Jewish Senior Living magazine   2016/2017

SPECIFIC STATE OR SIDE EFFECT? SEEKING A SAFER PRESCRIPTION FOR COMPLEX MEDICAL CONDITIONS

A new study to learn how to improve the prescribing of medicine in older adults with complex medical conditions will soon get underway, and may influence future strategies to optimize medication use at the Jewish Home.

Dr. Michael Steinman, researcher and geriatric physician.

When older adults have a number of physical problems that require different medications, there is a possibility that unintended harmful effects could occur, says Dr. Michael Steinman. That is why he is engaged in research that will advance the understanding of how to balance the benefits and harms of drugs in older people, and how to tailor medications to the unique circumstances and needs of each person.

A national leader in his research field, Dr. Steinman is a geriatric physician at the San Francisco Veterans Administration (VA). He also holds the positions of director of comparative effectiveness research at the University of California at San Francisco (UCSF) and director of research training for the UCSF Division of Geriatrics.

Along with Dr. Christine Ritchie, the Jewish Home-based UCSF Harris Fishbon Distinguished Professorship in Clinical Translational Research in Aging, Dr. Steinman is launching the study on safe prescribing of medicine for clinically complex older adults. This year also sees him joining Dr. Ritchie and leadership of the Jewish Home to identify opportunities to expand research at the Home.

Dr. Steinman is looking forward to this undertaking. “It’s a great opportunity to work with the residents and staff – in fact, the entire Jewish Home community – to discover new ways of improving care for people at the Home, as well as at other care facilities around the country and the world.”

This new work will supplement Dr. Steinman’s research program at the VA and UCSF where he works with people in the community who are being treated in clinics. While there are some commonalities and some differences between the general community and nursing home populations, problems do occur in both groups, Dr. Steinman says.

“When older people have several medical problems, they often receive multiple medications. Taking multiple medications increases the risk of side effects, interactions between drugs, and the chance that some of those medicines may not be helpful and may even be harmful. But figuring out which medications to stop and which to continue can be a big challenge.”

A first step may be to review lists of medications on a regular basis – something that is done at the Jewish Home and in other nursing homes. However, Dr. Steinman cautions: “A list doesn’t tell the whole story. It doesn’t really explain how much a patient is benefitting from the medication or suffering harm, or even if the medication is still needed.”

He suggests a more comprehensive approach. This can include blood tests in some cases and other assessments. The most important thing, he emphasizes, is asking patients how they are actually taking the drug, and how they feel. “Are they light-headed? Do they have headaches, constipation, or swelling in the legs? People can have those bothersome symptoms for a number of reasons, but unless we make a focused effort to consider the possibility that these symptoms could be a result of medication side effects, we might miss identifying something that could be alleviated by changing their medicines.”

Another issue to consider when prescribing medication is to understand what kind of goals a person has for their health and life, and to figure out how to prioritize thinking about the disease and treatment, he notes. “If living as long as they can is paramount, then that might lead us on a different path to someone whose main focus is on maximizing their quality of life and being comfortable.”

With so much to learn, “There are many opportunities and resources at the Jewish Home,” Dr. Steinman says. “I’m excited to join this community and partner with the Home to do research and provide knowledge that’ll help us find better ways of improving the health and care of older adults.”

“Taking multiple medications increases the risk of side effects, interactions between drugs, and the chance that some of those medicines may not be helpful and may even be harmful. But figuring out which medications to stop and which to continue can be a big challenge.”

RESEARCH STUDY’S RESULTS WILL BENEFIT RESIDENTS

This is very important work with a huge potential value, states Harris Fishbon Distinguished Professor Dr. Christine Ritchie about a new study on how to improve the prescribing of medications in older adults with complex medical issues.

Dr. Ritchie will partner with UCSF’s Dr. Michael Steinman on the study. The two have worked together on research (especially this topic) for a number of years and, along with Dr. Janice Schwartz of UCSF and the Jewish Home, have also collaborated on writing papers.

“This study will help to identify what are the best ways for working with older adults to figure out their main concerns with their medicines,” Dr. Ritchie explains. “We’ll work together with them to come up with ways to address those problems and concerns. We also want to do it in a manner that’s respectful and minimizes adverse outcomes of any kind.”

Most of the participants in the first phase of the work will be people living in the general community. “We hope the lessons learned will enable us to expand this work to the Jewish Home, other nursing homes, and communities the Jewish Home will be serving in the future as part of their expansion,” says Dr. Ritchie.

Ultimately, Dr. Ritchie reckons, the individuals who receive services in the Jewish Home and other nursing homes will get the greatest benefit from the study’s results because of their unique health challenges.

Dr. Christine Ritchie, Jewish-Home based UCSF Harris Fishbon Distinguished Professor.

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