WEBVTT 1 00:00:00.000 --> 00:00:02.585 (bright music) 2 00:00:05.380 --> 00:00:08.383 Welcome to today's webinar, Medication Management. 3 00:00:08.383 --> 00:00:10.510 I'm your host, Janet Barker Evans. 4 00:00:10.510 --> 00:00:13.596 In this webinar, we'll discuss why medication management 5 00:00:13.596 --> 00:00:17.642 is so crucial for seniors, how senior living can help 6 00:00:17.642 --> 00:00:19.102 and we're gonna share a few tips 7 00:00:19.102 --> 00:00:21.813 for at-home medication management. 8 00:00:22.272 --> 00:00:25.692 Dr. Michael Gloth is an Associate Professor of Medicine 9 00:00:25.692 --> 00:00:29.029 in the Division of Geriatric Medicine and Gerontology 10 00:00:29.029 --> 00:00:32.157 at Johns Hopkins University School of Medicine 11 00:00:32.157 --> 00:00:34.325 and a Clinical Professor of Geriatrics 12 00:00:34.325 --> 00:00:37.537 at Florida State University College of Medicine. 13 00:00:37.537 --> 00:00:41.082 He's President and CEO of AMDG Naples 100 14 00:00:41.082 --> 00:00:42.834 Senior Concierge and Consulting. 15 00:00:43.835 --> 00:00:46.254 Dr. Gloth, a Baltimore native, 16 00:00:46.254 --> 00:00:48.715 received his BS in Chemistry and Biology 17 00:00:48.715 --> 00:00:51.593 from the College of William & Mary in Virginia 18 00:00:51.593 --> 00:00:54.637 and his MD from Wayne State University School of Medicine. 19 00:00:55.680 --> 00:00:57.390 He currently serves on the boards 20 00:00:57.390 --> 00:00:59.934 of the Health and Aging Foundation 21 00:00:59.934 --> 00:01:02.687 and the Florida Medical Directors Association. 22 00:01:02.687 --> 00:01:05.482 In addition to that, he's president elect 23 00:01:05.482 --> 00:01:07.525 of the Florida Geriatric Society. 24 00:01:08.485 --> 00:01:11.362 His publications include "Medication Management 25 00:01:11.362 --> 00:01:15.575 in Older Adults", "Handbook of Pain Relief in Older Adults", 26 00:01:15.575 --> 00:01:17.160 and "Fit at Fifty and Beyond", 27 00:01:17.160 --> 00:01:18.953 an International Book Award winner. 28 00:01:20.038 --> 00:01:23.333 Dr. Gloth was named the 2006 Clinician of the Year 29 00:01:23.333 --> 00:01:25.502 by the American Geriatric Society. 30 00:01:25.502 --> 00:01:27.670 Welcome Dr. Gloth. 31 00:01:27.670 --> 00:01:29.506 - Thanks so much, pleasure to be here. 32 00:01:29.506 --> 00:01:30.340 - Yeah. 33 00:01:30.340 --> 00:01:33.468 So to start us off, could you explain 34 00:01:33.468 --> 00:01:38.014 what a geriatrician is and why somebody might wanna make 35 00:01:38.014 --> 00:01:39.432 an appointment to see one? 36 00:01:40.517 --> 00:01:44.813 - Yeah, so just as an individual ages 37 00:01:44.813 --> 00:01:46.856 and they go from seeing a pediatrician 38 00:01:46.856 --> 00:01:48.650 to an adult medicine physician, 39 00:01:48.650 --> 00:01:51.694 maybe an internal medicine physician or sometimes still 40 00:01:51.694 --> 00:01:54.781 stay with a family practice doc, but they'll switch 41 00:01:54.781 --> 00:01:56.699 to an older adult because pediatricians 42 00:01:56.699 --> 00:02:00.829 are trained in handling folks when they're younger 43 00:02:00.829 --> 00:02:04.791 with diseases and things that occur when they're younger. 44 00:02:04.791 --> 00:02:07.127 Physiologically, we change as we get older 45 00:02:07.127 --> 00:02:10.880 and so folks will move to a physician who has expertise 46 00:02:10.880 --> 00:02:12.966 in handling adults. 47 00:02:12.966 --> 00:02:16.761 Similar physiologic changes though take place as we age, 48 00:02:16.761 --> 00:02:19.597 and probably the most obvious for women is menopause, 49 00:02:19.597 --> 00:02:22.183 but there are lots of changes that occur 50 00:02:22.183 --> 00:02:24.978 that you may not recognize as you get older, 51 00:02:24.978 --> 00:02:27.814 drug metabolism changes, body distribution 52 00:02:27.814 --> 00:02:31.568 in terms of where medications are metabolized and stored, 53 00:02:31.568 --> 00:02:35.113 the types of diseases that are more common in older adults, 54 00:02:35.113 --> 00:02:38.950 all of those things change as we get older and as we age. 55 00:02:38.950 --> 00:02:41.494 And so getting someone who is an expert 56 00:02:41.494 --> 00:02:44.080 in older adults becomes an advantage 57 00:02:44.080 --> 00:02:47.250 in terms of functional survival, staying independent 58 00:02:47.250 --> 00:02:51.087 as long as possible, those things are better managed 59 00:02:51.087 --> 00:02:54.340 and more successfully managed by a geriatrician. 60 00:02:54.340 --> 00:02:57.093 So if you can get a geriatrician, which I will say 61 00:02:57.093 --> 00:02:59.512 they are not readily available everywhere, 62 00:02:59.512 --> 00:03:01.681 but if you can get one as you get older, 63 00:03:01.681 --> 00:03:05.185 it probably will pay you big health dividends later on. 64 00:03:05.185 --> 00:03:07.103 - That makes so much sense when you equate it 65 00:03:07.103 --> 00:03:10.148 to a pediatrician to a regular doctor, absolutely, 66 00:03:10.148 --> 00:03:11.149 that makes so much sense. 67 00:03:11.149 --> 00:03:13.818 I've never thought about it like that before. 68 00:03:13.818 --> 00:03:16.696 So when we think about older populations, 69 00:03:16.696 --> 00:03:21.701 why is medication management essential to understand? 70 00:03:22.702 --> 00:03:24.287 - The older adult, as I mentioned, 71 00:03:24.287 --> 00:03:26.915 does have some physiologic changes that occur 72 00:03:26.915 --> 00:03:31.920 and so it becomes really important that we recognize 73 00:03:31.920 --> 00:03:34.172 some of the complications that can occur 74 00:03:34.172 --> 00:03:35.840 as an individual gets older. 75 00:03:35.840 --> 00:03:38.801 So diseases certainly can have an impact, 76 00:03:38.801 --> 00:03:40.678 certainly chronic diseases. 77 00:03:40.678 --> 00:03:43.056 Older adults also take more medications 78 00:03:43.056 --> 00:03:45.892 than most younger adults, and so making sure 79 00:03:45.892 --> 00:03:50.772 that those drug-drug interactions are managed appropriately 80 00:03:50.772 --> 00:03:52.815 so that folks don't have real consequences 81 00:03:52.815 --> 00:03:54.400 from the medications that they take, 82 00:03:54.400 --> 00:03:56.110 that becomes very important. 83 00:03:56.110 --> 00:03:57.528 And then there are other things that changes 84 00:03:57.528 --> 00:03:59.781 when the individual gets older, 85 00:03:59.781 --> 00:04:03.326 not just how they metabolize their medications, 86 00:04:03.326 --> 00:04:06.496 but also in terms of the number of physicians 87 00:04:06.496 --> 00:04:09.916 that they're seeing, the number of medical complications, 88 00:04:09.916 --> 00:04:12.794 changes just directly associated with aging, 89 00:04:12.794 --> 00:04:15.588 and so suddenly becomes very, very important 90 00:04:15.588 --> 00:04:19.467 in terms of what drugs are taken, which drugs are stopped, 91 00:04:19.467 --> 00:04:21.177 which is also something that's important 92 00:04:21.177 --> 00:04:22.679 as individuals get older. 93 00:04:22.679 --> 00:04:26.307 So managing the medications, making sure that the time 94 00:04:26.307 --> 00:04:29.143 when they're taken, the types of drugs that are taken 95 00:04:29.143 --> 00:04:32.230 and how they interact, and even sometimes 96 00:04:32.230 --> 00:04:35.316 other things we'll talk about later in terms of maybe food 97 00:04:35.316 --> 00:04:38.111 or something like that, but it's very, very important, 98 00:04:38.111 --> 00:04:39.654 probably more so in older adults 99 00:04:39.654 --> 00:04:41.572 because just the sheer number of drugs 100 00:04:41.572 --> 00:04:43.908 that they take are gonna have worse complications 101 00:04:43.908 --> 00:04:45.702 in older adults than younger adults, 102 00:04:45.702 --> 00:04:47.870 even when they take the same number of drugs. 103 00:04:47.870 --> 00:04:48.329 - That's great. 104 00:04:48.329 --> 00:04:51.291 I think we have a slide to pop up to talk a little bit 105 00:04:51.291 --> 00:04:56.296 about some of the biggest challenges that face older adults 106 00:04:56.296 --> 00:04:58.423 when it comes to to medication. 107 00:04:59.090 --> 00:05:01.467 - Yeah, so this is a great point. 108 00:05:01.467 --> 00:05:04.178 So as I mentioned, it's not just the changes 109 00:05:04.178 --> 00:05:05.930 that are taking place in the individual, 110 00:05:05.930 --> 00:05:09.058 there's some characteristics about an older adult 111 00:05:09.058 --> 00:05:13.396 that make it really a paramount importance for us 112 00:05:13.646 --> 00:05:17.275 in terms of oversight of how folks are taking drugs. 113 00:05:17.275 --> 00:05:21.904 So the idea that while you may take a few medications, 114 00:05:21.904 --> 00:05:24.866 if you're getting them from one particular pharmacy 115 00:05:24.866 --> 00:05:28.870 all the time, a lot of times, pharmacies will monitor drugs 116 00:05:28.870 --> 00:05:31.289 and look for drug-drug interactions. 117 00:05:31.289 --> 00:05:33.916 As individuals get older, though they frequently 118 00:05:33.916 --> 00:05:35.835 will go to more than one pharmacy, 119 00:05:35.835 --> 00:05:37.754 maybe it's because they've moved, 120 00:05:37.754 --> 00:05:40.673 maybe it's because they're no longer picking things up 121 00:05:40.673 --> 00:05:42.467 from the pharmacy where they worked 122 00:05:42.467 --> 00:05:46.304 now that they're retired or they've had relationships 123 00:05:46.304 --> 00:05:49.098 with new pharmacies compared to ones 124 00:05:49.098 --> 00:05:51.601 that they've had previously, or there's a pharmacy 125 00:05:51.601 --> 00:05:55.146 close to one of the doctor specialists, it's far away. 126 00:05:55.146 --> 00:05:58.441 And so you end up having them deal with multiple pharmacies 127 00:05:58.441 --> 00:06:01.486 and a lot of times there's different pharmacy chains 128 00:06:01.486 --> 00:06:04.655 or the individual pharmacy itself doesn't communicate 129 00:06:04.655 --> 00:06:07.575 with the other pharmacies and so they don't know 130 00:06:07.575 --> 00:06:08.993 all the drugs that are being taken 131 00:06:08.993 --> 00:06:12.955 by one of their individuals that refer a client for them. 132 00:06:12.955 --> 00:06:15.958 The other thing that happens, as I mentioned, 133 00:06:15.958 --> 00:06:19.921 these multiple medications make it more complex. 134 00:06:19.921 --> 00:06:23.841 For an older adult, if they're taking more than one drug, 135 00:06:23.841 --> 00:06:27.220 that interaction is more likely to be problematic 136 00:06:27.220 --> 00:06:29.347 for an older adult than a younger adult, 137 00:06:29.347 --> 00:06:32.016 and most older adults are... 138 00:06:32.016 --> 00:06:34.185 Actually the average is about nine different 139 00:06:34.185 --> 00:06:36.896 prescription medications for an older adult. 140 00:06:36.896 --> 00:06:38.981 And then half of them get medications 141 00:06:38.981 --> 00:06:42.693 from more than one doctor and that includes samples, 142 00:06:42.693 --> 00:06:44.112 that can be a real problem. 143 00:06:44.112 --> 00:06:46.489 I've had problems with patients who have gotten 144 00:06:46.489 --> 00:06:50.076 a sample of a medication, I didn't know they got the sample 145 00:06:50.076 --> 00:06:51.452 and the specialist said it was great 146 00:06:51.452 --> 00:06:53.287 for that particular organ system 147 00:06:53.287 --> 00:06:55.998 but not for the patient in total. 148 00:06:55.998 --> 00:06:59.544 And so other problems were complicated 149 00:06:59.544 --> 00:07:03.005 because of the sample that was given by the specialist. 150 00:07:03.005 --> 00:07:04.757 And so going to more than one doctor 151 00:07:04.757 --> 00:07:07.552 sometimes can make things more complex. 