Geriatric Care Management and PIM

According to the Journal of American Geriatric Society, “A full 30% of hospital admissions in elderly patients may be related to drug related problems or toxic drug effects.” Potentially inappropriate medication (“PIM”) is widespread with the elderly in both acute and community-based settings.

One of the benefits of hiring a Geriatric Care Manager is that they can monitor medication use and side effects.Anticholinergics are one family of medications that are on the usual offender list. This family of drugs blocks the neurotransmitter acetylcholine and includes such common drugs as Paxil, Detrol, Demerol and Elavil. Common sleep aides such as Tylenol PM, Excedrin PM both contain Benadryl which is an anticholinergic as well. Geriatric Care Management’s role in patient advocacy is to protect their clients from not only polypharmacy but from “PIM” as well.

The most well known reference for which drugs are not tolerated well by the elderly is called the “Beer’s List.”  This is the standard to consult when reviewing your loved one’s medications for possible inappropriate medications. Beer’s list is not limited to anticholenergics but many of the medications on the list are.

Anticholinergic medications tend to produce these side effects:

1.      Dry mouth

2.      Constipation

3.      Blurred vision

4.      Confusion

5.      Urinary retention

6.      Dry eyes

7.      Drowsiness

One geriatrician quoted this saying when trying to make an impression on his audience at a workshop. When describing how these meds make the elderly feel, he said it makes them “Red as a beet, dry as a bone, blind as a bat, hot as a hare and mad as a hatter.”

Anti-cholinergics tend to slow GI motility, decrease secretions and increase heart rate. They decrease tolerance to heat and put the elderly at risk for cognitive decline and decreased overall function.  Always review your loved one’s medications with your primary physician and pharmacist for potentially inappropriate medications. Sometimes the medications on the “Beer’s List,” cannot be avoided and your primary physician has made the determination that the benefits outweigh the risks of the particular medication being used.  However, it is worth having the conversation to see if there are safer options which could be used. If there are not, then there may be counter measures to be used to be proactive in decreasing some of the expected side effects.

Quality control of medication usage for elderly clients is one of the functions of good Geriatric Care Management.

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