Steadfast Care Planning
Steadfast Care Planning is for people who want to learn how to best plan for their longevity including how to navigate extended care, long-term care insurance options, and other challenges that older adults face. Join Kelly Augspurger, Certified Senior Advisor (CSA)® and long-term care insurance specialist as she has thought-provoking conversations with industry professionals. Tune in as Kelly guides you on how to plan for care to live well.
Steadfast Care Planning
Pill Pile-Up: Navigating the Dangers of Medication Overload in Older Adults with Dr. Nancy Taylor
🎙️ What are the hidden dangers of polypharmacy and how it affects older adults?
Kelly chatted with Dr. Nancy Taylor about this and here are the key takeaways from their conversation:
🔹 Polypharmacy Awareness: Polypharmacy refers to using multiple medications at the same time, often leading to unintended side effects or complications. It’s crucial to regularly reconcile medications, especially after adding new prescriptions.
🔹 Communication is Key: Effective communication between patients and healthcare providers is essential. Schedule appointments with your healthcare provider with a clear agenda to address your medication concerns and ensure everything you’re taking is necessary and safe.
🔹 Consider Deprescribing: Deprescribing is the process of tapering or stopping medications that might not be required anymore. It's important to involve your healthcare team, including pharmacists, who can offer insights into safe medication management.
Reach out to Dr. Nancy Taylor to learn more:
LinkedIn: https://www.linkedin.com/in/dr-nancy-a-taylor-pharmd-bcpa-csa-a569929a/
Facebook: https://www.facebook.com/profile.php?id=100076660611031
Instagram: https://www.instagram.com/taylormadesac/
Website: https://www.drtadvocacy.com/
FREE Personal Healthcare Action Plan Workbook on her website.
For additional information about Kelly, check her out on Linkedin or www.SteadfastAgents.com.
To explore your options for long-term care insurance, click here.
Steadfast Care Planning podcast is made possible by Steadfast Insurance LLC,
Certification in Long Term Care, and AMADA Senior Care.
Come back next time for more helpful guidance!
Kelly Augspurger [00:00:02]:
Hi everyone. Welcome to Steadfast Care Planning where we plan for care to live well. I'm Kelly Augspurger, long-term care insurance specialist and your guide. With me today is Dr. Nancy Taylor, founder and CEO of Taylormade Senior Advocacy and Consulting, LLC where she designs and implements personalized healthcare action plans for busy people who want to achieve their best quality of life. During her 20 plus years as a pharmacist and patient advocate, Dr. Taylor has brought relief, confidence, and control to hundreds of patients and clients through her strategic action planning. Welcome, Dr.
Kelly Augspurger [00:00:37]:
Taylor.
Dr. Nancy Taylor [00:00:38]:
Hello. Thank you for having me today, Kelly.
Kelly Augspurger [00:00:40]:
Thanks so much for being here. Today we are going to be talking about medication over-treatment and the hidden dangers medication overload can cause specifically in our older adult population. So Dr. Taylor, can we jump right in?
Dr. Nancy Taylor [00:00:54]:
Absolutely. Let's go.
Kelly Augspurger [00:00:55]:
Okay. What is polypharmacy and what are some causes of it?
Dr. Nancy Taylor [00:00:59]:
Polypharmacy is a big word that just means we're using multiple medications to treat a single ailment, or disease state.
Kelly Augspurger [00:01:10]:
Okay.
Dr. Nancy Taylor [00:01:11]:
And then causes that we may see from this that we don't always recognize, but the more players we have, the more causes of polypharmacy. So take into account number of your specialists. Everybody has a PCP, but they've also got 3 to 5 specialists. Especially our older adult population. We also then take a look at disease states. The older we get, the more disease states that we have. So add that on top of your number of providers and we're starting to see this build up.
Dr. Nancy Taylor [00:01:43]:
But let's not forget that self-medicating has been on the rise for the last decade and that really plays a big part and people just don't realize that. So those are the 3 big ones that play into this cause of multiple medications to treat a single disease state, or ailment.
Kelly Augspurger [00:02:04]:
Okay. And when is the right time for people to reconcile their meds?
Dr. Nancy Taylor [00:02:09]:
Reconciling meds, that's a wonderful topic. People don't always realize that it should be done often and they don't know who should be doing it. But anytime that you attend your annual appointment, that's a really good time to reconcile medications. Sometimes it's a 6 month appointment. But the biggest thing is anytime you add a new medication is a really good time to reconcile all the medications because maybe the new one doesn't play so well with some of your older ones. So that's a wonderful time to make sure that they're all going to work well together.
Kelly Augspurger [00:02:45]:
Okay. And what do you see as the barriers that lead to poor medication reconciliation.
