♪ ♪ ♪ ♪ FUNDING FOR THIS PROGRAM IS MADE POSSIBLE IN PART BY THE KET ENDOWMENT FOR KENTUCKY PRODUCTIONS.

♪ ♪ ♪ ♪ >> WELCOME TO TONIGHT'S "NEXT CHAPTER FORUM" WHERE WE WILL BE TALKING ABOUT SENIORS AND MEDICATION.

I'M DR. WAYNE TUCKSON.

THIS PROGRAM IS PART OF KET'S MULTIPLATFORM INITIATIVE ON AGING CALLED "NEXT CHAPTER," THAT FOCUSES ON THE REWARDS AND CHALLENGES OF GROWING OLDER.

WE HOPE YOU'LL CHECK OUT OUR WEBSITE, KET.ORG/NEXT CHAPTER, THAT HOUSES MORE INFORMATION ABOUT TODAY'S TOPIC AND PAST SEGMENTS FROM THIS SERIES.??

A 2019 CDC REPORT TITLED "PRESCRIPTION DRUG USE AMONG ADULTS AGED 40 - 79 IN THE UNITED STATES AND CANADA" FOUND THAT 7 OF 10 ADULTS, OR 70% OF PEOPLE IN THE U.S.

AGED 40 - 79 YEARS OF AGE, WERE REGULARLY TAKING AT LEAST ONE MEDICATION PER DAY.

AND 1 IN 5, OR 22% WERE TAKING FIVE OR MORE PRESCRIBED MEDICATIONS PER DAY.

OVER-THE-COUNTER DRUGS SUCH AS COLD MEDICATIONS, DIETARY SUPPLEMENTS, OR ANY OF THE SUNDRY MEDICATIONS THAT PROMISE SCULPTED BODIES, INCREASED STAMINA, OR IMPROVED BRAIN POWER ARE IN ADDITION TO THE PRESCRIBED MEDICATIONS.

AND ARE NOT INCLUDED IN THAT.

WHEN JUST LOOKING AT THOSE 60 - 79 YEARS OF AGE THE AUTHORS FOUND THAT 84% WERE TAKING AT LEAST ONE PRESCRIBED MEDICATION PER DAY AND 35% WERE TAKING FIVE OR MORE MEDICATIONS PER DAY.

THAT WE TAKE MORE MEDICATIONS AS WE GET OLDER IS NOT UNEXPECTED AS WE ARE LIVING LONGER AND WITH MORE CHRONIC CONDITIONS THAN BEFORE.

THE PROBLEM WITH TAKING THIS NUMBER OF MEDICATIONS IS THAT THERE MAY BE DRUG-DRUG INTERACTIONS THAT CAN LEAD TO LIFE-THREATENING COMPLICATIONS.

TONIGHT, WE'LL DISCUSS THE PROBLEMS OF WHAT'S CALLED POLYPHARMACY AND HOW WE CAN AVOID COMPLICATIONS.

WE'LL EXPLORE ALTERNATIVE, NON-PHARMACOLOGIC AND NON-SURGICAL METHODS FOR CONTROLLING AND OR MANAGING THE SYMPTOMS OF SOME COMMON AILMENTS, AND HOW EATING PROPERLY WORKS ALONG WITH OTHER TREATMENTS TO PRESERVE AND IMPROVE OUR HEALTH.

WE HAVE FOUR EXPERT PANELISTS WHO WILL PROVIDE THEIR UNIQUE INSIGHT INTO THESE AND OTHER CONCERNS.

THEY ARE: DR. ANGELA SANDLIN.

DR. SANDLIN IS A GRADUATE OF THE UNIVERSITY OF KENTUCKY COLLEGE OF PHARMACY AND IS THE PHARMACY DIRECTOR AT BAPTIST HEALTH LAGRANGE.

AND IS ALSO DIRECTOR OF THE BAPTIST INFUSION CENTERS IN KENTUCKIANA.

DR. LAURA MORTON.

DR. MORTON IS THE JOHN C. WRIGHT, M.D.

ENDOWED PROFESSOR ON AGING, AND A PROFESSOR IN THE DEPARTMENT OF FAMILY AND GERIATRIC MEDICINE, AT THE UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE.

SHE IS THE DIRECTOR OF THE DIVISION OF GERIATRIC MEDICINE, THE DIRECTOR OF THE GERIATRIC MEDICINE FELLOWSHIP, AND THE DIRECTOR OF THE LONG-TERM CARE PROGRAM.

