Patient Examples
FALLS
An 88 year old woman that was living in an assisted living, had repeated falls, anywhere from 2-5 falls per week. She was hospitalized for a fractured hip, had a hip replacement then went to the nursing home to do therapy as she was too weak to return to her assisted living apartment. She had reported dizziness with standing, but the hospital work up for her dizziness did not find anything wrong. She continued to have falls.
On a medication review, she had been started on a medication for help with sleep about 2 months prior. This was around the time that the onset of her dizziness started. Once we discussed this, it made total sense to her. This particular medication, although it works very well for sleep, is not recommended in patients over 65 years old. It causes the blood pressure to drop from sitting to standing, which causes dizziness resulting in balance issues and falls. Once we changed her to a safer sleep aid, her dizziness resolved and her blood pressure no longer dropped with standing up.
POLYPHARMACY/
TOO MANY MEDICATIONS
This example is of a patient at an assisted living facility that I acquired because she had a tough time getting out to see her primary care doctor in the community. She was in her early 80's and not able to walk very far, and it took a great deal of effort and help from family to get to frequent appointments due to her generalized weakness. When I saw her for the first time at her assisted living, she was on 32 medications. She had complaints of chronic nausea.
Over the course of several weeks, we were able to de-prescribe and get her down to 21 medications. We first eliminated and slowly reduced medications that she simply no longer needed. After that, we were able to stop a few more, after having open and meaningful conversations about the benefits and risk of some medications at this point in her life.
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Not surprisingly, her nausea resolved, but since we cut back on so many medications, we really did not pin-point which medication was the cause. Big picture, it didn't matter, because her nausea is gone which improved her quality of life. This is unfortunately not an uncommon scenario.
CONFUSION FROM MEDICATIONS
Confusion is another very common side effect of medications. Confusion certainly can be caused by any number of acute illnesses, such as a stroke, heart attack, infection, electrolyte imbalance, or kidney failure to name just a few. However, it can also be caused by the wrong medication, or wrong combination of medications.
The most recent case I recall, was a 92 year old man that was cognitively very sharp at baseline per family report. He had seen his doctor for leg pain. He was diagnosed with sciatica, started on Tylenol and a muscle relaxant. He went to urgent care in another health care system a few weeks later for urinary urgency, going to the bathroom to frequently. They made sure he didn't have a urinary tract infection, and then started him on a medication to reduce the frequency of urination. Between the medication for muscle spasms, and the medication to reduce his urine frequency, they caused him to become acutely confused. Both medications have the possible adverse side effect of confusion, amongst others, due to the anti-cholinergic effect which are not recommended in the elderly.
After stopping the bladder medication, that per report didn't really help anyway, and reducing the dose of the anti-spasm medication, he returned to his cognitive baseline in a few days. A great result correcting this before he suffered a fall.