Dr. Nancy Taylor [00:02:51]:
The number one barrier is time and communication. I mean, let's face it, we have, what, 15 minutes when we go in and see our provider. And do they do a medication reconciliation at that time? No, because they don't have time time. So that's a big barrier right there. But there's also the communication. We have patient portals now. We still can leave messages with our providers. Yet there isn't that,
Dr. Nancy Taylor [00:03:17]:
sit down and talk about it, about what is still needed, what isn't, what do we need to change? Especially as we age, the metabolism in our body changes, and that's the way it's going to affect how our medications are going to work for us, or not work for us.
Kelly Augspurger [00:03:34]:
Sure. Okay, so how do we get around that then? If we only have such a limited amount of time with our doctor, whether it's 15 minutes, 30 minutes, whatever our PCP allows and has time for. If we don't have time, then when do we do it? Do we schedule a separate appointment with our PCP? Is that what older adults should do?
Dr. Nancy Taylor [00:03:54]:
You actually hit the right word, schedule. And I'm trying to get people to change the thought process of their appointments with their providers. The patient can run the appointment. Think of it as a meeting, like an executive meeting, not just a patient provider. Create your agenda ahead of time. What is it you really want to talk with with your provider? And send that to your provider way before your appointment so that they have that, they know what you want to talk about and that in this limited time, your concerns could be addressed.
Kelly Augspurger [00:04:30]:
That's a great idea.
Dr. Nancy Taylor [00:04:32]:
Yes. Isn't that fun?
Kelly Augspurger [00:04:33]:
It's so simple, but yet, I bet, so impactful.
Dr. Nancy Taylor [00:04:36]:
It is. It's a different mind change.
Kelly Augspurger [00:04:38]:
Yeah, we do that with so many other aspects of our lives. I mean, I personally think about financial planning, having a meeting, "Hey, these are the things we're going to discuss. This is kind of our agenda. Please let me know if there are things ahead of time that you want to make sure that we address." The same thing with our primary care doctor and medications. Let them know what you want to talk about.
Dr. Nancy Taylor [00:04:57]:
Yes, and they're open to that because even though they have time constraints from their clinics, or whoever, that they're working with, if they know what the most important thing is to the patient, that helps them be better providers. And they really do appreciate that.
Kelly Augspurger [00:05:14]:
Let's talk about deprescribing. This is a kind of a newer term, I think, that's being used in the United States. I don't know for me, I've just maybe in the last couple of years have heard this term. Maybe it's been around longer than that. But I think we've had more of a buzz around this term. So tell us, Dr. Taylor, what does deprescribing mean? And then what are barriers to deprescribing?
Dr. Nancy Taylor [00:05:36]:
Deprescribing, you're right. It has become the buzzword in medication right now, especially with our older adult population. Deprescribing just means getting off of certain medications, but you have to do it in a manner that's going to be safe. Safe and effective. That is one thing we always think about with medications. Are they going to be safe and effective when we go on them? But a lot of people don't always think about that when we need to get off of them. So when we look at deprescribing, again, time and communication is one of the biggest barriers. Because when we look at this and we look at the time, it does take time to evaluate what medications are no longer serving the patient and what is going to be the safest way to reduce that, or get off of it just altogether.
Dr. Nancy Taylor [00:06:35]:
Or there's different pathways that have to be done in order to make getting off of a medication done safely. Then we also have to take into account who's going to do it. Remember when I said one of the biggest causes of polypharmacy is the multiple providers? Who's responsible to take a look and say, "Oh, we probably should see if we should deprescribe?" Is it the patient's primary care? Is it their specialist? Is it their pharmacist? Pharmacists see that all the time. They were one of the last people that looks at everything that that patient has. So is it their responsibility to say, "Hey, I think we can start to deprescribe some things for this patient," and contact the doctor, or is it one of the physicians leading that charge? That's a really big, contentious thing right now.
Kelly Augspurger [00:07:28]:
And what's your opinion?
Dr. Nancy Taylor [00:07:29]:
My opinion, it needs to come from the team. I do believe that anyone who is on the team who thinks that there could be something that's causing an issue, I don't care if it's an occupational therapist, or someone working PT, or the pharmacist, or even home health care, if somebody's questioning it, a new behavior or something that hasn't improved, then I think that person needs to be the one that speaks up and says, "Hey, maybe we should take a look at this." And then I do think that deprescribing can be done very efficiently, pharmacy led, because pharmacists are in that union with providers and they can help the provider understand where things are and help shoulder some of that load before going to the provider and saying, "Hey, this is what I found. Let's talk about it."
Kelly Augspurger [00:08:30]:
So how does that change happen, Dr. Taylor? Because that's not common, right? For pharmacists to lead the charge of, "Hey, we're going to start deprescribing here. We think that there might be some conflicts, there's some things to address." But it's not commonplace, right, for pharmacists to lead the charge in this?
Dr. Nancy Taylor [00:08:46]:
It's not commonplace, yet. "Yet" is the word. There are pharmacists out there everywhere who are literally doing this on a daily basis, but they might just be talking about one specific drug that might not play well as opposed to analyzing the entire list. And so like we talked about scheduling an appointment, specifically have that meeting with your provider. Schedule an appointment with your pharmacist. They can take the time out and sit down and go over all of that med list with the patient. The patient can request that. And pharmacists love to be able to have that one-on-one time.