AND JOINING US IN OUR LEXINGTON STUDIO ARE• DR. DANIELA C. MOGA.

DR. MOGA HOLDS THE LARRY H. SPEARS ENDOWED CHAIR IN PHARMACOGENETICS, AT THE UNIVERSITY OF KENTUCKY COLLEGE OF PHARMACY AND IS A PROFESSOR AND ASSISTANT DEAN FOR RESEARCH, IN THE COLLEGE OF PHARMACY CLINICAL AND TRANSLATIONAL PROGRAMS.

SHE IS ON THE FACULTY OF THE INSTITUTE FOR PHARMACEUTICAL OUTCOMES AND POLICY, THE COLLEGE OF PUBLIC HEALTH DEPARTMENT OF EPIDEMIOLOGY, AND THE SANDERS-BROWN CENTER ON AGING.

DR. DANESH MAZLOOMDAST.

DR. MAZLOOMDAST TRAINED IN ANESTHESIOLOGY AT JOHNS HOPKINS AND COMPLETED EXTRA TRAINING IN INTERVENTIONAL PAIN AND MUSCULOSKELETAL AND REGENERATIVE MEDICINE.

DR. MAZLOOMDOOST IS THE MEDICAL DIRECTOR AT WELLWARD REGENERATIVE MEDICINE AND IS THE AUTHOR OF TWO BOOKS "FIFTY SHADES OF PAIN: HOW TO CHEAT ON YOUR SURGEON WITH A DRUG-FREE AFFAIR" AND THE "ORTHOBIOLOGICS BOOK" WELCOME TO YOU ALL AND THANKS FOR BEING WITH US TODAY.

>> THANK YOU.

>> Dr. MOOINGA, LET'S START OFF WITH YOU.

HOW DO YOU DEFINE THE TERM POLYPHARMACY.

POST PEOPLE DEFINE IT AS FIVE OR MORE MEDICATIONS TAKEN NOT TALKING ABOUT JUST PRECIPITATION BUT SUPPLEMENTS AND OVER THE COUNTER AND VITAMINS.

I BELIEVE MORE AND MORE THAT WE NEED TO COUNT EVERY SINGLE MEDICATION, NOT JUST PRECIPITATION MEDICATIONS-- NOT JUST PRESCRIPTION MEDICATIONS BECAUSE ARE THE NUMBER AND MORE MEDICATIONS WE TAKE, THE MORE AT RISK WE ARE FOR TAKING SOMETHING INAPPROPRIATE AND ALSO BECAUSE OF WHAT YOU MENTIONED EARLIER, THOSE POTENTIAL DRUG-DRUG, HERBAL, DRUG, VITAMINS, ANYTHING UNDER THE SUN THAT CAN CAUSE PROBLEMS DOWN THE ROAD.

SO I WILL ALSO LIKE TO SAY THAT WHILE SOMETIMES POLYPHARMACY CAN BE APPROPRIATE, IT IS ALSO AN EASY WAY FOR US TO FLAG POTENTIAL PROBLEMS DOWN THE ROAD.

SO FIVE AND MORE IS THE MAGIC NUMBER AND I WILL ALSO INSIST IT IS IMPORTANT TO COUNT EVERYTHING THAT A PATIENT IS TAKING.

>> Dr. MORTON, WHAT ARE SOME OF THE ILLNESSES THAT WE ARE SEEING NOW THAT WE HAVE MORE OF THESE CHRONIC ILLNESSES, THE TYPICAL THING THAT WE ARE TREATING FOR THESE DAYS.

>> MORE COMMONLY WE ARE SEEING MORE HYPERTENSION, HEART DISEASE.

WE ARE SEEING LUNG DISEASE, DIABETES AND IF YOU ARE FOLLOWING ALL THE EVIDENCE-BASED MEDICINE GUIDELINES, YOU ARE GETTING INTO MULTIPLE TREATMENT REGIMENS THAT CONTRIBUTE TO THE POLYPHARMACY.

>> WHO IS RESPONSIBLE FOR KEEPING TRACK OF ALL THIS.

WHO IS THE PERSON WHO SAYS I'M THE QUARTERBACK OR I'M GOING TO WATCH AND SEE WHAT EVERYBODY IS TAKING?

>> I LIKE TO SAY THE PRIMARY CARE PHYSICIAN OR WHOEVER THE PRIMARY CARE PROVIDER IS FOR FOR THE PATIENT IS THE MAIN PERSON WHO SHOULD BE THE CAPTAIN OF THE SHIP.

