Medication
The Institute for Healthcare Improvement along with the John A Hartford Foundation, American Hospital Association, and the Catholic Health Association of the United States developed a framework for Age Friendly Health Systems. You can see a brief overview of this under the “4Ms” on the Basics page.
We’re going to spend time in the second of the 4Ms - “Medication” - today. Medication is a huge tool in a physician or other healthcare provider’s work belt, and often patients find themselves on more and more medications as they age due to increasing chronic health problems or worsening serious health conditions. This results in what is called “polypharmacy.” There’s no true consensus on how many medications define polypharmacy, but I usually define it in my patients as five or more medications and it is very common in older adults. Polypharmacy is an enormous burden in eldercare and is worthy of it’s own deep dive another time.
Regarding the Medication standpoint of the 4M framework, some important questions to ask are:
“Is this medication necessary?”
“What side effects can occur? Will it affect my thinking? Will it affect my mobility?”
“Will this medication improve my quality of life?”
These are not only questions for patients to ask, but also for us as prescribers to ask as well. When we ask these questions it is important to remember the other M’s in the 4M Framework to ensure that everyone is in agreement! We don’t want to unnecessarily burden ourselves with unwanted side effects of medications if they limit the things that matter in our life, especially as we age.
A common example is that of blood thinning medications. As we age, we are more prone to major cardiac or cerebral events (think heart attack or stroke); unfortunately, we are also more prone to falling down and major bleeding. Blood thinning medications are typically prescribed after events such as these, but must be weighed carefully in persons who are more liable to fall and suffer severe consequences of a fall (like bleeding). This is a very difficult decision and conversation, but is important to whole person care!
The example above is very extreme, and many medications can be prescribed for illnesses or conditions that are not as serious as the example, but they should always be reviewed and viewed through the lens of the 4Ms! Never be afraid to ask your healthcare provider if a medication is necessary or what the expectation from taking certain medications are; that’s one of the reasons we’re around!
Key Points:
Medications are an important tool in the treatment of illness or chronic disease
Medications also come with unwanted side effects that can affect our mobility, cognition, and quality of life
Always ask your doctor about the importance of your medications!