Dr. Nancy Taylor [00:09:26]:
It could be the clinical pharmacist at your local clinic. It could be your local retail pharmacist you've known for 30 years. Walk in and say, "Hey, do you have time for this? Can we schedule a time to look at this? Because I'm just not sure that this is all right, yet." It could be something as similar as that, but I'm seeing it more and more with the geriatric treating pharmacists, ones that are working with geriatricians, or are doing their own type of clinical type of business. They've moved from some aspect of pharmacy, they're now in clinical and they're meeting with patients. They're part of that and they can start and lead that charge. There's just not enough of us, right?
Kelly Augspurger [00:10:12]:
We need more. We need more pharmacists. We need more pharmacists that are trained and are willing and want to deprescribe as well. What about families? I'm specifically thinking about like older adults. If we have an older adult, so maybe 80 plus, and you've got an adult child, maybe they're in their 50s and they're having to help mom and dad with medication and medication management because maybe mom and dad aren't quite up to doing that themselves anymore and need a little bit of help or supervision. Do they have the authority to go to the pharmacist and sit down and meet with mom or dad and the pharmacist? Do they need like a power of attorney to do that or can they just schedule the appointment because they're the adult child?
Dr. Nancy Taylor [00:10:53]:
They can't just take over as the adult child. But you said it right there in sitting down with mom or dad and a pharmacist going to the appointment with their parent. So the adult child can definitely be part of the solution because they're seeing it all the time.
Kelly Augspurger [00:11:11]:
Right.
Dr. Nancy Taylor [00:11:12]:
And that can make things really start in that deprescribing because they're starting to question it. Why is mom on so many meds? Does she really need these? Yeah, those are the first two questions to ask, "Can we get rid of any of these medications?" And so as the adult, I do this with my father-in-law, I am that 50 something working with the 80 something parent. And so we look at all of that, "What can we deprescribe?" And I will tell you, some of the first things we need to deprescribe are things that we start to self-medicate with because we think that we're doing ourselves good. We're in control of our health situation. But we may not be, we may unintentionally make it worse for ourselves because we've started to self-medicate.
Kelly Augspurger [00:12:06]:
When you say self-medicate, are you referring to strictly prescriptions, or even over the counters, supplements, & herbals? What do you mean when you say self-medicate?
Dr. Nancy Taylor [00:12:15]:
That's an excellent question. Because people think it has to be prescription and it's not. Here's a very good example, Kelly. Let's say that my 86 year-old father-in-law has been prescribed...let's say he's on omeprazole for acid reflux. All right, so he has that by prescription, but he goes over the counter and he picks up Tums and he picks up Pepcid.
Kelly Augspurger [00:12:44]:
Okay.
Dr. Nancy Taylor [00:12:45]:
Because he still has heartburn. In addition to his prescription, he's now taking 2 other over the counters that he didn't talk with his doctor about because it's not controlled. His acid reflux obviously isn't controlled. So now he's self-medicating plus this. So now he's on 3 medications, polypharmacy for one condition. So instead of having that conversation with his provider, he's solving the problem himself. But has he created more? He's definitely increased his pill burden. He's taking more pills and are they really necessary, or did we need to just change maybe something on the prescription side and he didn't need that?
Kelly Augspurger [00:13:27]:
Sure. Maybe the dosage, or how frequently he takes it. Okay, thanks for that clarification on self-medicating. The Steadfast Care Planning podcast is sponsored by the Certification for Long-Term Care, CLTC, an in depth training program that gives financial advisors the education and tools they need to discuss extended care planning with their clients. Look for the CLTC designation when choosing an advisor. If you're looking to become a CLTC, enroll in their masterclass and enter "Kelly" in the coupon code field for $200 off.
Kelly Augspurger [00:13:59]:
What about physiological changes in older adults where hidden dangers happen? What are those changes that you see?
Dr. Nancy Taylor [00:14:07]:
The biggest change that happens as we age is our metabolism changes. Our metabolism slows down our peristalsis, so everything that moves stuff through our body slows down. So it's slower down the throat through the intestines. And because of that, those changes make the absorption and the excretion of medications change. And here's a really good example of that. My mother has been on thyroid medication her entire life. Started in her 20s, she's now in her early 80s, but we started to notice about 5 years ago that she had more difficulty in controlling her temperature and her fatigue changed and she thought, "Well, gosh, maybe it's just getting older." And a lot of older people attribute these kinds of changes to aging.