WE WANT THAT CAPTAIN TO BE WORKING WITH THE PATIENT.

THE PATIENT SHOULD BE THEIR OWN ADVOCATE AND THEY'RE THE BEST PARTNER WITH THEIR PCP IN THIS PROCESS MUCH THAT PERSON NEEDS TO KEEP TRACK OF THE MEDICATION LIST, TAKE IT BETWEEN THE SPECIALISTS AND BACK TO THEIR PCP, IF THEY GO TO THE HOSPITAL OR NURSING HOME, THEY HAVE TO HOLD ON AND OWN THE MEDICATION LIST.

IF YOU ARE GOING TO MULTIPLE SPECIALISTS THAT IS VERY COMMON AS PEOPLE AGE AND DEVELOP MORE CHRONIC CONDITIONS, THE PRIMARY CARE PROVIDER HAS TO BE THE ONE THAT COORDINATES AND LOOKS OVER ALL OF THAT AND REVIEWS IT TO HAVE THE ONE CENTRAL REVIEW OF THE MEDICATIONS.

AND WE WORK WITH OUR INTERDISCIPLINARY TEAM AS WELL TO HELP.

>> DANESH, IF YOU WOULD PUT ON YOUR ANESTHESIA HAT AS WELL AS YOUR WELLNESS HAT, HOW DO YOU SEE THE COMMUNICATION THAT GOES ON WHEN PATIENTS HAVE MULTIPLE DRUGS AND HOW DOES IT IMPACT WHAT YOU ARE TRYING TO DO FOR SOMEBODY?

>> WAYNE, IT'S IMPORTANT TO LOOK AT HOW WE GOT TO THIS POSITION WHERE WE HAVE POLYPHARMACY AS A CONCERN.

HEALTHCARE HAS LONG BEEN FOCUSED ON ACUTE ILLNESSES.

IF WE GO BACK LIKE 60 TO 100 YEARS, WHAT KILLED PEOPLE WAS NOT HEART DISEASE.

IT WAS INFECTIONS.

OR INJURIES.

WE'VE GOTTEN REALLY GOOD AT TREATING THOSE ACUTE PROBLEMS.

NOW WE ARE OR DEALING WITH A SITUATION WHERE MOST PEOPLE ARE LIVING LONGER AND OVER COPPING THE ACUTE-- OVER COMING AT CUTE PROBLEMS AND THE PROBLEMS THEY FACE IS CAUSING MORTALITY OR MORBIDITY OR SHORTENING OF THEIR LIFE PREMATURELY OR LOWER QUALITY OF LIFE ARE CHRONIC CONDITIONS, AND SO IT'S EASY TO GET INTO THIS ROUTINE WHERE WE ARE JUST CHASING OUR TAILS TRYING TO TREAT PROBLEMS, CURE PROBLEMS WHICH IS MORE OF THE SHORT-TERM OR ACUTE PROBLEM MIND SET AND RATHER THAN LOOKING AT PREVENTATIVE APPROACHES THAT PREVENT PEOPLE FROM DEVELOPING INTO CHRONIC CONDITIONS, I THINK THE BIG THING THAT I FOCUS ON IS JUST THAT HOW DO WE PRESERVE LONG LONGEVITY AND QUALITY OF LIFE SO THAT WE ARE NOT HAVING TO INTRODUCE POLYPHARMACY BECAUSE AS THE REST OF THE PANEL WILL ALSO AGREE, IT'S CHALLENGING TO MANAGE CHRONIC CONDITIONS WHEN WE ARE ALREADY DEALING WITH POLYPHARMACY SITUATION.

>> SO, ANGELA, WE HAVE THE MEDICATIONS THAT ARE BEING PRESCRIBED.

BUT IF ANYBODY GOES INTO ANY PHARMACY, YOU KNOW, THERE IS A PLETHORA OF STUFF OUT THERE.

>> YES.

>> AND WHO IS KEEPING TRACK OF THAT AND WHAT POSSIBLE IMPACT CAN THAT HAVE?

>> THAT'S SO INTERESTING YOU WOULD SAY BECAUSE I ALWAYS SAY IF EVERYBODY IS IN CHARGE, THEN NOBODY IS IN CHARGE.

