<P>Complicating matters, many older adults are grappling with multiple chronic conditions. But most research is conducted on people with a single disease who are otherwise relatively healthy. Were learn- ing that whats right for the individual disease is often not right for the patient, adds Covinsky. MEDICATION DELUGE For older patients with multiple conditions, the medications can pile up quickly, says Michael Steinman, MD, an associate professor and resident alumnus who studies the problems caused by simultaneous use of multiple drugs. For example, a medication used to treat one disease may have an adverse effect on another disease, or one drug may interact poorly with another. Side effects are often indistinguishable from symptoms, he adds, which can create a troubling prescribing cascade. Say a patient with heart failure takes furosemide, a diuretic also known as Lasix. That can lead to urinary incontinence, so the doctor might prescribe another drug to treat that condition. But that drug could cause cognitive impair- ment, so the doctor might conclude that the patient has dementia. So yet another drug is prescribed to treat that problem. And on it goes. A better approach would be stopping or changing the first drug, Steinman explains. He is currently partnering with pharmacists to create evidence- based guidelines to improve how doctors prescribe medications for older adults. We want to help make sure they dont get too many medications or too few, but the right ones that are tailored to their needs, he says. AGE IS NOT A NUMBER Numerical age, it turns out, is not the best guide when caring for older adults – another reason why tailoring care to the individual is so critical. Division Chief Walter learned this early in her career when she felt stymied by cancer screening guidelines based on age. She had a robust 80-year-old patient who still enjoyed hiking but who couldnt get a mammogram because she was over the age cut-off. Yet she also had a very frail 75-year-old patient with dementia who could. I thought, ‘Thats crazy, she recalls. Her 80-year-old patient was more likely to benefit from screen- ing, Walter reasoned. And her dementia patient was more likely to be harmed, since inconclusive results can lead to biopsies and other invasive procedures that might exacerbate her existing illness. The dementia patient was also likely to die from dementia before an abnormality detected by screening could cause symptoms. In a series of seminal studies, Walter went on to demonstrate that life expectancy is more important than age in determining the benefits and risks of cancer screening. Her work transformed national cancer screening guidelines and, more recently, led to the development by several Division of Geriatrics faculty members of an app for iPhones and iPads. Called eProgno- sis: Cancer Screening, the app guides clinicians in talking with older patients about whether to start, stop, or continue screening for breast cancer and/or colorectal cancer. Covinsky, who directs UCSFs Claude D. Pepper Older Americans Independence Center, one of only 14 centers of excellence funded by the National Institute on Agings Pepper Centers program, has also exposed the limits of decision-making based on age. In groundbreak- ing research, he demonstrated that patients functional status – their ability to bathe, dress, walk, eat, manage their medications, and per- form other everyday tasks – is far more relevant than age in predicting Spring 2014 | UCSF MAGAZINE27 Geriatricians with a personal touch (from the left): Rebecca Conant, left, an expert in the benefits of house calls; Louise Walter, chief of the Division of Geriatrics; and Michael Steinman, rear, a national leader in improving how medications are prescribed for older adults with complex health problems. Since January 2011, roughly 10,000 Americans have turned 65 every day – a rate that will continue for almost two decades. SOURCES FOR LARGE-TYPE FACTS ON PAGES 26-29: CENTERS FOR DISEASE CONTROL AND PREVENTION AND US CENSUS BUREAU</p> <UL><LI><a href="http://www.mzines.net/publication/618/aelvmorax/1/1/">Front-Cover</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/2/2/">Inside-Front-Cover</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/3/3/">Page-1</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/4/4/">Page-2</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/5/5/">Page-3</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/6/6/">Page-4</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/7/7/">Page-5</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/8/8/">Page-6</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/9/9/">Page-7</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/10/10/">Page-8</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/11/11/">Page-9</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/12/12/">Page-10</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/13/13/">Page-11</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/14/14/">Page-12</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/15/15/">Page-13</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/16/16/">Page-14</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/17/17/">Page-15</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/18/18/">Page-16</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/19/19/">Page-17</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/20/20/">Page-18</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/21/21/">Page-19</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/22/22/">Page-20</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/23/23/">Page-21</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/24/24/">Page-22</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/25/25/">Page-23</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/26/26/">Page-24</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/27/27/">Page-25</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/28/28/">Page-26</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/29/29/">Page-27</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/30/30/">Page-28</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/31/31/">Page-29</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/32/32/">Page-30</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/33/33/">Page-31</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/34/34/">Page-32</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/35/35/">Page-33</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/36/36/">Page-34</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/37/37/">Page-35</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/38/38/">Page-36</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/39/39/">Page-37</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/40/40/">Page-38</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/41/41/">Page-39</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/42/42/">Page-40</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/43/43/">Page-41</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/44/44/">Page-42</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/45/45/">Page-43</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/46/46/">Page-44</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/47/47/">Page-45</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/48/48/">Page-46</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/49/49/">Page-47</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/50/50/">Page-48</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/51/51/">Page-49</a></LI> <LI><a href="http://www.mzines.net/publication/618/aelvmorax/52/52/">Back-Cover</a></LI> <LI><a href="http://www.mzines.net/publications/618/x/sitemap.xml" target="_blank">site map</a></LI> </UL>

 

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