Dr. Nancy Taylor [00:15:04]:
And it wasn't. We went and had thyroid tests done and sure enough, her dosing isn't where it should have been because her body is metabolizing that drug differently now that she's aged, even though she has been on it forever. And they all say that "I've been on that forever." That may be, but your body changes it. So then we need to adjust. So that's probably one of the biggest things is the change in metabolism. And when we start to slow down, the way drugs are absorbed and the way we get rid of them, we hold on to things differently in the body. So when you make a change, even a slight change to a drug regimen in an older adult, it can have very big consequences just because that body no longer handles it like it used to.
Kelly Augspurger [00:15:53]:
Okay. And that is actually a perfect segue to my next question, which is, and I've heard you say this before, for every cause there's always an effect and the effects can be dangerous. So what's a prescribing cascade? What does that mean?
Dr. Nancy Taylor [00:16:07]:
I love to talk about the prescribing cascade because it's something like deprescribing, people don't understand. And a prescribing cascade is treating symptoms. Let me give you a good example here. Let's say that, Kelly, you were prescribed a medication "A" for a new condition. Doctor says, "Come back and see me in two weeks, and let's see how this medication's working for you." You go back and you see the doctor and he says, "How are things?" You say, "Well, okay, I've noticed that this is starting to work, but I have this side effect that I don't really like." And the doctor says, "Okay, we can treat that.
Dr. Nancy Taylor [00:16:46]:
Not a problem." So he prescribes you drug "B" for your side effect from drug "A". Says, "Give me a call in a couple of weeks. Tell me how things are going." So now you're on 2 medications. You call him in a couple of weeks and you say, "Yeah, that side effect is much better. However, I'm now feeling this." He says, "Oh, okay, we can take care of that, too."
Dr. Nancy Taylor [00:17:09]:
And he prescribes you drug "C". All right. So now you're on drug "A" for your condition, drug "B" for a side effect, drug "C" for a side effect. And this is what a prescribing cascade is. Side effect comes up, we treat it, we get a new side effect, we treat it. And then you are on multiple drugs for one condition because those side effects came from the drug for that condition. And now we have polypharmacy that may not have ever really been needed had we looked at the original drug for the condition and maybe made a change there.
Kelly Augspurger [00:17:51]:
Okay, so that's ideally the solution then, Dr. Taylor, if you do have side effects, well, maybe we just need to try a different prescription?
Dr. Nancy Taylor [00:17:59]:
Maybe we need to go back and look at the original drug that we prescribed for that. Maybe we need to talk about, "Is the side effect tolerable? Is it going to go away with time? Did we really need to jump on another drug so soon?" So there are things that we need to question from the beginning as opposed to just keep treating side effects and we're in that prescribing cascade.
Kelly Augspurger [00:18:24]:
Right. Because before you know it, you could be on a dozen different medications. Maybe for just a few conditions.
Dr. Nancy Taylor [00:18:30]:
But then people start to think that their side effects are conditions, and they're not. They're side effects. You don't have a condition of nausea. Nausea is your side effect from that original drug. It's not a condition. It's just a side effect.
Kelly Augspurger [00:18:46]:
Yeah.
Dr. Nancy Taylor [00:18:46]:
So let's go back. Let's stop saying that we have all these conditions when they're truly side effects of an original condition.
Kelly Augspurger [00:18:55]:
Big difference. Yeah, condition versus side effects. Okay, and then what about what are some of the most common dangerous effects of polypharmacy? And I know you've touched on some of this, but can we concisely talk about this? What do you tend to see?
Dr. Nancy Taylor [00:19:08]:
What I tend to see is when we talk about polypharmacy, it is not uncommon to have drugs in the number of high teens or low 20s. Somebody could be on 18 medications and that could include prescription, over the counter medications, herbals, supplements. Because we're taking into account not only do we have a PCP giving us prescriptions and specialists giving us prescriptions and self-medicating. We have all of these and we're not getting rid of any. And a lot of them are lookalike drugs. You could open the pill box of an older adult and see 4 different round white pills. Yeah, right, right, absolutely. The fact is they're not sure necessarily what all they are.
Dr. Nancy Taylor [00:20:01]:
They know it's a round white pill, difference in size. They can't read the inscription on the pill. And so we run into issues where because they look alike, we may put the wrong drug in the box a number of times. And here's a really good example of this because this happens all the time. Okay?
Kelly Augspurger [00:20:22]:
Okay.
Dr. Nancy Taylor [00:20:23]:
Someone's filling their pill box. They are watching Jeopardy. And they're filling it and they're watching TV and they're taking the bottle and they're filling it. The phone rings and so they go and they answer the phone and it's their friend. They talk for a little bit. Yep. They talk about how Jeopardy's on. All right.
Dr. Nancy Taylor [00:20:41]:
Okay, thanks for talking. All right, bye. They go back, they just have white round pills in there. They don't know where they left off. They picked up the same bottle and they started over again. Oh, yeah, they have the same drug in their pillbox twice. So they're going to take double the amount without realizing what they've done. It happens all the time because things look alike.