152 00:07:07.552 --> 00:07:10.430 And then unfortunately, there are some drugs 153 00:07:10.430 --> 00:07:13.099 that really shouldn't be prescribed for older adults, 154 00:07:13.099 --> 00:07:15.226 and maybe they were prescribed when they were younger 155 00:07:15.226 --> 00:07:16.936 and it was appropriate, but now they're older, 156 00:07:16.936 --> 00:07:19.814 so the drug hasn't changed, but they have. 157 00:07:19.814 --> 00:07:23.234 And so as it turns out, one in 12 physician visits 158 00:07:23.234 --> 00:07:26.612 ends up in a Beers drug, which is a drug 159 00:07:26.612 --> 00:07:30.700 that is really recommended to be avoided by older adults. 160 00:07:30.700 --> 00:07:34.662 And unfortunately, some of those Beers drugs 161 00:07:34.662 --> 00:07:39.125 are prescribed more commonly in women than they are in men, 162 00:07:39.125 --> 00:07:41.752 and interestingly, as you get older, 163 00:07:41.752 --> 00:07:43.129 women live a little bit longer. 164 00:07:43.129 --> 00:07:46.007 So we have more women in the older adult population, 165 00:07:46.007 --> 00:07:48.342 so this is particularly disconcerting. 166 00:07:48.342 --> 00:07:50.720 And then finally, there are some disease processes 167 00:07:50.720 --> 00:07:52.638 that make it more difficult for patients 168 00:07:52.638 --> 00:07:54.307 to manage their medications, 169 00:07:54.307 --> 00:07:56.809 dementia being one of them that's very obvious. 170 00:07:56.809 --> 00:08:00.438 - Yeah, the idea of multiple pharmacies, I know my doctor 171 00:08:00.438 --> 00:08:03.649 has a pharmacy right onsite, and then my insurance plan 172 00:08:03.649 --> 00:08:05.568 requires me to do some things by mail order, 173 00:08:05.568 --> 00:08:08.237 so keeping track of it is hard today, right? 174 00:08:08.237 --> 00:08:10.490 You don't have your pharmacist anymore, right? 175 00:08:10.490 --> 00:08:13.409 - That's the other problem, is the mail order pharmacies, 176 00:08:13.409 --> 00:08:15.161 you've got a lot of people using them 177 00:08:15.161 --> 00:08:18.080 'cause they're less expensive, but they don't communicate 178 00:08:18.080 --> 00:08:21.167 very well with your local pharmacy on many occasions, 179 00:08:21.167 --> 00:08:23.461 and so that does become an issue as well. 180 00:08:23.461 --> 00:08:26.255 So you really rely on one person, 181 00:08:26.255 --> 00:08:28.216 usually it's going to be that geriatrician 182 00:08:28.216 --> 00:08:30.259 or that primary care physician 183 00:08:30.259 --> 00:08:32.720 or whatever the primary care provider is, 184 00:08:32.720 --> 00:08:35.973 maybe it's a nurse practitioner, but the bottom line is, 185 00:08:35.973 --> 00:08:39.310 is you gotta have one chef that's overseeing that soup, 186 00:08:39.310 --> 00:08:41.938 if you will, too many chefs spoil the pot, 187 00:08:41.938 --> 00:08:43.564 and a lot of times, that's true 188 00:08:43.564 --> 00:08:45.358 with too many physicians as well 189 00:08:45.358 --> 00:08:47.193 and too many pharmacies (indistinct). 190 00:08:47.193 --> 00:08:49.737 - Yeah, and the fact that they're seeing so many doctors, 191 00:08:49.737 --> 00:08:52.907 right, you may be seeing an eye doctor or an orthopedist, 192 00:08:52.907 --> 00:08:54.158 right, there's so many different doctors, 193 00:08:54.158 --> 00:08:56.077 it makes it so hard to keep track of. 194 00:08:56.077 --> 00:08:58.120 - So you mentioned this Beers drug, 195 00:08:58.120 --> 00:08:59.580 can you explain a little bit more 196 00:08:59.580 --> 00:09:01.040 about what Beers drugs are? 197 00:09:01.040 --> 00:09:03.084 I know we have another slide on this, yeah. 198 00:09:03.084 --> 00:09:07.255 - Sure and this is very helpful in terms of the slide 199 00:09:07.255 --> 00:09:09.799 because it goes through some of the things 200 00:09:09.799 --> 00:09:13.469 that the Beers List provides for physicians 201 00:09:13.469 --> 00:09:15.680 or other clinicians in general. 202 00:09:15.680 --> 00:09:17.265 So there was a time I actually sat 203 00:09:17.265 --> 00:09:21.185 on the Beers Criteria Panel, so we put together a list 204 00:09:21.185 --> 00:09:25.940 and at the time, Mark Beers, for whom that list is named, 205 00:09:25.940 --> 00:09:28.776 was the person who chaired that panel, 206 00:09:28.776 --> 00:09:32.530 and what it did was it allowed us to identify 207 00:09:32.530 --> 00:09:35.366 and we looked through literally thousands of articles 208 00:09:35.366 --> 00:09:38.202 about adverse events in older adults, 209 00:09:38.202 --> 00:09:42.331 and we identified drugs that were more likely 210 00:09:42.331 --> 00:09:45.293 to have serious side effects in older adults 211 00:09:45.293 --> 00:09:47.670 compared to a younger adult population. 212 00:09:47.670 --> 00:09:50.339 But it doesn't just look at drugs that are inappropriate 213 00:09:50.339 --> 00:09:52.508 for older individuals in general, 214 00:09:52.508 --> 00:09:55.720 the more recent Beers List have looked at drugs 215 00:09:55.720 --> 00:09:58.264 that are inappropriate for older adults 216 00:09:58.264 --> 00:10:00.975 who have specific medical conditions. 217 00:10:00.975 --> 00:10:04.604 So whereas a drug may be okay for older adults generally, 218 00:10:04.604 --> 00:10:06.731 if you have a particular disease process, 219 00:10:06.731 --> 00:10:09.525 it may actually be problematic for them. 220 00:10:09.525 --> 00:10:13.195 The other thing is the newer list has listed 221 00:10:13.195 --> 00:10:16.782 potentially dangerous drug-drug interactions 222 00:10:16.782 --> 00:10:19.493 and that's been very helpful as well 223 00:10:19.493 --> 00:10:24.498 because some younger adults can handle a mixture of drugs 224 00:10:24.707 --> 00:10:27.585 better than older adults can and because of changes 225 00:10:27.585 --> 00:10:31.839 in maybe kidney function or the way drugs are metabolized 226 00:10:31.839 --> 00:10:34.383 otherwise, as an individual gets older, 227 00:10:34.383 --> 00:10:37.345 those drug-drug interactions become more serious 228 00:10:37.345 --> 00:10:39.430 for the older adult. 229 00:10:39.430 --> 00:10:43.100 And then it has talked about the fact 230 00:10:43.100 --> 00:10:47.146 that there are potential side effects that may exist 231 00:10:47.146 --> 00:10:48.981 and you just need to be a little more cautious, 232 00:10:48.981 --> 00:10:50.775 meaning you need to observe people, 233 00:10:50.775 --> 00:10:54.278 particularly early on after they get started on a drug 234 00:10:54.278 --> 00:10:57.615 to make sure that they won't be problematic for older adults 235 00:10:57.615 --> 00:11:00.993 where they're a little bit more likely to have problems. 236 00:11:00.993 --> 00:11:05.915 And then there are drugs to have medications 237 00:11:05.915 --> 00:11:08.959 adjusted in terms of the dosage or maybe the frequency 238 00:11:08.959 --> 00:11:12.129 in which they're administered and the Beers List 239 00:11:12.129 --> 00:11:14.507 more recently has started to address that as well. 240 00:11:14.507 --> 00:11:17.968 So lots of helpful information for that clinician 241 00:11:17.968 --> 00:11:20.680 who's following the older adult, and let's face it, 242 00:11:20.680 --> 00:11:22.473 there are not enough geriatricians around, 243 00:11:22.473 --> 00:11:25.768 so this is really helpful for everyone who is prescribing it 244 00:11:25.768 --> 00:11:27.978 off for the older adult population. 245 00:11:28.187 --> 00:11:30.106 What are some other things older adults 246 00:11:30.106 --> 00:11:31.899 need to consider in terms of the medications? 247 00:11:31.899 --> 00:11:35.027 I think about medications where it has a little sticker 248 00:11:35.027 --> 00:11:36.654 that says, "Don't drink alcohol", 249 00:11:36.654 --> 00:11:39.532 or if you're taking... 250 00:11:39.532 --> 00:11:40.616 I take a lot of supplements, 251 00:11:40.616 --> 00:11:43.786 and my doctors always ask me what I'm taking to make sure. 252 00:11:43.786 --> 00:11:45.579 What are things like that are other things 253 00:11:45.579 --> 00:11:47.915 that adults should consider when they're older 254 00:11:47.915 --> 00:11:49.667 in terms of medication? 255 00:11:49.667 --> 00:11:51.210 Look, the supplement industry 256 00:11:51.210 --> 00:11:53.504 is a multi-billion dollar industry. 257 00:11:53.504 --> 00:11:56.924 It is unusual for me to walk into the home 258 00:11:56.924 --> 00:12:00.428 of one of my older adult patients, and I do a fair amount 259 00:12:00.428 --> 00:12:04.598 of house calls and interestingly, I'll get patients 260 00:12:04.598 --> 00:12:06.559 who bring in all their drugs into the office 261 00:12:06.559 --> 00:12:08.936 and they bring them all in, they don't bring in 262 00:12:08.936 --> 00:12:12.565 their supplements or sometimes some of the other things 263 00:12:12.565 --> 00:12:15.568 that they're taking and so when I'm in the home 264 00:12:15.568 --> 00:12:17.611 seeing them, they'll say, and I'll ask, 265 00:12:17.611 --> 00:12:19.155 do you have any supplements? 266 00:12:19.155 --> 00:12:20.781 They can actually go get them, 267 00:12:20.781 --> 00:12:22.408 either pull them out of the refrigerator 268 00:12:22.408 --> 00:12:23.367 or they can get them out 269 00:12:23.367 --> 00:12:25.828 of wherever they're keeping their supplements. 270 00:12:25.828 --> 00:12:27.538 And it's not always with their prescription drugs 271 00:12:27.538 --> 00:12:29.415 and they don't always think that supplements 272 00:12:29.415 --> 00:12:31.709 may actually cause a problem. 273 00:12:31.709 --> 00:12:34.462 And so it is important to look at that. 274 00:12:34.462 --> 00:12:37.548 It is also important to talk to people 275 00:12:37.548 --> 00:12:40.009 about when they take their medication, 276 00:12:40.009 --> 00:12:43.554 whether they take the medication with food or not with food. 277 00:12:43.554 --> 00:12:46.265 Some drugs are absorbed much better with food, 278 00:12:46.265 --> 00:12:48.934 other medications like thyroid medication 279 00:12:48.934 --> 00:12:50.895 really should be taken first thing in the morning 280 00:12:50.895 --> 00:12:53.814 without anything else, including other medications. 281 00:12:53.814 --> 00:12:56.650 A lot of osteoporosis drugs need to be taken 282 00:12:56.650 --> 00:12:58.402 just by themselves. 283 00:12:58.402 --> 00:13:01.280 Some of the bisphosphonate drugs like alendronate, 284 00:13:01.864 --> 00:13:05.034 which is probably the original of the bisphosphonate 285 00:13:05.034 --> 00:13:08.037 types of agents for osteoporosis, it's generic now 286 00:13:08.037 --> 00:13:10.080 so it's very commonly administered, 287 00:13:10.080 --> 00:13:12.708 but if you take that drug, even with a cup of coffee 288 00:13:12.708 --> 00:13:15.669 or another medication, you will absorb 289 00:13:15.669 --> 00:13:17.046 almost none of the drug. 290 00:13:17.046 --> 00:13:19.465 Even when you take it properly, you only absorb 291 00:13:19.465 --> 00:13:21.926 about point .7% of the drug. 292 00:13:21.926 --> 00:13:24.220 So it's absolutely imperative that you take that 293 00:13:24.220 --> 00:13:25.721 on an empty stomach. 294 00:13:25.721 --> 00:13:28.974 Other drugs should be taken with meals. 295 00:13:28.974 --> 00:13:31.977 There are some drugs that can cause a little bit of nausea 296 00:13:31.977 --> 00:13:34.396 and so sometimes we'll give that to people at night 297 00:13:34.396 --> 00:13:37.024 before they go to bed and it's one of the reasons 298 00:13:37.024 --> 00:13:39.527 why statins, for example, were recommended 299 00:13:39.527 --> 00:13:42.530 to be taken at nighttime because you'll be asleep 300 00:13:42.530 --> 00:13:45.032 when that time comes that you get a little nausea 301 00:13:45.032 --> 00:13:47.827 and so it doesn't really have any impact. 