Today we are introducing a new column jointly sponsored by the College of Physicians & Surgeons of Alberta and the Alberta Medical Association. Optimized Prescribing with Seniors will be a new tool to assist you as a prescribing physician in your care of your older patients.
Medication management for seniors is becoming increasingly complex due to a multitude of factors. In the past, much of medicine was focused on management of acute conditions requiring relatively straight-forward intervention. We then started to recognize the value of treatment of conditions for prevention of morbidity and mortality and, more recently, improvement in quality of life.
Patients themselves have changed and now express a desire to play a much more active role in their own drug management. This has led to a significant change in how medicine is practiced, and the types of issues we now contend with as physicians providing care for seniors.
The older patient of today is aging with multiple chronic diseases, each of which generally requires one or more medications to control. These medications must be balanced between the competing interests of treatment of each disease, and the potential for drug-drug or drug-disease interactions with other present conditions. Additional considerations include:
- The need for provision of preventative therapies.
- An array of new medications with potential but not necessarily known utility and risk.
- Medications for control of conditions without definitive markers of effectiveness.
- Interest in self-medication with non-prescription products.
- Cost/insurance coverage.
All of these increase the complexity of appropriately managing medications with this population. Each issue of OPS will take one of two approaches:
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- A clinical question with a brief synopsis of the evidence to provide guidance around use of a particular type of medication; or
- A summary approach to the management of more complex issues in medication management.
Articles will be evidence-informed, concise but to the point, and fully referenced. Most importantly, they will aim to provide practical support for you in your appropriate prescribing with seniors. We will solicit a number of authors for these articles, related on their areas of expertise. Based on initial feedback, potential topics to be addressed in the coming months may include such issues as:
- Appropriate use of antipsychotics.
- Recognition of anticholinergic burden.
- A short series on treatment targets in the frail elderly.
- A practical approach to stopping medications.
- Tips to improve adherence.
Because this is for you, we need your questions and suggestions. Is there a particular issue you would like to see addressed? Do you see a scenario frequently present in your office and want to know an ideal yet practical approach to management? Uncertain about the role of the “latest and greatest” new drug? Ask us!