Dr. Nancy Taylor [00:21:04]:
Right. Another aspect is the number of times people take a medication. We've been there, Kelly. I'm sure you've been there. You had an infection, maybe you had a sinus infection. You went and you got an antibiotic. And the instructions say take 1 capsule 4 times a day. You're like, "4 times a day.
Dr. Nancy Taylor [00:21:24]:
Okay. Breakfast, lunch, dinner, bedtime. I got this." How many times have you actually finished that entire route of medication at 4 times a day and you did not miss a dose?
Kelly Augspurger [00:21:36]:
Yeah, rarely, I'm sure rarely.
Dr. Nancy Taylor [00:21:39]:
Because we have lives. It could easily be that you got in that first dose and that second dose, and then maybe your family shows up and says, "Let's go out to dinner." "Great, let's go out to dinner." "Where's your pills?" "Oh, they're at home on the counter." So you miss that dinner dose, do you take it again at bedtime? Do you double up? Do you just skip it? What do you do?
Kelly Augspurger [00:22:01]:
What do you do? What are best practices there, Dr. Taylor, what do you do?
Dr. Nancy Taylor [00:22:06]:
And honestly, it depends on the drug. Because some drugs you don't want to double up, some you do just want to miss that dose. But here's the best way to do that is to talk with the provider about a medication dosing that's no more than twice daily. We are good at once to twice daily.
Kelly Augspurger [00:22:27]:
Makes sense.
Dr. Nancy Taylor [00:22:28]:
So if it's an antibiotic, let's say that's 4 times a day. This is where you say, is there a possibility that I could have an antibiotic that's only twice a day? Or, can I take this one at two in the morning and two at night? You can ask those types of questions. It's always good to ask questions, but we are the type of people that the more you have to take it, the more difficult it is to get the dosing in. And now I'm going to pivot really quickly because when looking at number of dosing, our older adults who, let's say they have Parkinson's, they could be taking pills 6 to 8 times a day just to control that disease state. What happens with that disease state when they have forgotten dose 4 and 5? Also, what happens to their quality of life when they have to live around dosing my medication? "I can't go do this because I can't miss my dose." Those are problems that happen with our older adult population. And besides the prescribing cascade, medications looking alike, medications having to take too many in a day, and the skipped medication, all of these depending on how it happens.
Dr. Nancy Taylor [00:23:47]:
And if could put an older adult back in the emergency room more frequently than they want to be just because of mixed medication, or too many, or not enough. And it comes down to that compliance. And it's hard to be compliant. Let's face it, it is hard to be compliant. So that is where the caregiver, the outside advocate, the spouse, home health, having a partner and staying on your medication, that can help remind you that can ask, "Did you take it? Oh, we didn't. Okay, here, let's find out what we do now." That's extremely important, especially in our older adult population.
Kelly Augspurger [00:24:30]:
Agree, definitely having an advocate there, whether it is any of those people you just named, but just kind of a checks and balances to make sure you're doing the right thing at the right time. So just to clarify, if we miss a dose, take it at the wrong time. Best to go back to your PCP, or to the pharmacist on, "Hey, what do I do? I was supposed to take this 4 times but only took it twice. Do I make up for that? What do I do?" So which person?
Dr. Nancy Taylor [00:24:56]:
Call your pharmacist.
Kelly Augspurger [00:24:58]:
Pharmacist.
Dr. Nancy Taylor [00:24:58]:
Okay, Your pharmacist. And let's face it, you'll get a hold of your pharmacist before you're going to get a hold of your doctor. Pharmacists are frontline and they're going to be able to guide you in that a whole lot better and quicker. So call your pharmacist.
Kelly Augspurger [00:25:13]:
The Steadfast Care Planning podcast is sponsored by AMADA Senior Care. AMADA provides complimentary consultation with a senior care advisor to find the right care from in-home caregiving to community care, as well as long-term care insurance claim advocacy and unique support partnerships for financial advisors to address family transitions and generational retention. To learn more, visit www.SteadfastWithAmada.com. Now, as far as pharmacies go, is there some kind of a national system that pharmacies use where they can see, "Okay, this person takes all of these different meds."
Dr. Nancy Taylor [00:25:56]:
Well, I wish there was, but there isn't. There is not one big system like Medicare. Medicare is a nationwide system, but pharmacies are not nationwide systems. There are umbrella systems. Take for example Kroger, or Walmart, who can have that umbrella to where any of their affiliates can look at what is there. And so where I live we have a lot of snowbirds. And so they want to be in a system that can look at both of their homes, where they are, back and forth. But let's take into account different types of pharmacies.
Dr. Nancy Taylor [00:26:37]:
The biggest thing is we see a lot of mail order. It comes with our insurance. Usually, however, that mail order system may not be in the same umbrella as your retail pharmacy. And because they're not, they can't see what the other person is filling. Same as if you are having medications compounded. The compound pharmacy cannot see what's at your retail pharmacy. They can't see what is at your mail order pharmacy. They only have what's in their compounding pharmacy.