302 00:13:47.827 --> 00:13:49.745 So there are lots of things like that. 303 00:13:49.745 --> 00:13:52.414 You mentioned alcohol, some drugs are absorbed 304 00:13:52.414 --> 00:13:54.750 very differently in the presence of alcohol 305 00:13:54.750 --> 00:13:57.586 and you tell somebody to take a drug in the evening, 306 00:13:57.586 --> 00:13:59.713 well, a lot of my older patients, 307 00:13:59.713 --> 00:14:01.757 they have their cocktail hour in the evening. 308 00:14:01.757 --> 00:14:04.510 It's very important social gathering to do that, 309 00:14:04.510 --> 00:14:07.012 and so recognizing that there may be 310 00:14:07.012 --> 00:14:08.973 some interactions there. 311 00:14:08.973 --> 00:14:11.058 Those kinds of things are really important. 312 00:14:11.058 --> 00:14:14.436 The duration, how long apart can people take drugs? 313 00:14:14.436 --> 00:14:17.398 You take it twice a day, well, taking it before 314 00:14:17.398 --> 00:14:19.608 and after lunch isn't really twice a day. 315 00:14:19.608 --> 00:14:22.528 And you gotta really stretch some of these medications out 316 00:14:22.528 --> 00:14:23.988 for longer periods. 317 00:14:23.988 --> 00:14:27.116 And so all of those things become very, very important 318 00:14:27.116 --> 00:14:28.701 in terms of oversight management. 319 00:14:28.701 --> 00:14:30.911 - It's interesting when you talk about what time of day 320 00:14:30.911 --> 00:14:32.371 and that something should be with food, 321 00:14:32.371 --> 00:14:33.497 some should be without. 322 00:14:33.497 --> 00:14:36.333 I'm thinking right now with my little pillbox 323 00:14:36.333 --> 00:14:37.835 that I've always supplements and medicines 324 00:14:37.835 --> 00:14:40.045 that I've got one for morning and one for night, 325 00:14:40.045 --> 00:14:41.672 and when you're saying that I'm thinking, 326 00:14:41.672 --> 00:14:43.382 wait, I don't know if I should be taking 327 00:14:43.382 --> 00:14:44.800 all those in the morning together. 328 00:14:44.800 --> 00:14:47.094 Maybe some of those shouldn't be with breakfast. 329 00:14:47.094 --> 00:14:50.306 So it's interesting, even tools that help us sometimes, 330 00:14:50.306 --> 00:14:52.558 we have to know a little bit more about it, right? 331 00:14:52.558 --> 00:14:53.893 - Right, yes. 332 00:14:53.893 --> 00:14:57.313 So I loved your your comment on people bringing medicines. 333 00:14:57.313 --> 00:14:58.814 My mom would always put them on a bag 334 00:14:58.814 --> 00:15:00.232 and take them to the doctor. 335 00:15:00.232 --> 00:15:01.191 - We love that when that happens, 336 00:15:01.191 --> 00:15:04.320 because they get them all in there, that's great. 337 00:15:04.320 --> 00:15:05.154 - Right. 338 00:15:05.154 --> 00:15:08.657 And whoever remembers what the milligrams are, whatever. 339 00:15:08.657 --> 00:15:11.744 - I've even found some people that have the wrong drugs 340 00:15:11.744 --> 00:15:14.997 in a pillbox that's labeled for something else, 341 00:15:14.997 --> 00:15:17.041 and that's a real shocker when you're going 342 00:15:17.041 --> 00:15:19.001 through the medication and you say, wait a minute, 343 00:15:19.001 --> 00:15:20.377 that drug should look like this. 344 00:15:20.377 --> 00:15:21.503 - That's interest... 345 00:15:21.503 --> 00:15:23.297 That's great for the doctor to see. 346 00:15:23.297 --> 00:15:25.549 - Yes, so it can be very helpful. 347 00:15:25.549 --> 00:15:29.345 - Do you have any examples that you could share with us 348 00:15:29.345 --> 00:15:31.555 of noncompliance issues 349 00:15:31.555 --> 00:15:33.807 that you've seen in older adult patients? 350 00:15:34.099 --> 00:15:38.395 - I can talk about a lot of circumstances 351 00:15:38.395 --> 00:15:41.398 like that, obviously, but since I talked a little bit 352 00:15:41.398 --> 00:15:45.194 about the specialists and getting a medication, 353 00:15:45.194 --> 00:15:48.322 I had a patient that we were seeing 354 00:15:48.322 --> 00:15:51.283 who was an older individual living 355 00:15:51.283 --> 00:15:53.744 in an assisted living environment 356 00:15:53.744 --> 00:15:57.289 and not having their drugs monitored 357 00:15:57.289 --> 00:15:58.791 by the assisted living folks. 358 00:15:58.791 --> 00:16:01.335 And sometimes you can have your drugs managed, 359 00:16:01.335 --> 00:16:03.545 they'll administer them, and that's a very helpful thing 360 00:16:03.545 --> 00:16:05.547 for some individuals. 361 00:16:05.547 --> 00:16:09.593 This individual was taking care of his own medications. 362 00:16:09.593 --> 00:16:12.304 He was also the caregiver for his wife, 363 00:16:12.304 --> 00:16:14.974 who was more informed than he was, 364 00:16:14.974 --> 00:16:19.979 and one day, he had a syncopal event, he passed out. 365 00:16:20.187 --> 00:16:23.565 So this was a very good assisted living facility 366 00:16:23.565 --> 00:16:28.445 and they called right away and I went over and saw him 367 00:16:28.445 --> 00:16:29.822 and one of the things that we always do 368 00:16:29.822 --> 00:16:32.366 when we get vital signs on our patients is we do it 369 00:16:32.366 --> 00:16:34.535 while they're seated and standing. 370 00:16:34.535 --> 00:16:38.288 So we look for what's called orthostatic hypotension, 371 00:16:38.288 --> 00:16:41.458 and that is a drop in blood pressure when they stand up. 372 00:16:41.458 --> 00:16:43.502 Well, sure enough, as we were trying to figure out 373 00:16:43.502 --> 00:16:45.004 what was going on with this gentleman, 374 00:16:45.004 --> 00:16:47.923 he was really not prescribed any medication from us 375 00:16:47.923 --> 00:16:51.385 that should have really caused a drop in blood pressure 376 00:16:51.385 --> 00:16:53.846 yet, when he stood up, he dropped his systolic 377 00:16:53.846 --> 00:16:57.182 blood pressure, that top number, 30 millimeters of mercury. 378 00:16:57.182 --> 00:17:01.854 So he obviously had a reason for passing out 379 00:17:01.854 --> 00:17:03.689 and we needed to correct that. 380 00:17:04.565 --> 00:17:05.607 And so I went through the list of drugs 381 00:17:05.607 --> 00:17:08.235 and I couldn't find anything that was causing 382 00:17:08.235 --> 00:17:11.739 a problem for him and so I just started stopping 383 00:17:11.739 --> 00:17:13.866 one medication at a time. 384 00:17:13.866 --> 00:17:16.368 And sure enough, we get finished, 385 00:17:16.368 --> 00:17:18.912 and at the end of the drugs, I said, I don't want you 386 00:17:18.912 --> 00:17:21.123 to take any more medication at all 387 00:17:22.082 --> 00:17:25.085 and I wanna see what happens to your blood pressure. 388 00:17:25.085 --> 00:17:29.465 So I came in the next day, blood pressure was fine. 389 00:17:29.465 --> 00:17:32.760 No drop, no more syncopal events. 390 00:17:33.677 --> 00:17:37.306 At this point, I wanted to resume some of his medications, 391 00:17:37.306 --> 00:17:38.974 so we started them one at a time. 392 00:17:38.974 --> 00:17:41.185 Now, he wasn't on a lot, we had been working with him 393 00:17:41.185 --> 00:17:42.936 for a while, we actually stopped many more drugs 394 00:17:42.936 --> 00:17:46.482 from the start and so I think probably 395 00:17:46.482 --> 00:17:50.194 about the fourth or fifth drug was the end of the drugs 396 00:17:50.194 --> 00:17:52.571 that we had resumed and he still had 397 00:17:52.571 --> 00:17:54.990 no orthostatic hypotension. 398 00:17:54.990 --> 00:17:58.368 So I said to him, listen, I gotta tell you, 399 00:17:58.368 --> 00:18:00.662 I'm not really sure why you had that drop 400 00:18:00.662 --> 00:18:02.956 in your blood pressure, but now we start 401 00:18:02.956 --> 00:18:04.917 all your medications back and you're fine, 402 00:18:04.917 --> 00:18:07.544 so I guess we can continue this and if it happens again, 403 00:18:07.544 --> 00:18:08.796 let me know. 404 00:18:08.796 --> 00:18:10.964 He said, "Well, can I start all my drugs again?" 405 00:18:10.964 --> 00:18:13.467 I said, sure, everything we started, you're good. 406 00:18:13.467 --> 00:18:14.301 You don't have a problem. 407 00:18:14.301 --> 00:18:18.055 And he said, "What about the one my urologist gave me?" 408 00:18:18.055 --> 00:18:18.931 I said, what? 409 00:18:19.807 --> 00:18:23.227 His urologist had given him a medication 410 00:18:23.227 --> 00:18:25.938 to help relax his urethral sphincter 411 00:18:25.938 --> 00:18:27.731 because he had a large prostate, 412 00:18:27.731 --> 00:18:31.693 a drug that's commonly given to people that have BPH 413 00:18:31.693 --> 00:18:34.113 or benign prostatic hyperplasia, 414 00:18:34.113 --> 00:18:36.990 yet it is also a drug that can lower blood pressure, 415 00:18:36.990 --> 00:18:41.203 and sure enough, this urologist had given him some samples 416 00:18:41.203 --> 00:18:42.621 and he had been taking them. 417 00:18:42.621 --> 00:18:46.625 Well, right then in there, we knew what the problem was 418 00:18:46.625 --> 00:18:49.128 and sure enough, a couple of days later, 419 00:18:49.128 --> 00:18:52.714 I got the consultation note from the urologist 420 00:18:52.714 --> 00:18:56.385 who told me, "Hey, we started him on this medication 421 00:18:56.385 --> 00:18:57.636 for his prostate." 422 00:18:57.636 --> 00:18:59.888 And of course, I had already called him by that time 423 00:18:59.888 --> 00:19:02.224 and said he can't take the drug. 424 00:19:02.224 --> 00:19:05.811 And so there are times when compliance isn't even related 425 00:19:05.811 --> 00:19:07.187 to the individual patient, 426 00:19:07.187 --> 00:19:09.606 sometimes it's because of medications 427 00:19:09.606 --> 00:19:11.567 that I don't know somebody's taking, 428 00:19:11.567 --> 00:19:13.986 and so that can be an issue as well. 429 00:19:15.195 --> 00:19:18.323 I have lots of examples of patients who decide 430 00:19:18.323 --> 00:19:22.202 to take twice as much drug half the period of time. 431 00:19:22.202 --> 00:19:24.037 Instead of taking four times a day, they're gonna take it 432 00:19:24.037 --> 00:19:27.040 two times a day but they get the total drug 433 00:19:27.040 --> 00:19:28.834 but it doesn't have the same effect 434 00:19:28.834 --> 00:19:30.961 because you can't stretch it out that way, 435 00:19:30.961 --> 00:19:34.131 or the two together cause an adverse event 436 00:19:34.131 --> 00:19:35.215 that would not have occurred 437 00:19:35.215 --> 00:19:37.301 from the lower doses of medication. 438 00:19:37.301 --> 00:19:40.596 So lots of examples out there but it does resonate 439 00:19:40.596 --> 00:19:42.639 that it is not just the patients that can sometimes 440 00:19:42.639 --> 00:19:44.892 cause a problem, sometimes we, physicians 441 00:19:44.892 --> 00:19:46.310 cause the problems ourselves. 442 00:19:46.810 --> 00:19:49.396 - The free sample, it's like, "Oh, good. 443 00:19:49.396 --> 00:19:50.981 I don't have to buy this. 444 00:19:50.981 --> 00:19:53.358 The doctor gave me a sample with the cost of medicines," 445 00:19:53.358 --> 00:19:54.610 it's like, "that's great." 446 00:19:54.610 --> 00:19:57.571 Who even thinks to say, "Oh, by the way, doc, 447 00:19:57.571 --> 00:19:59.698 this doc gave me the..." 448 00:19:59.698 --> 00:20:01.491 It's eye opening right now because you think 449 00:20:01.491 --> 00:20:03.160 about all these things and you're like, 450 00:20:03.160 --> 00:20:04.786 "Oh, yeah, I took the one in the afternoon 451 00:20:04.786 --> 00:20:06.330 because I wasn't gonna be around that night. 452 00:20:06.330 --> 00:20:07.372 Was that even smart?" 453 00:20:07.372 --> 00:20:09.917 - Yeah, I counsel my patients now 454 00:20:09.917 --> 00:20:12.044 not to change any medication 455 00:20:12.044 --> 00:20:13.378 unless they talk to me first, 456 00:20:13.378 --> 00:20:15.839 even if another physician prescribes it. 457 00:20:15.839 --> 00:20:17.758 I say it's great if they prescribe it, 458 00:20:17.758 --> 00:20:20.219 don't fill the prescription until you talk to me. 459 00:20:20.219 --> 00:20:23.931 And then once we have that conversation, we're good to go 460 00:20:23.931 --> 00:20:26.892 and I think that kind of oversight, 461 00:20:26.892 --> 00:20:29.394 since I'm looking at everything related to the patient 462 00:20:29.394 --> 00:20:31.355 rather than just one organ system. 