AND I THINK WE CAN HELP OUR PHYSICIANS SO MUCH FROM A PARMCY PERSPECTIVE IN-- IN A PHARMACY PERSPECTIVE IN GATHERING THAT INFORMATION, ESPECIALLY IF WE CAN GET THAT ALL IN ONE PLACE, IF THE PATIENT, AS MUCH AS POSSIBLE, USE THE SAME PHARMACY AND FORM THAT RELATIONSHIP WITH YOUR PHARMACIST WHERE YOU ARE TELLING THEM ABOUT THE HERBAL SUPPLEMENTS THAT YOU ARE TAKING, TELLING THEM ABOUT THE OVER-THE-COUNTER THINGS YOU TAKE SO WE CAN TAKE THAT INTO ACCOUNT AND DO A MEDICATION RECONCILIATION AND NOT JUST WHEN YOU ENTER THE HOSPITAL.

WE HAVE PHARMACY STAFF AS WAS MENTIONED THAT IT IS AN INTERDISCIPLINARY APPROACH WHERE WE LOOK AT EVERYTHING THAT YOU ARE TAKING AND UNFORTUNATELY PEOPLE GET THAT MIXED UP.

THEY ARE TOLD TO DISCONTINUE SOMETHING AND START ANOTHER MEDICATION BUT THEY END UP WITH BOTH.

THEY MAY BE TAKING DUPLICATE THERAPY, THINGS THAT HAVE DIFFERENT NAMES, TOPOROL AND LOPRESSOR.

THEY COME IN THE HOSPITAL ON BOTH OF THOSE.

THEY'RE THE SAME GENERIC NAME BUT THE PATIENT MISUNDERSTOOD, SLOWED THEIR HEART RATE AND THAT'S WHAT BROUGHT THEM INTO THE HOSPITAL IN THE FIRST PLACE.

WE SEE THAT.

WE SEE DUPLICATES OF THERAPY, DRUG-DRUG INTERACTIONS AS YOU MENTIONED BEFORE AND ALONG WITH THAT, PLEADING WITH FOLKS TO TELL ALL YOUR HEALTHCARE PROVIDERS ABOUT ALL THE MEDICINES YOU ARE TAKING AND PLEASE PLEASE CONSIDER OVER-THE-COUNTER MEDICINES AND HERBALS AS MEDICINES BECAUSE IT'S JUST BECAUSE IT'S HRBL FROM A NATURAL SOURCE DOESN'T MEAN IT CAN'T HURT YOU.

IT CAN.

IT CAN INTERACT WITH YOUR PRESCRIPTION MEDS.

SEND OUT A RED HERRING WHERE SOMETHING IS THE SIDE EFFECT OF A MEDICINE BUT REALLY IT WAS NOT SEEN AS SUCH.

SO WE ALL HAVE TO TAKE RESPONSIBILITY FOR THAT, INCLUDING THE PATIENT.

>> DANIEL, WHAT WOULD YOU SAY TO THAT BECAUSE THE CONCEPT THAT MANY OF US HAVE IS THAT IF THIS IS AN OVER-THE-COUNTER MEDICATION, A: IT IS GOING TO BE SAFE AND THEN WE ARE SAYING IT IS JUST AWE ACCEPT PLEMENT.

WE SEE SUPPLEMENTS NOW WHERE WE HAVE BASEBALL PLAYERS WHO WANT TO CONTINUE LOOKING STAR ATHLETES LIKE THEY WERE WHEN THEY WERE YOUNGER AND OLDER PATIENTS, YOU KNOW, ON TV, WANTING TO MAINTAIN THAT YOUTHFUL LIFESTYLE.

DO THESE THINGS HAVE POTENTIAL SIDE EFFECTS?

DO WE KNOW WHAT IS REALLY IN THESE THINGS?

>> ABSOLUTELY THEY CAN HAVE SIDE EFFECTS AND YOU BROUGHT UP WHETHER OR NOT WE EVEN KNOW WHAT IS IN THESE THINGS AND I WILL SAY THAT SOME OF THESE ARE NOT EVEN AS REGULATED AS PRESCRIPTION MEDICATIONS ARE, SO IT'S HARD TO TELL WHAT THEY CONTAIN.

