What does the doctor mean by, "Should consider placement given polypharmacy?"
A friend had an annual wellness visit and found this in her online visit summary, which was written by her M.D. She has mild and worsening cognitive impairment and wants to know what it means before she asks the doctor.
Given what you list as her medical issues, the medications are not excessive, and each one is focused on a different system - neurological, endocrine, vascular (blood thinner and statin) immune response, cardiac (lisinopril) and skeletal (fosamax and Oscar). A change in statin might help improve functioning, but not sure. At this point her husband and the patient need to ask the geriatrician to meet with them to discuss her health and what to expect, they need to get supportive services for her (if husband can verify that she does take all her meds on time and that he fills med boxes, then that is adequate management of polypharmacy). If she does not have a health care proxy chosen, and a power of attorney for health care given (husband and then an alternate, usually), that needs to be done post haste, while she is still legally capable to make these decisions. often the local senior services agency can do a home assessment and make safety suggestions, and also connect them to useful services for now, and in future. This seems like an odd note for a geriatrician who treats patient and.spouse...I wonder if there is something else going on that he did not want to put in record.
Fawnby, the placement part means the doctor is recommending your friend be placed in Assisted Living or another such managed care facility where her meds can be administered to her every day.
Idk what dose of Rosuvastatin your friend is taking, but my dh was prescribed 600mg 1x a day of it. It took his cholesterol down SO fast, esp his triglycerides, whereas no other statins were able to that, that he had a lot of harsh side effects. He had to stop taking it entirely for 3 weeks, then was put on 100 mgs tabs instead. I just wanted to let you know that. Yes, many of us NEED statins otherwise we'll die of heart attacks or strokes, yes....but Rostuvastatin is strong and can have worse side effects than the other statins that are frequently prescribed. Chuck was having bad muscle aches and cramps in his arms, bad fatigue and exhaustion, things like that. He seems ok with the 100 mg tabs.
Its tone deaf of this doctor to make recommendations w/o speaking to his patient first, imo. We all deserve to be treated with respect and dignity at all times by our health care providers, and not like we need to get an interpreter to understand what they're saying about us! 😶
Lealonnie, thank you for the helpful info and kind words. She’s taking rosuvastatin 40 mg., which seems really low now that you’ve told me what your husband takes. Maybe that’s because it’s so strong, like you said.
How old is your friend because I am with Isthis here. Statins have been proven to contribute to cognitive decline. I personally will not use them. My dictor agreed with me. At a certain age who cares if she has high cholesterol.
She’s had strokes in the past and that’s a way of making sure that plaque doesn’t build up in the arteries. She has had tests showing heart arteries are blocked and cardiologist is hoping to get less blockage. She has a lot going on, that’s for sure. Thanks for your input.
"Medicines are meant to help, not harm. But sometimes taking too many drugs can be dangerous, especially for older adults. The use of multiple drugs to treat diseases and other health conditions is known as polypharmacy. This is a growing concern for older adults."
What are her medications for? This could be medical jargon for her actual medical conditions, instead of writing all of it out. Just referencing all of her meds to point to her physical condition.
My dad had CHF, kidney disease, diabetes, dementia, a pacemaker /defibrillator requiring blood thinners, etc and he wasn't on 8 meds.
So why is she on 8 meds? That would be what I look at.
From what you said, I think the doctor should have spoken to her and not put that crap on the portal. May be time to find a geriatric doctor that gives a care.
Thanks for your reply. She's taking Aricept (memory), Synthroid (thyroid), lisinopril (blood pressure, I think), loratadine (allergies), Fosamax (osteopenia), Os-Cal (bones), rosuvastatin (cholesterol), Plavix (anti-clotting because she had a stroke 5 years ago). The doctor is a geriatrician/internist. Her husband, who has no cognitive issues, goes to the same doctor and he loads her pill boxes, but who knows if the doctor realizes that!
Your friend may be able to continue living at home if she has someone to load her medicine box and a check list to document when she takes them my mom had MCI with recent memory deficits. She remembered how to do things but not necessarily if she had done them. So I loaded her medicine box with her medicines and vitamins and we created a daily check list where she could check off things she had done, like take morning meds or brush her teeth. I wrote the day of the week on the top of the checklist and Mom could always match that to the day of the week on the medicine box. We did the same thing for recipes she wanted to bake/cook; I copied the recipe into a word document with little boxes beside each ingredient and step so she could check them off. No more extra salt!