463 00:20:31.355 --> 00:20:34.274 I think overall, that makes things a little better for them. 464 00:20:34.274 --> 00:20:35.734 - I think a lot of people assume 465 00:20:35.734 --> 00:20:37.236 that electronic medical records 466 00:20:37.236 --> 00:20:38.862 do magical things too, right? 467 00:20:38.862 --> 00:20:41.114 They think, "Oh, it's the same hospital system, 468 00:20:41.114 --> 00:20:42.407 they must be reading it." 469 00:20:42.407 --> 00:20:45.160 Your doctor doesn't know that another doctor put a note in, 470 00:20:45.160 --> 00:20:46.578 they didn't read it. 471 00:20:46.578 --> 00:20:48.247 - Right, and that happens too. 472 00:20:48.997 --> 00:20:51.750 - We expect magic in the system, so. 473 00:20:53.335 --> 00:20:55.504 So okay, let's talk a little bit about loved ones. 474 00:20:55.504 --> 00:20:57.965 If you're caring for somebody who's getting older, 475 00:20:57.965 --> 00:21:00.008 whether it's a spouse, a parent, whatever, 476 00:21:00.008 --> 00:21:03.637 what are some signs that your loved one might need help 477 00:21:03.637 --> 00:21:06.056 with managing their medications? 478 00:21:06.056 --> 00:21:11.061 - Yes, so we've got many clues that can arise 479 00:21:11.061 --> 00:21:14.564 and one of them is if the individual 480 00:21:14.564 --> 00:21:18.360 is managing their own medication and they say to you, 481 00:21:18.360 --> 00:21:21.571 "Hey, I need a refill on this drug," 482 00:21:21.571 --> 00:21:25.284 and you go in, and you look at that pill bottle 483 00:21:25.284 --> 00:21:29.371 and it says this drug was prescribed 30 pills 484 00:21:29.371 --> 00:21:34.126 on January 1 and now it's March and they're only filling 485 00:21:34.126 --> 00:21:36.837 that prescription in March, that's too much late, 486 00:21:36.837 --> 00:21:40.299 two months beyond what should have been the period 487 00:21:40.299 --> 00:21:43.552 of time for that medication that needed to be refilled. 488 00:21:43.552 --> 00:21:44.428 That's a clue. 489 00:21:44.428 --> 00:21:47.306 The other thing is it can happen on the other side. 490 00:21:47.306 --> 00:21:51.143 You go in to fill a prescription and the pharmacy says, 491 00:21:51.143 --> 00:21:53.478 "Hey, we've we filled this, there should be plenty 492 00:21:53.478 --> 00:21:56.148 of medication left, they should not have run out yet." 493 00:21:56.148 --> 00:22:00.110 So occasionally, maybe a physician tells them, 494 00:22:00.110 --> 00:22:03.613 "Double up on the medicine," and that means we need 495 00:22:03.613 --> 00:22:06.199 to write another prescription for twice the amount 496 00:22:06.199 --> 00:22:08.577 so the pharmacy knows what's going on. 497 00:22:08.577 --> 00:22:11.455 But that also may be a red flag that those medications 498 00:22:11.455 --> 00:22:14.166 are being taken too frequently, 499 00:22:14.166 --> 00:22:16.126 that they are not really compliant. 500 00:22:16.126 --> 00:22:19.004 And then the question becomes, why are they not compliant? 501 00:22:19.004 --> 00:22:20.881 Is it that they're having pain and they need 502 00:22:20.881 --> 00:22:24.176 more control of the pain or is it a situation 503 00:22:24.176 --> 00:22:26.845 where they just forgot they took the medication? 504 00:22:26.845 --> 00:22:31.767 And a lot of times, even in my own household, 505 00:22:31.767 --> 00:22:36.772 I'll have somebody say to me, my wife in particular, 506 00:22:36.813 --> 00:22:40.942 God bless her, but she takes thyroid medication, 507 00:22:40.942 --> 00:22:43.028 and she's given me permission to talk to everybody 508 00:22:43.028 --> 00:22:44.988 about this 'cause she's a really great example 509 00:22:44.988 --> 00:22:48.241 of hypothyroidism and that kind of thing, 510 00:22:48.241 --> 00:22:50.452 but it's a medication that needs to be taken 511 00:22:50.452 --> 00:22:53.538 first thing in the morning, and that's one, as I mentioned, 512 00:22:53.538 --> 00:22:55.415 no food, you really wanna take that 513 00:22:55.415 --> 00:22:57.459 before you take your other medications. 514 00:22:57.459 --> 00:22:59.169 So sometimes she'll say to me, 515 00:22:59.169 --> 00:23:01.213 Did I take my thyroid medication?" 516 00:23:01.213 --> 00:23:04.966 And one of the things about some of the thyroid medications, 517 00:23:04.966 --> 00:23:07.386 it actually colors your tongue. 518 00:23:07.386 --> 00:23:08.345 She'll hold her tongue out. 519 00:23:08.345 --> 00:23:10.680 So I will tell you, my wife sticks her tongue out 520 00:23:10.680 --> 00:23:11.681 at me, very commonly. 521 00:23:11.681 --> 00:23:13.892 - Oh, that's great. 522 00:23:13.892 --> 00:23:16.311 - Mostly to find out whether she took that medication 523 00:23:16.311 --> 00:23:19.815 in the morning then she forgets but but it's easy thing 524 00:23:19.815 --> 00:23:23.443 to do especially when you first wake up 525 00:23:23.443 --> 00:23:26.196 and you take it then you go to the restroom or whatever, 526 00:23:26.196 --> 00:23:28.407 you come back, and "Did I take that this morning?" 527 00:23:28.407 --> 00:23:31.118 So it's the kind of thing that can happen 528 00:23:31.118 --> 00:23:34.162 but when it's happening very frequently 529 00:23:34.162 --> 00:23:37.040 and it's happening multiple times during the day, 530 00:23:37.040 --> 00:23:40.252 a lot of times, that becomes an issue in terms of cognition 531 00:23:40.252 --> 00:23:44.548 and then it may be pathologic and you wanna create 532 00:23:44.548 --> 00:23:46.675 some mechanism to help people in terms 533 00:23:46.675 --> 00:23:49.845 of how they take their medication, reminders, 534 00:23:49.845 --> 00:23:51.888 maybe pill boxes, things like that, 535 00:23:51.888 --> 00:23:54.474 and there are lots of other things that can be done 536 00:23:54.474 --> 00:23:58.145 to help people, especially if they have lots of medications, 537 00:23:58.145 --> 00:23:59.604 which are more complicated. 538 00:24:00.272 --> 00:24:03.442 Do you have any tips on how to approach that subject? 539 00:24:03.442 --> 00:24:06.319 Because obviously, you're talking to your parent, right? 540 00:24:06.319 --> 00:24:08.738 We all get pushed back on the, "You're my child, 541 00:24:08.738 --> 00:24:09.573 stop telling me." 542 00:24:09.573 --> 00:24:12.242 Any tips on how to approach that subject, 543 00:24:12.242 --> 00:24:14.327 whether it's a spouse, parent, whatever? 544 00:24:14.327 --> 00:24:16.371 - Yeah, it can be a little challenging 545 00:24:16.371 --> 00:24:19.875 in terms of identifying somebody, 546 00:24:19.875 --> 00:24:24.421 one, who's having problems and the other is helping them. 547 00:24:24.421 --> 00:24:26.882 Keep in mind, some of these medications are very expensive, 548 00:24:26.882 --> 00:24:29.342 and so when you're filling it earlier, 549 00:24:29.342 --> 00:24:32.179 that's a cost to the individual and say, 550 00:24:32.179 --> 00:24:34.473 "You know you went through that prescription 551 00:24:34.473 --> 00:24:38.185 faster than usual, is there something we can do 552 00:24:38.185 --> 00:24:42.105 to maybe help you regulate when you take your medication? 553 00:24:42.105 --> 00:24:45.484 And having that kind of a discussion, 554 00:24:45.484 --> 00:24:50.155 one, saves you money, mom, and two, look, 555 00:24:50.155 --> 00:24:51.823 we all have trouble, you're getting and being 556 00:24:51.823 --> 00:24:54.743 on a lot of medications, are there some things we can do 557 00:24:54.743 --> 00:24:57.704 to help you in terms of keeping track of this?" 558 00:24:57.704 --> 00:24:59.915 You say to somebody, "I don't know how you keep track 559 00:24:59.915 --> 00:25:02.375 of all these medications, I don't think I could do it." 560 00:25:02.375 --> 00:25:04.794 Well, that's a great intro to get you 561 00:25:04.794 --> 00:25:08.048 to have that conversation and then work with some things 562 00:25:08.048 --> 00:25:10.217 to help in terms of the compliance overall. 563 00:25:10.425 --> 00:25:11.593 - Yeah, that's great. 564 00:25:11.593 --> 00:25:13.470 And those can be hard conversations. 565 00:25:13.762 --> 00:25:14.763 - Oh, yes. 566 00:25:14.763 --> 00:25:18.141 - Are there ways and in what ways can senior living help 567 00:25:18.141 --> 00:25:19.976 with medication management? 568 00:25:19.976 --> 00:25:21.561 We touched on this earlier, 569 00:25:21.561 --> 00:25:23.396 but what are some specific ways on that? 570 00:25:23.396 --> 00:25:25.690 I talked a little bit about that patient 571 00:25:25.690 --> 00:25:27.859 that didn't have medication oversight. 572 00:25:28.610 --> 00:25:30.612 Medication oversight can be really helpful. 573 00:25:30.612 --> 00:25:33.365 So if you're in a senior living environment, 574 00:25:33.365 --> 00:25:36.535 if you're in assisted living, that can be a feature 575 00:25:36.535 --> 00:25:38.328 that's provided through the assisted living, 576 00:25:38.328 --> 00:25:41.081 much as they may offer laundry service 577 00:25:41.081 --> 00:25:43.458 or they oftentimes will offer oversight 578 00:25:43.458 --> 00:25:45.627 in terms of medication and that may mean 579 00:25:45.627 --> 00:25:48.505 just checking to be sure that you took your medicine 580 00:25:48.505 --> 00:25:50.924 or it may be that they actually come in 581 00:25:50.924 --> 00:25:52.342 and give you the medication. 582 00:25:52.342 --> 00:25:54.594 And so those are options that are out there. 583 00:25:54.594 --> 00:25:59.599 Some senior living folks even have a mechanism in place 584 00:25:59.641 --> 00:26:02.727 where you can get called to remind you to take your drug. 585 00:26:02.894 --> 00:26:06.982 A lot of them will provide mechanisms for you in the house. 586 00:26:06.982 --> 00:26:09.693 Maybe it's pillboxes, you talked about you have a pillbox, 587 00:26:09.693 --> 00:26:11.903 it's morning pills and afternoon pills, 588 00:26:11.903 --> 00:26:13.822 those are very commonly used. 589 00:26:13.822 --> 00:26:17.325 They can get filled the week before and the facility 590 00:26:17.325 --> 00:26:20.745 can help do that, and then you just take them each day, 591 00:26:20.745 --> 00:26:23.373 and then next week, they fill them all again, 592 00:26:23.373 --> 00:26:25.208 you take your pills in the morning, you take your pills 593 00:26:25.208 --> 00:26:27.586 in the evening and you go through each day 594 00:26:27.586 --> 00:26:29.754 and that helps you in terms of keeping track 595 00:26:29.754 --> 00:26:32.048 of what you've taken and what you haven't taken. 596 00:26:32.048 --> 00:26:34.050 There are some devices that are out there 597 00:26:34.050 --> 00:26:36.928 that actually will administer medications 598 00:26:36.928 --> 00:26:38.054 and sound an alarm. 599 00:26:38.054 --> 00:26:40.682 So there are a variety of things that are out there. 600 00:26:40.682 --> 00:26:44.894 I have Alexa remind me every morning to take my vitamins 601 00:26:44.894 --> 00:26:47.022 because even though I have them in the little container, 602 00:26:47.022 --> 00:26:48.815 if I don't go to it, right? - [Dr. Michael] Right. 603 00:26:48.815 --> 00:26:51.276 What are some other organizational tools, 604 00:26:51.276 --> 00:26:54.404 assistive technology, apps, what are some of those? 605 00:26:54.404 --> 00:26:55.864 And I think we have a slide to share 606 00:26:55.864 --> 00:26:56.865 on some of these as well. 607 00:26:56.865 --> 00:26:59.576 - Yes, so there are a variety of devices that are out there. 