the good things summer has to offer. If you know an older person who would benefit by living in our community, please contact us for a tour, or check out our website for more information. Stay cool, everyone!Resources used in article:Center for Disease Control: https://www.cdc.gov/extreme-heat/risk-factors/extreme-heat-and-older-adults-aged-65.html#:':text=Older%20adults%20do%20not%20adjust,control%20its%20temperature%20or%20sweatNational Institute on Aging: https://www.nia.nih.gov/health/safety/hot-weather-safety-older-adultsHarvard Medicine: https://magazine.hms.harvard.edu/articles/effects-heat-older-adultsChat GPT

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.