It sounds to me the doctor is suggesting that she look into Assisted Living so that someone can effectively help manage her medications and make sure they are taken properly. (correct dose, on time, and instructions followed. Some should be taken with food, some with no food, some have to wait 30 minutes before you eat, some meds you have to be upright for 30 minutes. Lots of different instructions for each medication) If he cognition is declining the chance of taking the medications incorrectly increases. the alternate to Assisted Living would be a caregiver that would manage her meds and make sure she is safe. There are medication dispensers that will dispense medications at the correct time so there is little chance to over dose BUT someone has to fill them and with declining cognition she may have to be reminded to take the meds that are dispensed.
Here's the deal. This person, managing 8 medications, has cognitive issues. Presumably, she is living alone and taking these medication on her own.
The doctor is thinking "8 medications is a lot to keep straight, for anyone. My patient would be better served in a good AL with a Medication Management program".
One hopes the doctor FIRST thought "does my patient NEED all of these medications?".
It reads to me like a recommendation for an AL or appropriate facility. But polypharmacy on it's own is not really a reason people need to be placed in care.
If the doc thinks she isn't safe living on her own then they need to be explicit about the reasons, and IMO not discussing the problems with the patient (and if possible including her substitute decision maker or other trusted family member/friend) is a total cop out.
the simultaneous use of multiple drugs to treat a single ailment or condition. the simultaneous use of multiple drugs by a single patient, for one or more conditions.
(Most of us elders are taking too many medications. Because my husband is diagnosed with Alzheimers, he's no longer taking any medications that dull or fog his memory.)
Becky, What does the placement part of it mean? Placement of the medicines where she can't get them? Placement in a care facility? She's taking 8 drugs after this visit for various things wrong with her.
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At this point her husband and the patient need to ask the geriatrician to meet with them to discuss her health and what to expect, they need to get supportive services for her (if husband can verify that she does take all her meds on time and that he fills med boxes, then that is adequate management of polypharmacy).
If she does not have a health care proxy chosen, and a power of attorney for health care given (husband and then an alternate, usually), that needs to be done post haste, while she is still legally capable to make these decisions.
often the local senior services agency can do a home assessment and make safety suggestions, and also connect them to useful services for now, and in future.
This seems like an odd note for a geriatrician who treats patient and.spouse...I wonder if there is something else going on that he did not want to put in record.
Idk what dose of Rosuvastatin your friend is taking, but my dh was prescribed 600mg 1x a day of it. It took his cholesterol down SO fast, esp his triglycerides, whereas no other statins were able to that, that he had a lot of harsh side effects. He had to stop taking it entirely for 3 weeks, then was put on 100 mgs tabs instead. I just wanted to let you know that. Yes, many of us NEED statins otherwise we'll die of heart attacks or strokes, yes....but Rostuvastatin is strong and can have worse side effects than the other statins that are frequently prescribed. Chuck was having bad muscle aches and cramps in his arms, bad fatigue and exhaustion, things like that. He seems ok with the 100 mg tabs.
Its tone deaf of this doctor to make recommendations w/o speaking to his patient first, imo. We all deserve to be treated with respect and dignity at all times by our health care providers, and not like we need to get an interpreter to understand what they're saying about us! 😶
Wishing the best outcome for your friend.
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My dad had CHF, kidney disease, diabetes, dementia, a pacemaker /defibrillator requiring blood thinners, etc and he wasn't on 8 meds.
So why is she on 8 meds? That would be what I look at.
From what you said, I think the doctor should have spoken to her and not put that crap on the portal. May be time to find a geriatric doctor that gives a care.
If he cognition is declining the chance of taking the medications incorrectly increases.
the alternate to Assisted Living would be a caregiver that would manage her meds and make sure she is safe.
There are medication dispensers that will dispense medications at the correct time so there is little chance to over dose BUT someone has to fill them and with declining cognition she may have to be reminded to take the meds that are dispensed.
The doctor is thinking "8 medications is a lot to keep straight, for anyone. My patient would be better served in a good AL with a Medication Management program".
One hopes the doctor FIRST thought "does my patient NEED all of these medications?".
If the doc thinks she isn't safe living on her own then they need to be explicit about the reasons, and IMO not discussing the problems with the patient (and if possible including her substitute decision maker or other trusted family member/friend) is a total cop out.
the simultaneous use of multiple drugs to treat a single ailment or condition.
the simultaneous use of multiple drugs by a single patient, for one or more conditions.
(Most of us elders are taking too many medications. Because my husband is diagnosed with Alzheimers, he's no longer taking any medications that dull or fog his memory.)
What does the placement part of it mean? Placement of the medicines where she can't get them? Placement in a care facility? She's taking 8 drugs after this visit for various things wrong with her.