CARE OF THE AGING PATIENT: CLINICIAN’S CORNER FROM EVIDENCE TO ACTION Managing Medications in Clinically Complex Elders “There’s Got to Be a Happy Medium” Michael A. Steinman, MD Multiple medication use is common in older adults and Joseph T. Hanlon, PharmD, MS may ameliorate symptoms, improve and extend quality of life, and occasionally cure disease. Unfortunately, mul- PATIENT’S STORY tiple medication use is also a major risk factor for pre- Mr L is an 84-year-old man with dementia and a medical scribing and adherence problems, adverse drug events, and history of atrial fibrillation, diabetes mellitus, hyperten- other adverse health outcomes. Using the case of an older sion, hyperlipidemia, chronic kidney disease, gastritis, and gastroesophageal reflux disease. His past surgeries include patient taking multiple medications, this article summa- a transurethral bladder resection for bladder cancer with sub- rizes the evidence-based literature about improving medi- sequent urinary incontinence and a lumbar decompres- cation use and withdrawing specific drugs and drug classes. sion for spinal stenosis in 2008. It also describes a systematic approach for how health pro- Mr L lives with his wife, Mrs L, who also cares for him. fessionals can assess and improve medication regimens He is a retired
JAMA – American Medical Association
Published: Oct 13, 2010
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