The Importance of Social Engagement 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.  

During May is Mental Health Month, we talk a lot about being kind to your mind. But what does that actually look like? We can start by:Recognizing the good in our lives. When we take a moment to be grateful for the positive things in our life, we become more in tune with the good things that are all around us. This doesnt mean that we dont acknowledge the negatives; instead of dwelling on the bad, we can thank the experience for the lesson it taught us and continue to seek out the positives. When we make an effort to be mindful in this way, we begin to appreciate lifes simple pleasures more.Practicing self-compassion. Self-compassion means giving ourselves grace through the hard times. Rather than criticizing ourselves or ignoring the pain, acknowledging how we feel, and giving ourselves time to really feel those emotions helps us properly move forward.Changing our self-talk. When we find ourselves being negative or hard on ourselves, we can take a deep breath and change our tone. Positive self-talk does wonders for the mind. Doing this helps us be more understanding and patient towards ourselves and others, and more focused on our goals.Reflecting. At the end of every day, pick a rose (something good about the day), a thorn (something that was challenging), and a bud (something to look forward to). By reflecting on how our day was, we build emotional intelligence through understanding ourselves more.Doing something each day that we enjoy. As simple as this sounds, this often gets overlooked as an essential element of healthy living. Whether thats exercise, baking, crafting, reading a book, or watching TV, reserve time each day to spend doing activities that fill our cup.Taking care of our physical health. The body and mind are so connected which means that consistent care of the body (which impacts the soul and mind) is like preventative medicine. Small acts of physical self-care can quickly add up and help protect, promote, and maintain health and wellbeing. Prioritizing sleep, drinking enough water, and fueling with nutritious foods can go a long way.When it comes to being kind to our minds, doing just a little bit is better than doing nothing at all. Spending even 10 minutes at a time doing something you enjoy can go a long way toward beating the stressors of everyday life. Just reading one chapter or going on a 5-minute walk around the block is an example of being kind to your mind! Taking care of ourselves helps us feel calmer, more refreshed, and more energized.Self-care is an important part of building resilience or bouncing back from stress, trauma, and burnout. The strategies outlined above can help you recognize your emotional responses to stress and develop coping skills to manage them. This May lets be kind to our minds and encourage our loved ones to do the same.

Storing, Securing, Saving Lives: Firearm Safety and Suicide PreventionFirearms are used in nearly 50% of all suicides in the United States.Many suicide attempts are made with little planning during a short-term crisis period, and evidence has shown that putting time and distance between a person feeling suicidal and a firearm can significantly impact the survival rate.Lethal means restriction (practicing safe firearm storage) is an evidence-based practice shown to reduce death by suicide. Even if someone attempts suicide in another manner, they have an increased chance of survival because other means are less lethal. By keeping secure firearm storage in mind, we can all help reduce the number of suicides involving firearms.No one takes their life for a single reason. We all have mental health, just as we all have physical health, and conditions such as depression, anxiety, and substance use problems especially when unaddressed increase the risk of suicide. That risk is greater when a firearm is present and accessible in the home.  American Foundation for Suicide PreventionWe can all prevent firearm deaths by following the universal rules of gun safety:- Treat all guns as if they are always loaded.- Always point the gun in a safe direction.- Always keep your finger off the trigger until you are ready to shoot.- Always keep the gun unloaded until ready to use.- Be sure of your target and whats beyond.- Never use alcohol, over-the-counter drugs, or prescription drugs before or while shooting.- Use only the correct ammunition for your gun.- Wear eye and ear protection as appropriate.- Seek proper instruction, such as a firearm safety class.- Be sure the gun is safe to operate.- Store your guns safely and securely when not in use.- Consider temporarily off-site storage if a family member may be suicidal.When an emotional crisis (like a break-up, job loss, or legal trouble) or a major change in someones behavior (like depression, violence, or heavy drinking) causes concern, storing guns outside the home for a while may save a life. Family, friends, as well as some shooting clubs, police departments, or gun shops may be able to store guns for you temporarily. *If you are worried about a friend or a family member:Trust your gut and dont wait for them to reach out. Let them know you care.Ask them directly about suicide and encourage them to seek help. Talking about suicidal thoughts and showing concern will not put someone at greater risk.Talk about gun safety and options for temporary off-site firearm storage.If you are going through a difficult time:North Range Behavioral Health is a provider of Colorado Crisis Services. This no-cost resource connects people with free, immediate, and confidential help all day, every day.Call: 844.493.TALK (8255)Text TALK to 38255Walk-in: 928 12th Street in GreeleyFind other Colorado walk-in centers at ColoradoCrisisServices.orgSafe storage of firearms can protect you and those you love. It's okay to give firearms and gun lock keys to trusted family members or friends when life gets tough.*To become fully informed about making a temporary gun transfer, review Colorado gun laws, including C.R.S 18-12-112, or consult an attorney.Resources:Gun Safety and Your Health: A Proactive Guide to Protect You and Those around You by the American College of SurgeonsFirearm Suicide Prevention & Lethal Means Safety for VeteransFirearms and Suicide Prevention American Foundation for Suicide Prevention