The October 3, 2019 Department of Internal Medicine’s Medical Grand Rounds, “IMPROVE-ing Complex Medication Management in Older Adults: Lessons from the Initiative to Minimize Pharmaceutical Risk in Older Veterans,” was presented by Marcia Mecca, MD, assistant professor of medicine (geriatrics). Mecca is a clinician-educator and the co-director of geriatric resident education for Yale Geriatrics.
“As someone who spent years of training learning how to prescribe medications, it was during my geriatrics fellowship where I learned the word deprescribing,” said Mecca. “I have cured a patient with impaired sense of taste with deprescribing. I cured a patient of dizziness by deprescribing. And I cured a patient with apathy and poor appetite by deprescribing. I am hooked on deprescribing.”
Deprescribing is the process of decreasing or stopping a medication. The puzzle of managing medications in complex older adults with multiple chronic conditions can be difficult. Polypharmacy, which is very common, is considered five or more medications and can be problematic. Being on more medications is associated with falls, declines in cognition and function, increases in symptoms like dizziness and upset stomach, as well as other adverse drug effects, as described in the Journal of the American Geriatrics Society publication, led by Terri Fried, MD.
Mecca shared a story about a patient that was taking more than 20 medications per day and how she teaches trainees to evaluate his medication list for appropriateness.
She walked through the American Geriatrics Society’s Beers Criteria and the National Center for Quality Assurance guidelines. She shared her data from the IMPROVE Polypharmacy Project, an experiential medical education project designed to teach an interprofessional team of trainees in the VA Connecticut Center of Excellence in Primary Care Education, published in Journal of General Internal Medicine. Mecca and Fried noted that the benefits of a medication are attenuated when it is added to an already complex regimen and potential harms increase as described in their Journal of the American Geriatrics Society paper. In this work, they offer clinicians a new model for evaluating medication appropriateness in older adults.
If we want to make change, we must work together as partners to train future physicians to use this new knowledge in the care of the next generation.
Dr. Marcia Mecca
“The connections and impact that I have made with patients reminded me about what drew me to internal medicine and geriatrics in the first place,” said Mecca.
“If we want to make change, we must work together as partners to train future physicians to use this new knowledge in the care of the next generation.”
To learn more about Mecca’s work and watch Medical Grand Rounds, Yale faculty can watch the Grand Rounds video, visit the IMPROVE Polypharmacy Project website, or review her bio.
The Section of Geriatrics is one of the 11 sections within the Department of Internal Medicine at Yale School of Medicine. For more information on their work, visit Geriatrics.