WE DO HAVE THE ADVERTISEMENT THAT GOES DIRECTLY TO THE PUBLIC AND THAT CREATES A FALSE IMPRESSION OF SAFETY AND THAT'S WHY IT IS SO IMPORTANT FOR PATIENTS TO BE EDUCATED AND UNDERSTAND THAT NOT ONLY DO THEY HAVE TO SHARE INFORMATION ABOUT THE PRESCRIPTION MEDICATIONS THAT MIGHT BE PRESCRIBED BY DIFFERENT SPECIALISTS THEY'RE SEEING BUT ALSO ANYTHING THAT MAYBE THEIR FRIEND RECOMMENDED OR THEY'RE LOOKING AT THE PHARMACY, SO ON THE SHELF AND SAW IT MIGHT BE A GOOD IDEA TO TAKE BECAUSE AGAIN, IT'S HERBAL.

IT'S A SUPPLEMENT OR A VITAMIN.

HOW CAN THAT HURT?

BUT IT CAN.

AND SO IT IS REALLY IMPORTANT TO BE AWARE OF THESE THINGS AND I AM GLAD THAT THE PHARMACISTS AND WE HAVE REPRESENTATION HERE, IT IS IMPORTANT FOR PATIENTS TO GET TO KNOW THEIR PARM SIFTS-- PHARMACISTS, BUILD A RELATIONSHIP.

THEY'RE THERE IN THE COMMUNITY AND THAT'S ONE OF THE THINGS THAT WE SEE MORE AND MORE.

THEY ARE MORE READILY AVAILABLE TO HELP THE PATIENTS AND EVEN EMPOWER THEM TO NAVIGATE, YOU KNOW, WORKING WITH DIFFERENT SPECIALISTS AND THEIR PCP AND KEEPING TRACK OF EVERYTHING THEY'RE TAKING.

>> YOU KNOW, LAURA, I THINK DANESH MENTIONED IT AND TOUCHED ON IT A BIT.

WE HAVE PATIENTS, ESPECIALLY YOUR PATIENT POPULATION, AS A GERITICIAN WHO ARE IN FLUX, FROM HOME TO THE HOSPITAL, LONG-TERM CARE BACK HOME WITH THEIR PROVIDER.

HOW DO WE KEEP TRACK OF THOSE MEDICATIONS THAT THEY'RE GETTING AT EACH STEP OF THE WAY?

>> SO THAT, AGAIN, IS A HUGE CHALLENGE.

AND IT'S A GREAT QUESTION AND I THINK IT'S AN EVERYDAY OBSTACLE THAT WE ALL REALLY FIGHT EVERY SINGLE TIME THERE IS A TRANSITION.

AND WHEN WE THINK ABOUT TRANSITIONS, WE THINK ABOUT THE ONES YOU MENTIONED BUT WE DON'T THINK ABOUT THE ONES, TOO, THAT ARE BETWEEN SPECIALISTS AND BACK TO THE PRIMARY CARE AND ONE SPECIALIST TO ANOTHER BETWEEN HEALTH SYSTEMS, IF YOU GO TO A DIFFERENT HEALTH SYSTEM, BECAUSE ALL OF THE RECORDS, EVEN THOUGH THINGS ARE ELECTRONIC, ARE NOT NECESSARILY ALL TOGETHER.

AND THAT'S WHERE THE PATIENT HAS TO BE AN ADVOCATE FOR THEMSELVES, TO REALLY SAY HEY, THIS IS MY LIST.

AS A JER TRIGS, WE HAVE WHAT THEY CALL A BROWN BAG THEY WOULD BRING INTO THE OFFICE.

BRING IN ALL OF THE PRESCRIPTION MEDICATIONS, THE HERBALS, VITAMINS, ALL OF THE SUPPLEMENTS INTO THE OFFICE SO SOMEBODY CAN REALLY TAKE A LOOK AND THE BEST THING REALLY MOTIVATED PATIENTS WILL OFTEN HAVE A LIST TYPED UP THAT THEY KEEP AND THAT THEY SAY HERE, IT'S ON MY PHONE.

TAKE A LOOK OR THEY'LL HAVE PRINTED COPIES AND REALLY TRYING TO UPDATE IT AT EACH STEP AND MAKING SURE THAT YOU ARE THERE, YOU ARE ADVOCATING FOR YOURSELF.

IF YOU CAN'T, IF YOU HAVE A LOVED ONE OR SOMEONE WHO CAN ADVOCATE FOR YOU, THAT'S REALLY IMPORTANT TO BE THAT VOICE AND TRY TO BE THAT CONTINUITY AS WE NAVIGATE THE SYSTEM.

>> EVERYBODY HAS ELECTRONIC HEALTH RECORD RIGHT NOW.

CAN YOU GO AND ACCESS THIS RECORD AND SAY OKAY, HERE IS WHAT THE PATIENT IS TAKING ACROSS ALL THESE PLATFORMS?