Dr. Nancy Taylor [00:27:14]:
And maybe what you've told them. When you have multiple pharmacies, it really is patient responsibility to make sure that all those pharmacies know what you are taking, what's been added, maybe what's been taken off. Because all of them want to make sure again that all your drugs are going to play safely together. And if they are unaware, there is that unintentional possibility of a problem. And we don't want that. So it's very important that the patient let all of their pharmacies know what they're taking and if there's been additions, or reductions.
Kelly Augspurger [00:27:52]:
Okay. So since we don't have a national system, I could see how this could exacerbate the polypharmacy issue that we have.
Dr. Nancy Taylor [00:27:59]:
Absolutely.
Kelly Augspurger [00:28:00]:
Patients need to be on top of it. And if they can't, then their caregiver, spouse, adult child, whoever in their life that's helping them and is responsible in managing that, needs to speak up to make sure that the pharmacist knows, "Hey, by the way, so and so is also taking X, Y and Z." in order that we don't have additional issues happen.
Dr. Nancy Taylor [00:28:19]:
Let's not forget technology. I want to bring that up with this really quick because we have a lot of savvy older adults out there and there are a lot of apps that can be on the phone that they can just keep track of their medications. Plus we have these wonderful patient portals. If we've got savvy older adults who use those portals all the time, they can pull that up and then they can just take that and show it to the other pharmacist.
Kelly Augspurger [00:28:48]:
Yeah.
Dr. Nancy Taylor [00:28:49]:
So that way they don't have to constantly remember. But here's the other thing, let's go old school, where our older, older adults, some don't even like to have computers around. But that's okay. The wallet card is still good. Even writing it on the piece of paper and updating it with a crossing it out, or adding it and keep it in the wallet. That's also really good too, because we can't remember all of that all the time. But having it on you is helpful.
Kelly Augspurger [00:29:16]:
Yeah. Especially if you're on more than a dozen medications and you've got different dosages and different times of day. There's no way even someone that is fully cognitively aware is not going to remember all of that. It's just too much to keep track of. So what about even, I would imagine, PCPs could, when you're checking out, if that older adult doesn't use technology, or computer, they could print that list for them. Do you ever see that?
Dr. Nancy Taylor [00:29:41]:
Absolutley.
Kelly Augspurger [00:29:42]:
Okay, and then they just keep track of it and update it as needed. But then that's an easier way for them to manage it. Okay, what about, I know we briefly touched on supplements earlier, but what needs to be considered with supplements, herbals and over the counters?
Dr. Nancy Taylor [00:29:59]:
A couple of things we need to remember. Over the counter medication is still medication and it came from behind the counter. So way back when, when a lot of these drugs started coming out, let's take a look at acetaminophen, which is Tylenol. It didn't just start out as an over the counter medication. And we're seeing more and more of the drugs that were prescription are now available over the counter. So I just want people to remember that over the counter medications are still a medication. So that doesn't mean that they're extremely safe just because they're over the counter.
Dr. Nancy Taylor [00:30:39]:
Herbals and supplements are completely different because they are not FDA approved. And what that means is they have not gone through that stringent process that the FDA requires for prescription and over the counter medications. So herbals and supplements can be different from tablet to tablet, capsule to capsule, because they don't have that regulation. And so it's very important to realize that when you're taking herbals and supplements, you're not getting this therapeutic level. You're going to be getting this...and it just happens. And so that can be dangerous when it comes to inhibiting absorption of prescription medications. Or maybe it enhances some of the way that your prescription medications release in the body. And therefore, now we've taken maybe that homeostatic aspect that we had, we've added in some herbs and supplements.
Dr. Nancy Taylor [00:31:46]:
And now that absorption that we kind of had a level about, now we've kind of got this going inside and we didn't intend for it to happen. We read these things are good for us, so we're taking them.
Kelly Augspurger [00:31:58]:
Yeah.
Dr. Nancy Taylor [00:31:58]:
But you have to understand that they really can affect the prescription side. And so it's always very good to, before you decide to add an herbal or a supplement, to ask your pharmacist, "Can you see if this will be a problem with my medication list?" You're right there. You're going to buy them there. So ask first.
Kelly Augspurger [00:32:22]:
Okay.
Dr. Nancy Taylor [00:32:22]:
They can help you with that double check.
Kelly Augspurger [00:32:24]:
Right. Because if you are ingesting it, it could definitely affect the other medicines that you are taking. Sound advice. And then how can we alleviate some of the polypharmacy issues that we face?
Dr. Nancy Taylor [00:32:35]:
Well, I want to make something kind of clear when I talked about communication before being a barrier. There are a couple of really challenging things for patients when it comes to communicating with their providers. And I just want to put this out there so people understand, especially older adults, our providers are in an authoritative position, and especially older adults, that is how they have been raised, is to see the provider as the authority when it comes to health. And so they may not share what they're taking for over the counter medications, or vitamins, or supplements, or herbals with their provider for 2 big reasons. One, they may feel that they're going to get in trouble with their provider and, "The provider didn't prescribe this over the counter that I'm taking. So maybe they'll get mad at me for taking it because it wasn't what they prescribed." And so they don't tell their provider everything that they're on because they're afraid of getting in trouble.