608 00:26:59.576 --> 00:27:01.828 We talked a little bit about the pillboxes 609 00:27:01.828 --> 00:27:05.373 that provide mechanisms for folks to be able 610 00:27:05.373 --> 00:27:10.170 to actually see what they take when they take. 611 00:27:10.170 --> 00:27:12.922 We also talked about a device that's out there 612 00:27:12.922 --> 00:27:16.551 that you can fill it with the medications 613 00:27:16.551 --> 00:27:19.888 and it will actually have an alarm or even a voice 614 00:27:19.888 --> 00:27:22.766 that says "Time to take your medication." 615 00:27:22.766 --> 00:27:25.518 And it will drop the pill out when it's appropriate. 616 00:27:25.518 --> 00:27:27.479 And so that's really good. 617 00:27:27.479 --> 00:27:29.731 The first thing you have here is the Medi Pack, 618 00:27:29.731 --> 00:27:31.107 the Medi Dose Pack. 619 00:27:31.107 --> 00:27:32.901 That's a marvelous thing that the pharmacy 620 00:27:32.901 --> 00:27:34.736 oftentimes will provide. 621 00:27:34.736 --> 00:27:36.863 A lot of the facilities out there, 622 00:27:36.863 --> 00:27:39.240 if they have a pharmacy in-house will provide 623 00:27:39.240 --> 00:27:41.117 all their medications this way. 624 00:27:41.117 --> 00:27:43.787 But in essence, it's sort of like your pillbox 625 00:27:43.787 --> 00:27:48.166 except it has each pill individually wrapped 626 00:27:48.166 --> 00:27:50.835 and you just punch it out of the dose pack 627 00:27:50.835 --> 00:27:53.338 and you take your medication and you know 628 00:27:53.338 --> 00:27:55.674 it's been taken because it's not in that slot anymore, 629 00:27:55.674 --> 00:27:57.050 and it tells you when the next one 630 00:27:57.050 --> 00:27:59.386 is supposed to be taken and what the medication is. 631 00:27:59.386 --> 00:28:03.139 And so it really leaves very little room for error, 632 00:28:03.139 --> 00:28:04.974 you don't have people putting the wrong pills 633 00:28:04.974 --> 00:28:07.936 in the wrong bottle because it comes the way it is, 634 00:28:07.936 --> 00:28:12.565 and so it is probably a safer way to administer medications 635 00:28:12.565 --> 00:28:14.943 and a reliable way to monitor to make sure 636 00:28:14.943 --> 00:28:16.778 people are taking what they're supposed to 637 00:28:16.778 --> 00:28:18.405 when they're supposed to take it. 638 00:28:19.656 --> 00:28:21.449 Here's another reminder. 639 00:28:21.449 --> 00:28:24.577 This actually can be programmed into your phone. 640 00:28:24.577 --> 00:28:27.622 You can put it onto your computer but it'll sound 641 00:28:27.622 --> 00:28:29.999 a chime and it gives you an alert 642 00:28:29.999 --> 00:28:32.210 when you're supposed to take your medication. 643 00:28:32.210 --> 00:28:33.962 That's really helpful for people that have 644 00:28:33.962 --> 00:28:36.172 to take something four times a day, 645 00:28:36.172 --> 00:28:37.924 and you can put that into your phone, 646 00:28:37.924 --> 00:28:39.801 and it's hard to remember four times a day, 647 00:28:39.801 --> 00:28:41.010 I have trouble doing that. 648 00:28:41.136 --> 00:28:43.138 If you take something once a day, 649 00:28:43.138 --> 00:28:45.348 it's probably a little easier, especially if you take it 650 00:28:45.348 --> 00:28:47.016 in the morning when you first get up. 651 00:28:47.225 --> 00:28:49.144 When you start getting multiple times 652 00:28:49.144 --> 00:28:51.855 during the course of the day with multiple drugs, 653 00:28:51.855 --> 00:28:53.148 it does become more challenging, 654 00:28:53.148 --> 00:28:54.858 and these kinda reminders that you could put 655 00:28:54.858 --> 00:28:56.901 either on your phone or some other device 656 00:28:56.901 --> 00:28:58.945 can be very helpful, yeah. 657 00:28:58.945 --> 00:29:02.449 - We did a webinar a little over a year ago on technology. 658 00:29:02.449 --> 00:29:05.243 So an Alexa or Google Home or Google echo, 659 00:29:05.243 --> 00:29:07.245 these are all things that you could just tell them, 660 00:29:07.245 --> 00:29:09.831 "Remind me at 2:00, 4:00 and 8:00", whatever 661 00:29:09.831 --> 00:29:10.665 "PM to take medicine." 662 00:29:10.665 --> 00:29:11.499 It's a great thing 663 00:29:11.499 --> 00:29:13.710 that it's just some (indistinct) medicine. 664 00:29:13.710 --> 00:29:14.669 Yeah. 665 00:29:14.669 --> 00:29:16.629 - Very good, yes. 666 00:29:16.629 --> 00:29:18.673 And here's one of the things I was talking about 667 00:29:18.673 --> 00:29:22.135 in terms of a dispenser where you can program this 668 00:29:22.135 --> 00:29:25.597 to administer this medications when they're supposed to. 669 00:29:25.597 --> 00:29:28.224 A lot of these will have either an alarm 670 00:29:28.224 --> 00:29:30.977 or it will verbally say time to take, 671 00:29:30.977 --> 00:29:32.604 and it may even tell you which drug it is 672 00:29:32.604 --> 00:29:35.648 that you're supposed to take and some of them 673 00:29:35.648 --> 00:29:38.943 will either tell you, it's time to take such and such, 674 00:29:38.943 --> 00:29:40.820 the pill will come out and it'll say, 675 00:29:40.820 --> 00:29:42.614 "Remember to take it with food." 676 00:29:42.697 --> 00:29:45.408 So some of these are very sophisticated. 677 00:29:45.742 --> 00:29:49.287 Are there other resources that people can turn to 678 00:29:49.287 --> 00:29:51.164 for medication management online 679 00:29:51.164 --> 00:29:54.250 or some good source of info? 680 00:29:54.250 --> 00:29:55.084 - Sure. 681 00:29:55.084 --> 00:29:56.294 There are a few websites 682 00:29:56.294 --> 00:29:58.338 that I find particularly helpful. 683 00:29:58.379 --> 00:29:59.839 This slide is a great illustration. 684 00:29:59.839 --> 00:30:03.384 So the one at the top says Health and Aging Foundation, 685 00:30:03.384 --> 00:30:04.636 that's actually a foundation 686 00:30:04.636 --> 00:30:07.013 of the American Geriatric Society. 687 00:30:07.013 --> 00:30:08.264 I actually sit on the board 688 00:30:08.264 --> 00:30:09.808 for the Health and Aging Foundation. 689 00:30:09.808 --> 00:30:11.976 It's a marvelous organization that provides 690 00:30:11.976 --> 00:30:15.814 lots of very reliable medical education 691 00:30:15.814 --> 00:30:18.691 and tools for the general public, 692 00:30:18.691 --> 00:30:20.568 and I would strongly recommend folks 693 00:30:20.568 --> 00:30:21.611 with other questions, 694 00:30:21.611 --> 00:30:23.822 not just related to medication management, 695 00:30:23.822 --> 00:30:27.492 but to take a look at that healthandaging.org website. 696 00:30:27.492 --> 00:30:29.035 But it does have some good tips 697 00:30:29.035 --> 00:30:31.037 in terms of managing medications on there 698 00:30:31.037 --> 00:30:33.081 and polypharmacy as well. 699 00:30:33.081 --> 00:30:34.415 The other one that you have up there 700 00:30:34.415 --> 00:30:38.628 is National Institute on Aging, which is a great resource. 701 00:30:38.628 --> 00:30:40.922 I used to sit on the National Advisory Council 702 00:30:40.922 --> 00:30:45.927 on Aging to NIH and that's a group that oversees grants 703 00:30:45.927 --> 00:30:48.096 and things like that to the national institutes 704 00:30:48.096 --> 00:30:50.473 of health related to aging. 705 00:30:50.473 --> 00:30:53.059 And this is a website that was developed 706 00:30:53.059 --> 00:30:56.521 through the government and it's a very reliable website 707 00:30:56.521 --> 00:30:58.022 and I know the government's getting 708 00:30:58.022 --> 00:31:00.191 a lot of hassle right now in this time of COVID 709 00:31:00.191 --> 00:31:02.193 about whether information is good or bad, 710 00:31:02.193 --> 00:31:04.195 this is a great website in terms 711 00:31:04.195 --> 00:31:06.990 of being reliable, useful information, 712 00:31:06.990 --> 00:31:09.409 very helpful for the general public, 713 00:31:09.409 --> 00:31:12.954 and I would recommend folks to go to this website. 714 00:31:12.954 --> 00:31:15.248 It's run by the National Institute on Aging, 715 00:31:15.248 --> 00:31:18.293 and that's part of the National Institutes of Health 716 00:31:18.293 --> 00:31:22.005 and a wonderful resource for managing medications, 717 00:31:22.005 --> 00:31:24.632 but lots of other topics that are common 718 00:31:24.632 --> 00:31:27.427 in an older adult population that need to be addressed, 719 00:31:27.427 --> 00:31:32.640 and these are two very reliable, useful, good websites 720 00:31:32.640 --> 00:31:34.934 to give you helpful information, 721 00:31:34.934 --> 00:31:36.769 and you don't have to question whether, 722 00:31:36.769 --> 00:31:38.354 "Well, I got this off of..." 723 00:31:38.354 --> 00:31:41.399 I don't wanna be too critical about Dr. G. 724 00:31:41.399 --> 00:31:42.650 or anybody else like that. 725 00:31:42.650 --> 00:31:44.944 I'm not talking about me when I say Dr. G, 726 00:31:44.944 --> 00:31:48.448 but the reality of it is there some websites 727 00:31:48.448 --> 00:31:50.241 that are out there that give you lots of information, 728 00:31:50.241 --> 00:31:52.535 but not very useful information and cause more problems 729 00:31:52.535 --> 00:31:54.078 than they resolve. 730 00:31:54.078 --> 00:31:55.747 - Well, that goes to my next question, 731 00:31:55.747 --> 00:31:57.790 because my doctor is always warning me to stop talking 732 00:31:57.790 --> 00:31:58.875 to Dr. Google. 733 00:31:59.250 --> 00:32:01.544 He says, "You know how to call me. 734 00:32:01.544 --> 00:32:03.755 Stop looking things up on your own 735 00:32:03.755 --> 00:32:05.131 'cause you don't know where you're going." 736 00:32:05.131 --> 00:32:07.592 So with that in mind, are there places 737 00:32:07.592 --> 00:32:09.427 people should not look? 738 00:32:09.427 --> 00:32:12.430 Like just Googling, like me, I can convince myself 739 00:32:12.430 --> 00:32:14.766 I have any disease by googling symptoms. 740 00:32:14.766 --> 00:32:17.560 - Yeah, I don't wanna disparage any particular websites 741 00:32:17.560 --> 00:32:20.355 but but you've already I think, talked 742 00:32:20.355 --> 00:32:22.732 about some very popular websites that are out there 743 00:32:22.732 --> 00:32:25.610 where a lot of folks go and they get information. 744 00:32:25.610 --> 00:32:29.405 And I spend an inordinate amount of my time 745 00:32:29.405 --> 00:32:33.117 with my patients, talking to them about information 746 00:32:33.117 --> 00:32:35.244 they've gotten, it's not reliable, 747 00:32:35.244 --> 00:32:36.829 and where it doesn't apply to them. 748 00:32:36.829 --> 00:32:39.666 And they say, "Well, I'm sure I have this, this and this.", 749 00:32:39.666 --> 00:32:44.587 and for a lot of older adults, they have multiple complaints 750 00:32:44.587 --> 00:32:47.298 that are associated with multiple medical problems, 751 00:32:47.298 --> 00:32:49.884 and it's not all related to just one thing. 752 00:32:49.884 --> 00:32:52.553 It's much more common in the younger adult population 753 00:32:52.553 --> 00:32:56.474 to have four or five symptoms related to a single illness. 754 00:32:56.474 --> 00:32:59.352 That's much less common in an older adult population, 755 00:32:59.352 --> 00:33:01.604 and you really need someone who spends time with you 756 00:33:01.604 --> 00:33:05.525 getting a very good history and also doing 757 00:33:05.525 --> 00:33:07.443 a very good clinical exam. 758 00:33:07.443 --> 00:33:10.905 And I spend a lot of time with our medical students, 759 00:33:10.905 --> 00:33:13.700 I have third and fourth year students that work with me 760 00:33:13.700 --> 00:33:16.035 on a routine basis and teaching them 761 00:33:16.035 --> 00:33:19.539 clinical examination skills and how much you can learn 762 00:33:19.539 --> 00:33:22.041 from that, as opposed to ordering 763 00:33:22.041 --> 00:33:25.670 just a ridiculous number of tests, and if you get 764 00:33:25.670 --> 00:33:27.338 a good history and a good physical, 765 00:33:27.338 --> 00:33:30.967 a good clinician generally will have a pretty good idea 766 00:33:30.967 --> 00:33:32.093 of what's going on. 767 00:33:33.219 --> 00:33:36.514 But trying to get all that information just on a website, 768 00:33:36.514 --> 00:33:39.183 I even have difficulty when I'm trying to do telemedicine 769 00:33:39.183 --> 00:33:42.562 when I'm looking at somebody, that additional advantage 770 00:33:42.562 --> 00:33:44.981 of being able to do an examination etc, 771 00:33:44.981 --> 00:33:47.734 it's going to help people much, much more. 772 00:33:47.734 --> 00:33:49.444 I don't wanna be overly critical of this. 773 00:33:49.444 --> 00:33:50.987 I think it's wonderful that people 774 00:33:50.987 --> 00:33:53.823 are becoming more educated and getting more information 775 00:33:53.823 --> 00:33:58.828 about their own health, but there's a reason why we spend 776 00:33:58.828 --> 00:34:01.080 an awful long time in medical school. 