Any Symptom in an Older Adult is a Medication Side Effect Until Proven Otherwise

Mike Steinman recently published a paper in JAMA about sensible medication managment in older adults.  I’ve had the opportunity to see him speak about this issue on a couple of occassions.  I wanted to share a few take home “GeriPal” pearls, leading with the title of the post:

• Any symptom in an older adult is a medication side effect until proven otherwise
• Review medication lists and sort by indication.  Most older adults are on at least one unnecessary medication, or one where the harms outweigh the benifits in light of the patient’s goals, social and clinical circumstances, and life expectancy.
• If you taper it up, taper it down
• When starting a medication, start low, and go slow
• Warfarin, hypoglycemic agents, and digoxin account for one-third of all adverse drug event related emergency department visits by older adults.  Doesn’t mean don’t prescribe them, just prescribe thoughtfully and monitor for adverse side effects.
• Most adverse drug events are due to a failure of monitoring, not prescribing innapropriate medications

by: Alex Smith