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.