777 00:34:01.080 --> 00:34:03.791 I mean, in addition to the four years of college, 778 00:34:03.791 --> 00:34:06.669 it was four years of medical school, a year of internship, 779 00:34:06.669 --> 00:34:09.922 two years of residency, three years of Geriatric fellowship 780 00:34:09.922 --> 00:34:12.383 before I actually went out on my own seeing patients. 781 00:34:12.383 --> 00:34:17.138 And so it is it is much more complex than spending 782 00:34:17.138 --> 00:34:20.391 a few minutes online and trying to figure out what you have. 783 00:34:20.391 --> 00:34:22.560 - Good point for us all to remember. 784 00:34:23.978 --> 00:34:27.523 So we are now at the point where we're gonna answer some Q&A 785 00:34:27.523 --> 00:34:29.317 The first one is a great question, I wanna know 786 00:34:29.317 --> 00:34:30.651 the answer to this one too. 787 00:34:30.651 --> 00:34:34.655 "What age should one consider moving to a geriatrician?" 788 00:34:34.655 --> 00:34:36.157 - It is a very common question. 789 00:34:36.157 --> 00:34:39.702 In my practice, I don't see anyone less than the age of 65. 790 00:34:40.578 --> 00:34:43.414 There are some people that argue it could go as low as 55 791 00:34:43.414 --> 00:34:46.626 if they have a lot of comorbid conditions. 792 00:34:46.626 --> 00:34:48.795 There are other geriatricians who only see people 793 00:34:48.795 --> 00:34:51.672 over the age of 85, but I think most commonly, 794 00:34:51.672 --> 00:34:55.426 we're talking about 65 because of physiologic changes 795 00:34:55.426 --> 00:34:59.847 that occur in terms of how organs function 796 00:34:59.847 --> 00:35:02.517 and some anatomical changes that occur 797 00:35:02.517 --> 00:35:05.269 as we get older as well and disease processes 798 00:35:05.269 --> 00:35:08.106 that are more common start to really manifest themselves 799 00:35:08.106 --> 00:35:09.565 after the age of 65. 800 00:35:09.565 --> 00:35:13.444 So I think most of us are content to use 65 as a cut off. 801 00:35:13.736 --> 00:35:15.613 We have a question coming in from Facebook 802 00:35:15.613 --> 00:35:18.241 and from Zoom about the Beers List. 803 00:35:18.241 --> 00:35:20.785 "Can lay person access the Beers List 804 00:35:20.785 --> 00:35:24.038 to check the medications their spouse or parent is taking 805 00:35:24.038 --> 00:35:27.208 to see if there's anything that might be problematic?" 806 00:35:27.208 --> 00:35:28.960 - Yes, they can. 807 00:35:28.960 --> 00:35:33.297 They can go to the Health and Aging Foundation website 808 00:35:33.297 --> 00:35:34.799 at healthandaging.org. 809 00:35:34.799 --> 00:35:37.343 The American Geriatric Society's website 810 00:35:37.343 --> 00:35:40.138 also has a copy of that 811 00:35:40.138 --> 00:35:41.722 and I think that's available actually 812 00:35:41.722 --> 00:35:44.350 to the general public as a PDF. 813 00:35:44.350 --> 00:35:48.980 It is a little technical in some aspects 814 00:35:48.980 --> 00:35:51.524 but I think most people could at least look 815 00:35:51.524 --> 00:35:53.651 at the medications that are on the list 816 00:35:53.651 --> 00:35:56.571 and see whether or not they had a list of those drugs, 817 00:35:56.571 --> 00:35:58.781 whether they were taking any individual. 818 00:35:58.781 --> 00:36:00.741 I do wanna caution people 819 00:36:00.741 --> 00:36:02.618 that just because it's on the list doesn't mean 820 00:36:02.618 --> 00:36:05.204 you can't take one of those drugs, it's just generally 821 00:36:05.204 --> 00:36:07.290 that it would be inappropriate for an older adult 822 00:36:07.290 --> 00:36:09.167 and you want somebody who has real expertise 823 00:36:09.167 --> 00:36:13.045 deciding whether or not the merits outweigh the risk 824 00:36:13.045 --> 00:36:15.756 that are higher in the older adult population. 825 00:36:15.756 --> 00:36:17.717 - And from an advocacy standpoint, a great thing 826 00:36:17.717 --> 00:36:19.093 to bring up to your doctor, right? 827 00:36:19.093 --> 00:36:20.803 And say, "Hey, I saw this.", right? 828 00:36:20.803 --> 00:36:22.763 So that's where being informed is great 829 00:36:22.763 --> 00:36:24.682 'cause you can say, "Hey, heard about this Beers List, 830 00:36:24.682 --> 00:36:25.683 let's look this up." 831 00:36:25.683 --> 00:36:27.393 And the doctor may say "No, because the amount 832 00:36:27.393 --> 00:36:30.229 we have you on, whatever," but it's great to know that, 833 00:36:30.229 --> 00:36:31.480 to be informed. 834 00:36:31.480 --> 00:36:33.941 - Yeah, I spend a lot of time educating physicians 835 00:36:33.941 --> 00:36:37.820 actually about the Beers List and suggesting drugs 836 00:36:37.820 --> 00:36:40.907 other than what are on the Beers List and alternatives 837 00:36:40.907 --> 00:36:43.784 and the Beers List more recently, the articles 838 00:36:43.784 --> 00:36:46.120 that have come out on the Beers List 839 00:36:46.120 --> 00:36:49.373 have actually started to list alternative agents 840 00:36:49.373 --> 00:36:51.042 compared to those that are on the list, 841 00:36:51.042 --> 00:36:53.294 so little safer options for us. 842 00:36:55.338 --> 00:36:58.382 - Here's another great question, "Is a geriatrician covered 843 00:36:58.382 --> 00:37:00.051 by insurance Medicare?" 844 00:37:00.968 --> 00:37:04.388 - Generally they are, and there are physicians 845 00:37:04.388 --> 00:37:07.683 like other physicians are out there that specialize 846 00:37:07.683 --> 00:37:08.517 in other things. 847 00:37:08.517 --> 00:37:10.269 So your cardiologist is probably covered, 848 00:37:10.269 --> 00:37:12.605 your geriatrician is covered, your internist 849 00:37:12.605 --> 00:37:15.107 would be covered, your pediatrician would be covered, 850 00:37:15.107 --> 00:37:17.068 well, not by Medicare, let me clarify that. 851 00:37:17.068 --> 00:37:18.152 (Janet and Dr. Michael laugh) 852 00:37:18.152 --> 00:37:22.323 Generally not by Medicare, but certainly, the older adult, 853 00:37:22.323 --> 00:37:25.534 if you can get a geriatric specialist, 854 00:37:25.534 --> 00:37:27.578 that would be what I would recommend 855 00:37:27.578 --> 00:37:32.500 despite my bias here, I think it makes pretty logical sense 856 00:37:32.500 --> 00:37:34.126 to think about a geriatrician, 857 00:37:34.126 --> 00:37:36.754 especially if an older individual is more frail. 858 00:37:38.172 --> 00:37:41.050 Now, I will say there are some physicians 859 00:37:41.050 --> 00:37:43.010 that are concierge physicians. 860 00:37:43.010 --> 00:37:47.932 And so concierge physicians usually charge a fee upfront. 861 00:37:47.932 --> 00:37:49.433 I can tell you in Collier County here, 862 00:37:49.433 --> 00:37:53.229 most of the geriatricians are actually concierge physicians. 863 00:37:53.229 --> 00:37:55.439 And actually, I mean, a lot of good internist 864 00:37:55.439 --> 00:37:57.650 are concierge physicians down here too. 865 00:37:57.650 --> 00:37:59.568 So there is a certain amount of bureaucracy 866 00:37:59.568 --> 00:38:01.237 with Medicare and some physicians 867 00:38:01.237 --> 00:38:02.571 have dropped out of Medicare 868 00:38:02.571 --> 00:38:05.866 because of the regulations and the burdensome, 869 00:38:06.742 --> 00:38:09.412 well, not just regulations, but the burdensome risks 870 00:38:09.412 --> 00:38:11.205 that are associated with Medicare. 871 00:38:11.205 --> 00:38:12.832 And so because of that, there are some physicians 872 00:38:12.832 --> 00:38:14.542 who have dropped out of Medicare. 873 00:38:15.251 --> 00:38:16.877 Here's a question from someone that says, 874 00:38:16.877 --> 00:38:18.087 "I'm worried about my mom 875 00:38:18.087 --> 00:38:19.880 when she's out and running errands. 876 00:38:19.880 --> 00:38:22.216 Should she keep a list of medications with her 877 00:38:22.216 --> 00:38:24.468 or should she carry all her medications with her? 878 00:38:24.468 --> 00:38:26.721 What's the best protocol?" 879 00:38:26.721 --> 00:38:31.684 - So when an older adult is out, living their life, 880 00:38:32.059 --> 00:38:34.312 which we want them to do, we want them to go out and shop, 881 00:38:34.312 --> 00:38:36.272 we want them to run their errands, 882 00:38:36.272 --> 00:38:38.065 they don't necessarily need to carry 883 00:38:38.065 --> 00:38:39.317 all their medications with them, 884 00:38:39.317 --> 00:38:41.193 but I think it always makes sense to have 885 00:38:41.193 --> 00:38:42.945 a list of your medications with you 886 00:38:42.945 --> 00:38:44.572 in case you have a problem. 887 00:38:44.572 --> 00:38:46.991 So I can tell you when EMS comes on the scene, 888 00:38:46.991 --> 00:38:49.160 anytime I've been on the scene with a patient 889 00:38:49.160 --> 00:38:51.287 who's had a problem when EMS has gotten there, 890 00:38:51.287 --> 00:38:54.123 they've always asked me, even when I'm not 891 00:38:54.123 --> 00:38:56.125 in the emergency room or anyplace else, 892 00:38:56.125 --> 00:38:59.712 if I'm sitting there out in the community having dinner 893 00:38:59.712 --> 00:39:01.464 and somebody has a problem and I go over to help them, 894 00:39:01.464 --> 00:39:04.383 when EMS comes they always ask, 895 00:39:04.383 --> 00:39:06.260 "What medications are you taking?" 896 00:39:06.260 --> 00:39:09.680 And so if you have that list readily available, 897 00:39:09.680 --> 00:39:11.766 that's a very helpful thing should you have 898 00:39:11.766 --> 00:39:13.934 something happen more urgently. 899 00:39:13.934 --> 00:39:17.104 - Yeah, my aunt keeps it on her notes on her phone. 900 00:39:17.104 --> 00:39:18.689 So it's always right there. 901 00:39:18.689 --> 00:39:21.609 - It's a great thing to do and I think having access 902 00:39:21.609 --> 00:39:23.694 to that is a very helpful thing. 903 00:39:23.694 --> 00:39:26.197 Not as helpful if you're unconscious, of course, but- 904 00:39:26.197 --> 00:39:27.448 - Right, you don't know, but- 905 00:39:27.448 --> 00:39:28.282 - Right. 906 00:39:28.282 --> 00:39:31.702 But nonetheless, most urgent circumstances, 907 00:39:31.702 --> 00:39:33.954 you're not unconscious and and having a list 908 00:39:33.954 --> 00:39:35.206 of those medications- - Very helpful. 909 00:39:35.206 --> 00:39:36.374 Better than not having it. 910 00:39:36.374 --> 00:39:39.001 We have a couple of questions about mail-in 911 00:39:39.001 --> 00:39:41.754 as well as the medications that are packed together. 912 00:39:41.754 --> 00:39:44.256 Is it safe to have a company pack these things together? 913 00:39:44.256 --> 00:39:45.716 Is the company gonna know what can 914 00:39:45.716 --> 00:39:47.676 and can't be combined together? 915 00:39:47.676 --> 00:39:49.887 And how reliable are these services 916 00:39:49.887 --> 00:39:52.390 in catching medications that may not go together?" 