Kelly Augspurger [00:33:44]:
Yeah.
Dr. Nancy Taylor [00:33:45]:
The other aspect is a lot of people, and this is all ages, don't believe that anything over the counter, or an herbal, or supplement can have an effect on their prescriptions. They think that they're two parallel paths. And so therefore they don't even think to mention it because it's not a prescription. "Yeah, my doctor deals with all my prescriptions," and so it doesn't even phase them to share that information. And therefore there's that communication. So we see all of this build up on the provider side, the patient side. We haven't had medication reconciliations, nobody's looked at it to start deprescribing. We have a lack of communication and we don't quite understand maybe how it all works.
Dr. Nancy Taylor [00:34:37]:
And so we just kind of go along and until something major happens, or somebody questions it, we're not going to have anything done with it. We're just going to move right along.
Kelly Augspurger [00:34:49]:
Right.
Dr. Nancy Taylor [00:34:50]:
And unfortunately, that's kind of where our society is. So I'm very thankful for all of the caregivers, family members, advocates out there who are questioning it, who are looking at it, who want to step in and say we should at least just check this out.
Kelly Augspurger [00:35:10]:
Yeah.
Dr. Nancy Taylor [00:35:11]:
Because they are the ones that are going to be headlining this movement of deprescribing when someone starts to look at it and question it and say, "Wow, I didn't realize that my father was taking all of this, the counter is full of bottles."
Kelly Augspurger [00:35:29]:
Yeah.
Dr. Nancy Taylor [00:35:30]:
"Is this safe?" Great question. Let's dive into it.
Kelly Augspurger [00:35:33]:
Okay, so communications at the top of the list. I would imagine even things like reducing the number of pharmacies is important and helpful. Like do we really need to have 3 different pharmacies where we're getting our prescriptions filled? Can we have just one? Or, if that one doesn't have everything, at least limit it to 2?
Dr. Nancy Taylor [00:35:51]:
And that is a really good observation that you're bringing up. And it is true. The more pharmacies you have, the more chance of errors that you're going to have and the multi medication you're going to have. Do you remember when I said look at that umbrella, they can see who's seen what. When you as an older adult, every year you get to take a look at your medication plan.
Kelly Augspurger [00:36:15]:
Right.
Dr. Nancy Taylor [00:36:15]:
We've got open enrollment. That happens with Medicare. Take a look and see who would be providing that mail order pharmacy and who would be providing your brick and mortar pharmacy. Could you select a plan that they're both under the same umbrella? And then you've reduced at least by one pharmacy because now they can see what's happening there. And so anytime you can reduce a pharmacy, that's great. Maybe you want to look at transferring your prescriptions from a pharmacy that is on the outside of your plan to one that's inside your plan. So yes, anytime you can bring one down. Absolutely.
Dr. Nancy Taylor [00:36:58]:
Because pharmacies, they just don't have that lifeline between each other and they don't talk to one another.
Kelly Augspurger [00:37:07]:
Well, how do you feel about geriatricians? Does that help the process as well? Is that going to help alleviate some of the polypharmacy issues? Because geriatricians are trained with older adults and so maybe they have different, or better insights into the medications that older adults are taking. And if so, when do you suggest people, older adults start seeing a geriatrician?
Dr. Nancy Taylor [00:37:28]:
I love geriatricians. Having a geriatrician is for some of the reasons you just said. They have longer appointment times. Geriatricians understand the deprescribing and they work with pharmacists to get it done. Geriatricians understand that certain benchmark processes need to be done in aging that don't always get done with general PCPs. So I am very pro-geriatrician. We are in a geriatrician shortage right now. So those who can get into a geriatrician, fantastic.
Dr. Nancy Taylor [00:38:06]:
That's great. But there are just so few people that are going into that as a specialty. More and more, I think we'll see more and more come around. But the one thing that I will say is that we're going to be seeing more PCPs move their patients to geriatricians if they have them. And that's twofold. One, the PCP is pressed for time. There are so many people out that need a PCP. And so they know that they're not going to be able to give the time to their older adults who just require extra time in moving from the waiting room into the exam room.
Kelly Augspurger [00:38:49]:
Yeah, absolutely.
Dr. Nancy Taylor [00:38:49]:
The extra time it takes to get your shoes off and on. And so by helping them move over to a geriatrician within that practice, then they have given that patient the time and the attention they need. And then they are also then free to work with more patients that are coming into the practices all the time. So I do love the geriatrician.
Kelly Augspurger [00:39:15]:
Okay. At what age do you see people typically start using a geriatrician, or maybe the recommended age, or at least point in their life? When is that? Like, when is the best time?
