Dr Michael Steinman on the Importance of Medication Management Strategies for Older Adults

Multimorbidity in older patients creates a challenge because you're dealing with multiple diseases and multiple medications, explained Michael Steinman, MD, professor of medicine, University of California, San Diego.

Why are medication management strategies particularly important for older patients?
One of the issues with older patients is the presence of multimorbidity, so the challenge has become that much more complex because we’re not just dealing with a single disease, were dealing with multiple diseases and thinking about the interaction of all of those diseases, including the multiple medications a patient may be taking. They might make sense for one disease at a time, but when you add up all of the diseases and a patient ends up taking 18 medications, 9 of which are interacting with each other, and the patient can’t pay for their electric bill because they’re spending all their money on medications, that’s a problem.

So, being attentive the unique needs that arise from the presence of multimorbidity and thinking holistically about the patient and how to optimize their medication regimen in a way that makes sense for the person, not just the individual disease, is critical.

Are there challenges with trying to reach and engage these patients?
I think there’s a lot of variability in what strategies work for different patients. For example, if a strategy is just focused on getting patients to remember to take their medications more, that could be really useful for patients whose primary problem is just they forget to take their medications and having improved strategies for helping them, for example, with medication organizers or reminders. But, just to build on that example, a lot of nonadherence isn’t due to forgetting, it’s due to patients not thinking their medication is useful, not understanding why they’re taking it, or having real or perceived side effects and not wanting to take the medicine as a result.

Again, we need to be patient-centered on how we approach these things and really understanding what’s going on in the patient’s mind, why they’re acting or not acting a certain why, what’s going on in the prescriber’s mind, why they’re acting or not acting in a certain way, and addressing those levers accordingly.
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