917 00:39:52.848 --> 00:39:54.809 - So there's not a set answer to that. 918 00:39:54.809 --> 00:39:57.853 There are some companies that are excellent at doing this. 919 00:39:57.853 --> 00:40:00.022 They are very, very good. 920 00:40:00.022 --> 00:40:02.650 The pharmacists that are involved in the process, 921 00:40:02.650 --> 00:40:04.777 most of the circumstances where this happens, 922 00:40:04.777 --> 00:40:06.987 there are pharmacists that are involved, 923 00:40:06.987 --> 00:40:09.573 and the pharmacists are pretty good about looking 924 00:40:09.573 --> 00:40:12.868 at those kinds of combinations that are potentially harmful. 925 00:40:12.868 --> 00:40:15.621 But to make a blanket statement, they're all good, 926 00:40:15.621 --> 00:40:18.499 or they're all bad, I don't think that's really legitimate, 927 00:40:18.499 --> 00:40:20.126 just like all physicians are not good 928 00:40:20.126 --> 00:40:21.252 and not all physicians are bad, so. 929 00:40:21.252 --> 00:40:22.962 - Yeah, 'cause that came in from the co-packing 930 00:40:22.962 --> 00:40:24.588 as well as the mail-in service 931 00:40:24.588 --> 00:40:25.965 - And it doesn't hurt to bring in 932 00:40:25.965 --> 00:40:28.759 those kinds of packets into the physician office 933 00:40:28.759 --> 00:40:31.720 when you bring in your list of medications 934 00:40:31.720 --> 00:40:33.889 and we tell people bring in your drugs, 935 00:40:33.889 --> 00:40:36.851 bring it in that packaging and make sure 936 00:40:36.851 --> 00:40:39.270 that the what is combined is actually appropriate 937 00:40:39.270 --> 00:40:40.479 to be combined. 938 00:40:40.479 --> 00:40:42.690 - That's a good idea. 939 00:40:42.690 --> 00:40:44.024 All right, here's a good one. 940 00:40:44.024 --> 00:40:46.277 "My dad doesn't like to take his medication, 941 00:40:46.277 --> 00:40:48.821 he says it makes him feel old. 942 00:40:48.821 --> 00:40:51.115 Do you have any tips on ways around this 943 00:40:51.115 --> 00:40:52.825 or how to address it with him so he'll take it?" 944 00:40:52.825 --> 00:40:55.744 I don't know, taking medicines, then we're all feeling 945 00:40:55.744 --> 00:40:57.121 old that we have to take medicine. 946 00:40:57.121 --> 00:40:59.748 Do you have any advice or tips for this person? 947 00:40:59.748 --> 00:41:04.670 - I will tell you, when I've had patients come in to me 948 00:41:04.670 --> 00:41:07.465 and I go through their list and I say, 949 00:41:07.465 --> 00:41:11.218 "I think we can probably stop a few of these drugs, 950 00:41:11.218 --> 00:41:14.763 and you actually may feel better," their eyes light up. 951 00:41:14.763 --> 00:41:16.223 I don't know very many people 952 00:41:16.223 --> 00:41:18.642 who want to take more medication. 953 00:41:18.642 --> 00:41:20.561 Now, I do know there are patients that I have 954 00:41:20.561 --> 00:41:23.022 who when they have a problem, they think immediately 955 00:41:23.022 --> 00:41:25.483 I'm going to write a prescription, 956 00:41:25.483 --> 00:41:29.445 and I don't always do that and they question that sometimes, 957 00:41:29.445 --> 00:41:31.822 but the reality of it is, is nobody wants to spend 958 00:41:31.822 --> 00:41:33.782 all day long taking drugs. - Right. 959 00:41:33.782 --> 00:41:36.660 - And at least not what we're talking about, 960 00:41:36.660 --> 00:41:37.703 how we're talking about it. 961 00:41:37.703 --> 00:41:42.124 So the reality of it is there may be medications 962 00:41:42.124 --> 00:41:44.251 that are needed, but there also may be medications 963 00:41:44.251 --> 00:41:48.047 that are not needed and I think that concept of going 964 00:41:48.047 --> 00:41:51.383 to a geriatrician can really be helpful. 965 00:41:51.383 --> 00:41:52.843 There's no question in our practice, 966 00:41:52.843 --> 00:41:55.054 we stop many more drugs than we start, 967 00:41:55.054 --> 00:41:56.972 it usually makes people feel better, 968 00:41:56.972 --> 00:42:01.018 they actually have fewer side effects when you do that. 969 00:42:01.018 --> 00:42:03.270 Some drugs that have been on board for a long time 970 00:42:03.270 --> 00:42:05.731 don't need to be continued, and some drugs 971 00:42:05.731 --> 00:42:08.192 that were started by other clinicians, 972 00:42:08.192 --> 00:42:10.277 you just need to have the courage to walk in there 973 00:42:10.277 --> 00:42:12.279 and say, "Hey, we're gonna give this a trial, 974 00:42:12.279 --> 00:42:14.323 I don't think you need to be on this. 975 00:42:14.323 --> 00:42:16.700 I don't have really good notes from the other physician," 976 00:42:16.700 --> 00:42:19.662 or maybe the other physician is not even alive anymore. 977 00:42:19.662 --> 00:42:23.123 And we're gonna give a trial and see how this goes, 978 00:42:23.123 --> 00:42:24.708 and it just means you need to communicate 979 00:42:24.708 --> 00:42:26.585 pretty much upfront. 980 00:42:26.585 --> 00:42:30.506 But as things accrue, there are more drugs 981 00:42:30.506 --> 00:42:32.550 that are needed in terms of managing 982 00:42:32.550 --> 00:42:34.552 certain medical conditions. 983 00:42:34.552 --> 00:42:37.972 I talk to my patients sometimes about exercise. 984 00:42:37.972 --> 00:42:40.724 Exercise is likely to make you feel better, 985 00:42:40.724 --> 00:42:43.727 it's likely to help you have longer functional survival, 986 00:42:43.727 --> 00:42:47.273 meaning you're gonna be more active the older that you get, 987 00:42:47.273 --> 00:42:50.985 and it's sometimes more about that than chronological age, 988 00:42:50.985 --> 00:42:53.737 and sometimes the medications are gonna do that as well. 989 00:42:53.737 --> 00:42:58.158 And I remember seeing a funny cartoon that said, 990 00:42:58.158 --> 00:43:00.703 "Would you like to exercise an hour a day 991 00:43:00.703 --> 00:43:03.205 or be dead 24 hours a day?" 992 00:43:03.205 --> 00:43:06.458 And sometimes that's the way it is with medications. 993 00:43:06.458 --> 00:43:09.712 There are some medications that are literally needed 994 00:43:09.712 --> 00:43:13.257 to stay alive and so that discussion 995 00:43:13.257 --> 00:43:15.718 about what's really important and what isn't 996 00:43:15.718 --> 00:43:18.429 and recognizing that the pure number of medications 997 00:43:18.429 --> 00:43:21.015 are more likely to cause problems in older adults 998 00:43:21.015 --> 00:43:23.934 and maybe that that dad who says, 999 00:43:23.934 --> 00:43:26.729 "I'm taking too many drugs," needs to have somebody 1000 00:43:26.729 --> 00:43:28.606 really review those medications and see 1001 00:43:28.606 --> 00:43:31.233 if there are some that can be discontinued, 1002 00:43:31.233 --> 00:43:32.818 and that includes supplements. 1003 00:43:32.818 --> 00:43:33.902 So yeah. 1004 00:43:33.902 --> 00:43:36.780 - I think that's a great convo to have with the doctor 1005 00:43:36.780 --> 00:43:37.990 in that too, so that's great. 1006 00:43:37.990 --> 00:43:40.492 I know my doctor always tells me regarding exercise, 1007 00:43:40.492 --> 00:43:41.744 movement is medicine. 1008 00:43:41.744 --> 00:43:43.120 I'm like, I love that. 1009 00:43:43.120 --> 00:43:44.788 - That's good, that's very good. 1010 00:43:44.830 --> 00:43:46.874 "How often is the Beers List updated, 1011 00:43:46.874 --> 00:43:49.293 and how often should I go back and check that?" 1012 00:43:49.293 --> 00:43:52.338 - So the Beers List gets updated every few years. 1013 00:43:52.338 --> 00:43:57.301 So 2015, then 2019 and there's another one 1014 00:43:57.593 --> 00:43:59.053 due to come out pretty soon, 1015 00:43:59.053 --> 00:44:01.138 so we may see another one in 2022. 1016 00:44:01.138 --> 00:44:03.724 I think they're putting that together right now. 1017 00:44:03.724 --> 00:44:06.477 "Is there a technology or device that will allow me 1018 00:44:06.477 --> 00:44:08.562 to know my mother did take her medication? 1019 00:44:08.562 --> 00:44:10.606 She does not live with me." 1020 00:44:10.606 --> 00:44:13.651 - So the only way you can really tell if the individual 1021 00:44:13.651 --> 00:44:19.615 has taken the medication is if you're using the pillboxes, 1022 00:44:20.491 --> 00:44:23.035 if the mom's reliable, you can ask her, 1023 00:44:23.035 --> 00:44:26.413 "Is the pillbox empty?", for that day. 1024 00:44:26.413 --> 00:44:28.207 And the other thing you can do 1025 00:44:28.207 --> 00:44:30.959 is, "Hey mom, put it on FaceTime, 1026 00:44:30.959 --> 00:44:32.461 let me see your pillboxes." 1027 00:44:32.461 --> 00:44:34.713 And you can actually look and see what's been taken 1028 00:44:34.713 --> 00:44:36.799 and what hasn't been taken. 1029 00:44:36.799 --> 00:44:39.009 Short of using something that shows that 1030 00:44:39.009 --> 00:44:42.012 or having one of those electronic devices that says, 1031 00:44:42.012 --> 00:44:44.390 "Hey, take your medicine.", and it drops in the cup 1032 00:44:44.390 --> 00:44:46.767 and hopefully, it's not for drugs still in the cup 1033 00:44:46.767 --> 00:44:49.978 by the end of the day that haven't been taken. 1034 00:44:49.978 --> 00:44:52.272 Those kinds of things are the only ways 1035 00:44:52.272 --> 00:44:53.691 to really check up on it. 1036 00:44:54.525 --> 00:44:56.193 If your mom doesn't want you to know 1037 00:44:56.193 --> 00:45:00.864 whether she took her medication and she's with it mentally, 1038 00:45:00.864 --> 00:45:02.783 she's gonna be able to hide it from you. 1039 00:45:02.783 --> 00:45:06.954 And I can tell you, my father-in-law, when he died, 1040 00:45:06.954 --> 00:45:08.914 there were drugs he didn't wanna take, 1041 00:45:08.914 --> 00:45:12.835 and when we were cleaning up his house, 1042 00:45:12.835 --> 00:45:16.130 there was a little spot that he had behind his bed 1043 00:45:16.130 --> 00:45:18.799 and he probably had 30 pills back there 1044 00:45:18.799 --> 00:45:20.092 that he just didn't wanna take them 1045 00:45:20.092 --> 00:45:21.885 and so he put them behind the bed. 1046 00:45:23.095 --> 00:45:25.347 And nobody knew about it until after he died. 1047 00:45:26.140 --> 00:45:27.725 And it wasn’t because… 1048 00:45:27.725 --> 00:45:29.768 He'd actually died in an automobile accident, 1049 00:45:29.768 --> 00:45:32.187 so it wasn't related to his medications, 1050 00:45:32.187 --> 00:45:33.105 whether he took them or not. 1051 00:45:33.105 --> 00:45:36.150 So I can't tell you whether he was on too many drugs or not, 1052 00:45:36.150 --> 00:45:38.986 but I know this, that he didn't wanna take drugs 1053 00:45:38.986 --> 00:45:41.196 and nobody knew he didn't take some of the medication 1054 00:45:41.196 --> 00:45:43.449 that he was supposed to be taking. 1055 00:45:43.449 --> 00:45:45.701 - I know you said at the top of this too 1056 00:45:45.701 --> 00:45:49.788 when it comes to if you're not refilling, right, 1057 00:45:49.788 --> 00:45:52.499 if you go to your mom's house and she's past time 1058 00:45:52.499 --> 00:45:54.710 to need a refill, of course, she's not taking it, right? 1059 00:45:54.710 --> 00:45:57.880 So there's things like that or refilling too soon, 1060 00:45:57.880 --> 00:46:00.966 those things are triggers to but on a day to day basis, 1061 00:46:00.966 --> 00:46:02.509 that might be hard, but maybe that device, 1062 00:46:02.509 --> 00:46:04.678 maybe that device has some interface that says. 1063 00:46:04.678 --> 00:46:07.306 But you're right, she still has to take them out of the cup. 1064 00:46:07.306 --> 00:46:08.932 - Right, so. 1065 00:46:08.932 --> 00:46:10.184 - Here's a great question. 1066 00:46:10.184 --> 00:46:13.228 "It seems like my medications are constantly changing 1067 00:46:13.228 --> 00:46:15.564 from generic to some kind of formula, 1068 00:46:15.564 --> 00:46:18.233 does that affect the way it works in my body 1069 00:46:18.233 --> 00:46:20.194 and do I need to talk to my doctor to adjust 1070 00:46:20.194 --> 00:46:21.820 any supplements I take?" 1071 00:46:22.821 --> 00:46:27.493 - So the supplement issue is more of a problem for me 1072 00:46:27.493 --> 00:46:29.953 than the medication changes going from generic 1073 00:46:29.953 --> 00:46:32.706 or from one prescription plan to another. 