The goal of Geriatric Review is to reduce medication errors in the elderly and to provide services to organize and compile important medical information. In addition to receiving a medication card, that will be updated as frequently as needed, Dr. Garry will assure you are not on any inappropriate medications and that there are no drug interactions.
The patient’s medical history can also be reviewed to ensure that proper management has been implemented, and that pertinent tests have been ordered. This information can be given to the patient in a record synopsis or placed on a key chain drive. This key chain drive will be password protected and ensure ease when traveling and new physician/emergency room visits.
Geriatric Review will help you avoid being another statistic. By educating you about your own health care, we put you back in charge. We will also make it easier for those who live in two or more places to help coordinate their care. Whatever your needs are, Geriatric Review has services that are right for you.
Medications in the elderly are effected by many different factors that affect how they should be prescribed
Absorption, distribution, elimination, metabolism, pharmacodynamics and side effects
Many physicians are not aware about how these processes effect prescribing medications in the elderly. This leads to many seniors getting inappropriate medications or incorrect doses of medications. Studies have shown that roughly 25% of seniors are receiving potentially harmful medications.
Some examples are medications that have very long half lives being prescribed to the elderly. A single dose of valium (diazepam) can last 80 hours in the elderly. If this medication is prescribed three times a day, it will build up and can result in falls and hip fractures. Other medications have side effects that warrant that they shouldn’t be used in older patients, especially since there are safer alternatives. It is estimated that upwards of 40% of seniors are on an inappropriate medication.
Avoid Polypharmacy (taking too many medications)
Unfortunately the principles of geriatrics are not widely known by most physicians. This leads to a patients being started on one medication and others being added to treat its side effect because the side effect is not recognized as being caused by the first medication. An example is a patient that is started on Lasix (furosemide) for edema in her legs. This leads to a potassium supplement and urgency of urination. The patient is then started on a bladder relaxant such as Ditropan (oxybutinin) which leads to memory problems and constipation. The patient is then started on Aricept (donepezil) for memory loss and Miralax (glycolax) for constipation. The potassium can aggravate esophageal reflux which leads to an acid blocker. The patient is this example is a real life patient. She ended up on 5 medications, all related to the treatment of her swelling. She was eventually taken off of all these medications and managed with compression hose, low salt diet and nocturnal leg elevation.
Make sure you are on the appropriate medications for your illness
Diabetes- Most diabetics should be on a ACE - Inhibitor or ARB, take a daily aspirin, have their good cholesterol HDL >40, and their bad choelesterol LDL <70
Heart Disease- Most patients with coronary artery disease (heart attack) should be on a an ACE/ARB, beta blocker, aspirin, have their good cholesterol ( HDL ) >40, and their bad cholesterol LDL <70
Memory loss- Patients with cognitive issues should be on a cholinesterase inhibitor with or without an NMDA receptor blocker. They should also not be on any medications that can negatively affect their memory.
Osteoporosis- Studies have shown that only 6% of patients after hip fracture are receiving proper treatment. Osteoporosis is one of the many illnesses that can negatively affect your health. It is also a disease that is usually not optimally managed. Has your doctor checked your vitamin D-25 level? Is it above 30? Are you on the best therapy for your bones?
Make sure medical records are complete, accurate and available
Medical records are known to have mistakes and even doctors find medical errors in their own charts (http://www.contracostatimes.com). Once a medical error enters your chart, it is likely to be perpetuated. This is in part because physicians rely so heavily on old medical records. In order to receive optimal care, patients and treating doctors need to have immediate access to accurate medical records. An accurate, encompassing medical history doesn’t help you if it’s locked away in your physician’s office. You need to be sure you have access to your medical records when you need it. All too often you end up in the hospital at night or on weekends, or even while traveling. This can make it hard for doctors to get an accurate medical history, during the first 24hrs when important medical decisions are being made. By carrying a complete summary of your medical records, physicians will have access to your records when they need it. A patient of mine was recently transported by ambulance to a neighboring hospital. An EKG there suggested that he was in complete heart block and I received a call asking who I wanted to put the pacemaker in. I was able to get an electronic copy of that EKG and send the hospital the patients EKG from his last visit. It was clear that the gain on the EKG machine was not set properly and the patient avoided getting a pacemaker he didn’t need. All because of records being available when decisions are being made. It usually takes several days for hospitals to get medical records that are requested.
Make sure you are up to date on your entire preventive care
