• Episode 34 - 4M's To Discuss With Your Physician

  • Oct 5 2020
  • Length: 35 mins
  • Podcast

Episode 34 - 4M's To Discuss With Your Physician

  • Summary

  • Episode 34: the 4M’s

    4M’s to discuss with your physician: Medications, Mobility, Mentation, Matters Most (what Matters Most)

    Help shape patient-centered care

    Reduce hospitalizations, decrease the need for care

    Mobility - evaluate yearly

    Measures:

    Gait speed is one measure (slower than 1 m/s increased risk of falling, increased risk of hospitalization)

    Timed get up and go

    Balance evaluation by physical therapy

    Getting up from chair without using arms

    Next step:

    Home exercise program (NIH healthy aging)

    Physical therapy

    Multi-disciplinary falls and stability clinic

    Driving

    - Multiple falls indicate increased risk for driving safety issues

    Everyday movement is important to maintain mobility

    Home exercises, Youtube exercises

    Medications

    Beer’s list - potentially inappropriate medications for older adults due to risk of side effects

    Examples include benadryl, benzodiazepines, narcotic pain medications, some seizure medications

    Need to look at benefits versus side effects

    Evaluate for “prescribing cascades” - one medication is used to treat a side effect of another medication, and then another medication is used to treat side effects of that medication.

    Polypharmacy - more than 6 medications is polypharmacy. More medications = more side effects and medication interactions. Deprescribing can help with this.

    Goals of care can help determine which medications are adding value

    Matters Most

    It’s important to discuss what’s important and what makes life worth living, then delve deeper.

    “What could you live without and still feel you have good quality of life?” Focuses on quality of life rather than just quantity

    Patients can bring this topic up by bringing in an Advance Care Directive or Polst form, or mentioning this as a goal of the visit

    Evolves depending on stage of life

    Mentation

    Assessment of memory and cognition, as well as mood

    Generally we evaluate cognition when family brings up a concern or clinician notices a change

    Can be done as part of Medicare Wellness Exam

    Depression and anxiety can look like physical symptoms and cognitive changes in older population

    Next steps if a concern is present:

    Evaluate medications, which can impact cognition and mood

    Obtain more information from screening tests, family members

    Consider referral for further testing; this isn’t required to make a diagnosis

    Neuropsych testing can distinguish between depression, anxiety, dementia

    References

    NIH National Institute on Aging

    Deprescribing

    Advance Care Planning

    https://www.cdc.gov/aging/pdf/acp-resources-public.pdf

    POLST: Portable Medical Orders

    Health pearl: Get your influenza vaccines! They’re very important this year.

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