Dr. Nancy Taylor [00:39:25]:
I think the best time to start looking at that is 60. And I know that seems really young, but that 60 to 65 is when the metabolism in the body starts to change. And we look in the mirror and we're looking at, "Oh, yeah, look at me. I'm still doing things I did in my 30s." And this is great. But the inside of your body is saying, "Well, wait up. You may look that way, you may feel that way, but we're not going to process things that way."
Kelly Augspurger [00:39:51]:
Things are changing, we're changing.
Dr. Nancy Taylor [00:39:53]:
We're going to change you from the inside out.
Kelly Augspurger [00:39:55]:
Yeah.
Dr. Nancy Taylor [00:39:56]:
So it's good time to think about it. Start having those conversations with your primary care physician, "Do you recommend I move to a geriatrician? Do you have one in your office? Is this the time I should start moving? Is this something we should think about and reconsider, you know, in two years?" But it's good to start having those conversations.
Kelly Augspurger [00:40:17]:
Okay, great. And then briefly, is there a good time to get rid of medication, old medications, creams, ointments, eye drops? Like, how long do you hold on to medications?
Dr. Nancy Taylor [00:40:29]:
That's a good question. And if you look at your bottles, your bottles are, or your creams, your label, the prescription label, it tells you that you basically have a year. However, some of the best practices are a little different. We pay out so much money for these prescriptions.
Kelly Augspurger [00:40:50]:
Yeah.
Dr. Nancy Taylor [00:40:51]:
And most of our older adults, they want their money's worth. I mean, everybody wants their money's worth. But if you look at our older adults, they don't throw anything out. They will use things even if they are expired. And so there are best practices on that. And I'm glad that you said that. I do have best practices on expired medications.
Dr. Nancy Taylor [00:41:14]:
I have a handout on that. People can email me for it.
Kelly Augspurger [00:41:17]:
Great.
Dr. Nancy Taylor [00:41:18]:
And because it's a lot to talk about right here.
Kelly Augspurger [00:41:21]:
Sure.
Dr. Nancy Taylor [00:41:22]:
But I do provide that for people on the best practices when it comes to getting rid of medications and what types and for how long. So I'd be happy to get that handout to people.
Kelly Augspurger [00:41:33]:
That would be wonderful. So, yeah, if you have interest, reach out to Dr. Taylor. We're going to talk about her contact info here in just a minute. But, yeah, I highly recommend doing that because I think probably most people, not even just older at all, we probably have meds, ointments, creams in our cabinets, or drawers for years that we haven't used. We're just holding on to just in case.
Kelly Augspurger [00:41:54]:
Well, yeah, take a look at her best practices sheet to see, "Okay, do I really need this? I've had this, like, 10 years now. Is it worth it to keep it or not?"
Dr. Nancy Taylor [00:42:03]:
Yes, I had a woman just yesterday, we were talking and she says, "Oh, well, is this still good?" And she went to her cabinet and brought it as a cream that expired in 2016. And I said, "No," I said, "Throw that out. Yeah, yeah, that's dangerous."
Kelly Augspurger [00:42:18]:
Time to get rid of it. Well, Dr. Taylor, any final advice on what people can do, or how they can plan to live well?
Dr. Nancy Taylor [00:42:24]:
I think the whole idea of living well and having that best quality of life is to analyze where you want to be, set those goals, take a look at where you are now and figure out, "Can I get there myself, or do I need some help with that?" And that's where you can bring in family, you can bring in caregivers, you can bring in an advocates to help you get there. And you are not a slave to your medication. I want people to know that. Don't be a slave to your medication, because there's not always a pill for everything. And we're in that, "You want the pill for the ill, but maybe we get rid of the ill and you don't need the pill."
Kelly Augspurger [00:43:08]:
Oh, I love that. I love that wise advice. That's terrific. Well, Dr. Taylor, where can people find more information about you and get that best practices sheet for getting rid of old meds and creams.
Dr. Nancy Taylor [00:43:19]:
Absolutely. My website is www.DRTAdvocacy.com and that's D R T Advocacy.com There's a wealth of information on there. I suggest people start reading the blogs also, lots of good information on health and wellness through those. And then people can find me on LinkedIn. Dr. Nancy A. Taylor on LinkedIn.
Dr. Nancy Taylor [00:43:42]:
And then you can just drop me an email at: nancy@drtadvocacy.com I love hearing from people. You want that best practices list, you want the transitions of care list/checklist, nancy@drtadvocacy.com and I will make sure that you get it.
Kelly Augspurger [00:44:00]:
Wonderful. Well, Dr. Taylor, we covered a lot today and I know that people are going to learn something from our episode and hopefully they can pass it along to other family members, friends, people within their circle because there's a lot of really good things that we discussed here and I think really important, particularly in our older adult population. So thank you so much for your time and your expertise. Have a terrific day.
Dr. Nancy Taylor [00:44:23]:
Thank you so much. Kelly. This was great.