1074 00:46:32.706 --> 00:46:35.876 Prescription plans generally have a contract 1075 00:46:35.876 --> 00:46:37.711 with certain providers. 1076 00:46:37.711 --> 00:46:40.547 And so you may be taking one formulation of a drug 1077 00:46:40.547 --> 00:46:42.007 and at the end of the year, 1078 00:46:42.007 --> 00:46:43.634 when you switch prescription plans 1079 00:46:43.634 --> 00:46:46.762 or it gets switched for you, you find that you can't keep 1080 00:46:46.762 --> 00:46:49.223 taking that brand name that you were taking before. 1081 00:46:49.223 --> 00:46:52.059 And a lot of people get very concerned about that. 1082 00:46:52.059 --> 00:46:56.396 Most of the generics are quite equivalent to the brand names 1083 00:46:56.396 --> 00:46:59.817 and one brand name is not a lot different 1084 00:46:59.817 --> 00:47:03.570 from the other brand name if it's the same generic drug. 1085 00:47:05.072 --> 00:47:09.576 There are certain circumstances where that doesn't apply, 1086 00:47:09.576 --> 00:47:13.831 and there are not very many, but you will have some patients 1087 00:47:13.831 --> 00:47:17.876 who have a reaction to a generic that they did not have 1088 00:47:17.876 --> 00:47:20.128 to the brand name or when a brand name is switched 1089 00:47:20.128 --> 00:47:21.797 from one brand to another, 1090 00:47:21.797 --> 00:47:24.258 they may have a response that they did not have. 1091 00:47:25.300 --> 00:47:27.928 In those circumstances, it's important to document 1092 00:47:27.928 --> 00:47:30.305 that there's a problem with the switch 1093 00:47:30.305 --> 00:47:33.976 and work with the prescription plan to go back 1094 00:47:33.976 --> 00:47:37.271 to the previous formulation. 1095 00:47:37.271 --> 00:47:40.023 That usually is very difficult to do, 1096 00:47:40.023 --> 00:47:42.568 and these prescription plans do not like to do that, 1097 00:47:42.568 --> 00:47:44.194 it's a lot of work for your physician. 1098 00:47:44.194 --> 00:47:46.780 Oftentimes, I have to appeal it. 1099 00:47:46.780 --> 00:47:50.075 Usually when I get to the appeal process, I get approved, 1100 00:47:50.075 --> 00:47:52.536 but it is a bit of a hassle to do it. 1101 00:47:52.536 --> 00:47:56.039 It's unfortunate that the prescription plans 1102 00:47:56.039 --> 00:48:00.127 have these folks that are making decisions 1103 00:48:00.127 --> 00:48:02.546 who have never seen the patient, really don't know 1104 00:48:02.546 --> 00:48:05.299 their medical history and yet they can make 1105 00:48:05.299 --> 00:48:08.093 those decisions based on the insurance. 1106 00:48:08.093 --> 00:48:10.679 Now, there's always an option to pay out of pocket, 1107 00:48:10.679 --> 00:48:12.306 not go that way, but some of these drugs 1108 00:48:12.306 --> 00:48:14.057 are pretty expensive, and that doesn't become 1109 00:48:14.057 --> 00:48:16.643 a realistic option for some individuals. 1110 00:48:16.643 --> 00:48:19.688 Most drugs, however, are fine when you make the switch 1111 00:48:19.688 --> 00:48:21.273 and do not cause a problem fortunately. 1112 00:48:21.398 --> 00:48:22.900 Anyone who has ever had to argue 1113 00:48:22.900 --> 00:48:26.862 with your pharmacy provider, it's an interesting 1114 00:48:26.862 --> 00:48:28.530 couple of afternoons. 1115 00:48:28.530 --> 00:48:29.489 - It is a challenge, I can tell you. 1116 00:48:29.489 --> 00:48:30.657 - [Janet] It it really is. 1117 00:48:30.657 --> 00:48:32.534 - Wastes a lot of our time, unfortunately. 1118 00:48:32.534 --> 00:48:33.911 - Absolutely. 1119 00:48:33.911 --> 00:48:35.537 Okay, here's another great question. 1120 00:48:35.537 --> 00:48:39.166 "I have some drugs filled at a compound pharmacy." 1121 00:48:39.166 --> 00:48:40.834 I've had experience with this before. 1122 00:48:40.834 --> 00:48:43.420 "Do they typically interact with my main pharmacy 1123 00:48:43.420 --> 00:48:45.672 for drug interactions or should I provide them 1124 00:48:45.672 --> 00:48:47.674 with a list for my main pharmacy?" 1125 00:48:47.841 --> 00:48:51.970 - Compounding is challenging and I will tell you, 1126 00:48:51.970 --> 00:48:55.599 I've used compounding for some drugs 1127 00:48:55.599 --> 00:48:59.353 because it's much less expensive in some circumstances. 1128 00:48:59.353 --> 00:49:02.022 Sometimes it works, sometimes it doesn't, 1129 00:49:02.022 --> 00:49:05.150 and when you go to a compounder, the pharmacist 1130 00:49:05.150 --> 00:49:08.153 can compound an agent and provided to you but oftentimes, 1131 00:49:08.153 --> 00:49:11.490 the absorption is not consistent 1132 00:49:11.490 --> 00:49:13.450 and that means serum levels 1133 00:49:13.450 --> 00:49:15.744 that you're going to have are not the same, 1134 00:49:15.744 --> 00:49:17.621 and usually to compound it, 1135 00:49:17.621 --> 00:49:19.998 it requires some other congener in there 1136 00:49:19.998 --> 00:49:21.541 to keep the medication 1137 00:49:21.541 --> 00:49:23.835 and allow it to either get through the skin 1138 00:49:23.835 --> 00:49:26.171 or keep it together with another drug, 1139 00:49:26.171 --> 00:49:29.257 and sometimes people have reactions to those congeners 1140 00:49:29.257 --> 00:49:30.759 that are in the product. 1141 00:49:30.759 --> 00:49:34.096 So there are times when you can compound. 1142 00:49:34.096 --> 00:49:36.682 As a physician, generally my patients will tell me 1143 00:49:36.682 --> 00:49:39.059 when they're getting something from a compounder 1144 00:49:39.059 --> 00:49:40.185 and I have to prescribe it 1145 00:49:40.185 --> 00:49:41.812 through that compounding pharmacy 1146 00:49:41.812 --> 00:49:45.148 so I know that they're getting it through that mechanism. 1147 00:49:45.148 --> 00:49:48.819 And it just requires a little more vigilance on my part 1148 00:49:48.819 --> 00:49:52.072 to make sure that their levels are getting high enough. 1149 00:49:52.072 --> 00:49:55.158 Some men who are hypogonadal end up taking testosterone, 1150 00:49:55.158 --> 00:49:57.494 it can be a very expensive drug, 1151 00:49:57.494 --> 00:50:00.038 it isn't always covered adequately 1152 00:50:00.038 --> 00:50:04.334 by their prescription plan, and to go to a compounder, 1153 00:50:04.334 --> 00:50:06.628 you have to follow these testosterone levels 1154 00:50:06.628 --> 00:50:08.463 and make sure they don't get too high 1155 00:50:08.463 --> 00:50:10.966 and also that they do come back into a normal range. 1156 00:50:10.966 --> 00:50:13.301 And so it requires a little more effort 1157 00:50:13.301 --> 00:50:15.804 when somebody uses somebody to compound a drug, 1158 00:50:15.804 --> 00:50:19.266 but there are times when you can't get medications 1159 00:50:19.266 --> 00:50:21.268 into somebody, particularly if they're in hospice 1160 00:50:21.268 --> 00:50:24.438 or something like that and folks who do compounding 1161 00:50:24.438 --> 00:50:28.233 can be very helpful with those routes of administration. 1162 00:50:28.233 --> 00:50:30.527 If you haven't had experience of the compound pharmacy, 1163 00:50:30.527 --> 00:50:32.529 it's like it does introduce a whole different 1164 00:50:32.529 --> 00:50:34.364 world of stuff, right? 1165 00:50:34.364 --> 00:50:36.283 - It is, it can be helpful at times, 1166 00:50:36.283 --> 00:50:38.035 it can be problematic at times too. 1167 00:50:38.035 --> 00:50:40.620 So it requires a little more vigilance on our part. 1168 00:50:40.829 --> 00:50:42.372 - All right, here's a question. 1169 00:50:43.331 --> 00:50:44.791 Again, about a mail order services, 1170 00:50:44.791 --> 00:50:47.711 "How reliable is the mail order service 1171 00:50:47.711 --> 00:50:50.505 in catching these things that shouldn't be going together?" 1172 00:50:50.505 --> 00:50:53.008 And I'm guessing it depends on the mail order service, 1173 00:50:53.008 --> 00:50:54.468 maybe to your point before. 1174 00:50:54.885 --> 00:50:57.387 - If it's through a prescription plan, 1175 00:50:57.387 --> 00:50:59.973 there are some that are pretty good, and I'll get a notice 1176 00:50:59.973 --> 00:51:03.101 that says, "Do you realize your patient is taking this? 1177 00:51:03.101 --> 00:51:06.063 Do you want them taking both of these drugs?" 1178 00:51:06.063 --> 00:51:07.939 For me, most of the time, it's an annoyance 1179 00:51:07.939 --> 00:51:09.775 because I follow drugs pretty closely, 1180 00:51:09.775 --> 00:51:16.698 but I am sure that that warning or that message of concern 1181 00:51:16.698 --> 00:51:18.450 is helpful in general. 1182 00:51:18.450 --> 00:51:23.872 And so it does, I think, help us to avoid complications 1183 00:51:23.872 --> 00:51:28.126 from things that maybe generally should not be combined 1184 00:51:28.126 --> 00:51:32.005 or in some circumstances are not advisable to combine. 1185 00:51:33.048 --> 00:51:36.093 So I don't have any criticism with that. 1186 00:51:36.093 --> 00:51:39.137 Not all mail order services do that. 1187 00:51:39.137 --> 00:51:42.390 The ones that are not specific to your prescription plan, 1188 00:51:42.390 --> 00:51:46.061 a lot of times, those are just you order it online, 1189 00:51:46.061 --> 00:51:47.562 you get what you get, they have no idea 1190 00:51:47.562 --> 00:51:49.022 what else you're taking, you're just getting 1191 00:51:49.022 --> 00:51:50.941 that particular drug from that service. 1192 00:51:50.941 --> 00:51:52.818 They have no oversight whatsoever. 1193 00:51:52.818 --> 00:51:55.904 And so you really rely heavily on your clinician 1194 00:51:55.904 --> 00:51:58.031 who's prescribing for you to know all the drugs 1195 00:51:58.031 --> 00:51:59.783 that you're taking in and making sure 1196 00:51:59.783 --> 00:52:01.493 you don't have those interactions. 1197 00:52:01.493 --> 00:52:04.037 - Yeah, we had a comment come in from Teresa 1198 00:52:04.037 --> 00:52:05.497 who says that with her mom, 1199 00:52:05.497 --> 00:52:06.998 she had a home healthcare service come 1200 00:52:06.998 --> 00:52:09.209 and set up her meds each week, do the refills, 1201 00:52:09.209 --> 00:52:10.460 another service give the reminder. 1202 00:52:10.460 --> 00:52:12.003 So there's other options out there too 1203 00:52:12.003 --> 00:52:13.463 she's sharing with us that she's used. 1204 00:52:13.463 --> 00:52:15.715 So thank you for that, Teresa. 1205 00:52:15.715 --> 00:52:18.135 So we are at the end and Dr. Gloth, I wanna thank you 1206 00:52:18.135 --> 00:52:19.094 for joining us today. 1207 00:52:19.094 --> 00:52:21.805 This was such an informative session, I love it. 1208 00:52:21.805 --> 00:52:23.598 And thank you to all of you for watching 1209 00:52:23.598 --> 00:52:26.393 and for being here and asking all your great questions. 1210 00:52:26.393 --> 00:52:28.854 As we said, we're gonna be emailing you a recording 1211 00:52:28.854 --> 00:52:30.730 and a transcript of this webinar. 1212 00:52:30.730 --> 00:52:32.691 So you'll be able to view it again and share this 1213 00:52:32.691 --> 00:52:34.192 with your family and friends. 1214 00:52:34.192 --> 00:52:36.236 Please come back and join us again in March 1215 00:52:36.236 --> 00:52:40.699 for our next webinar, Travel After COVID-19. 1216 00:52:40.699 --> 00:52:41.741 - Should be a good one. 1217 00:52:41.741 --> 00:52:44.119 Appreciate it and thank all of those in the audience 1218 00:52:44.119 --> 00:52:45.912 who participated and watched. 1219 00:52:45.912 --> 00:52:47.247 - Great, thank you. 1220 00:52:47.247 --> 00:52:49.666 Each of our webinars here features a different subject. 1221 00:52:49.666 --> 00:52:53.003 You can visit brookdale.com/intheknow to discover more. 1222 00:52:53.003 --> 00:52:54.171 We hope to see you again soon. 1223 00:52:54.171 --> 00:52:57.632 Until next time, we hope you all stay safe, happy and well. 1224 00:52:57.632 --> 00:52:58.466 Thank you.