>> IT IS NOT CONSISTENT.

THAT'S THE CHALLENGE.

THERE IS A WAY TO DO IT, BUT IT'S NOT AS READILY AVAILABLE AS YOU WOULD THINK.

WE THINK ABOUT HOW WE LOOK AT OUR EMAIL ON OUR PHONES OR LOOK AT OUR EMAIL ON THE COMPUTER.

BUT IT TAKES SOME MORE STEPS AND DEPENDING ON WHAT SITE OF CARE YOU ARE AT, THEY MAY NOT CONNECT AT ALL.

>> HOW ABOUT YOU ANGELA?

>> SO TRUE.

WE SEE IT EVERY TIME SOMEONE COMES IN THE HOSPITAL F. WE ARE FORTUNATE ENOUGH TO HAVE A LIST AND I ADVOCATE FOR THAT, A LIST OF EVERYTHING YOU TAKE, KEEP IT UP TO DATE, INCLUDE YOUR HERBALS AND OVER THE COUNTER MEDICINES BUT WE DO FIND THAT IT IS INCONSISTENT WHETHER, DEPENDING ON WHAT AND ELECTRONIC HEALTH RECORD YOU USE WILL NOT BE CONSISTENT.

WE OFTEN, AS WE DO MEDICATION RECONCILIATION, AS WE TRY TO WRITE THAT LIST WHEN SOMEONE IS BROUGHT INTO THE HOSPITAL, WE FIND IT VERY MUCH A CHALLENGE TO DIG AND DIG AND CALL THEIR LOCAL PHARMACY, WE CALL THEIR PROVIDERS.

IT'S A COMMUNICATION ISSUE AND A LACK OF COMMUNICATION.

SO A LOT OF TIMES LEFT HAND DOESN'T KNOW WHAT THE RIGHT HAND IS DOING AND ALL YOUR DIFFERENT PROVIDERS DON'T KNOW WHAT OTHERS HAVE PRESCRIBED AND AGAIN THE PHARMACY CAN BE A CLEARING HOUSE AND THAT'S-- I FIND THAT IS SO IMPORTANT.

>> ONE OF THE THINGS THAT I THINK OUR OLDER PATIENTS NOT NECESSARILY EVERYBODY BUT PAIN PAIN CONTROL TENDS TO BE A THING.

AS WE AGE, THE CHANCE OF DEVELOPING ARTHRITIS INCREASES IF FOR NO OTHER REASON THAN FROM SIMPLE WEAR AND TAXPAYER.

SURGERY, AND MEDICAL TREATMENT WITH NONSTEROIDAL ANTI-INFLAMMATORY DRUGS SUCH AS IBUPROFEN, NAPROXEN, AND OTHER SIMILAR ACTING MEDICATIONS HAVE PROVEN TO BE EFFECTIVE IN TREATING OR AT LEAST MODIFYING THE SYMPTOMS OF ARTHRITIS.

UNFORTUNATELY, BECAUSE OF AN INCREASED RISK FOR DEVELOPING SERIOUS COMPLICATIONS AFFECTING THE KIDNEYS, HEART, AND GASTROINTESTINAL SYSTEM, THE USE OF THESE MEDICATIONS IN MANY OLDER PATIENTS IS LIMITED, IF NOT CONTRAINDICATED.

UNFORTUNATELY, IN SOME CASES, THE PRESENCE OF CONCURRENT MEDICAL CONDITIONS INCREASES THE RISK FOR SURGERY SUCH THAT THEY MAY EXCEED THE POTENTIAL BENEFITS OF THE PROCEDURE.

FORTUNATELY, THERE ARE OTHER NON-SURGICAL AND NON-PHARMACEUTICAL TREATMENTS THAT CAN DECREASE PAIN AND DISCOMFORT.

TO TALK ABOUT THESE OPTIONS, WE SPOKE TO DR. ROBERT GENTILE.

DR. GENTILE EARNED HIS BACHELOR OF APPLIED SCIENCE, IN PHYSICAL THERAPY, AT THE UNIVERSITY OF LOUISVILLE, AND HIS DOCTORATE IN PHYSICAL THERAPY AT REGIS UNIVERSITY.

HE IS NOW IN PRACTICE AS A PHYSICAL THERAPIST WITH KORT PHYSICAL THERAPY IN ST. MATTHEWS, KENTUCKY.

>> I ALWAYS TALK ABOUT THE THREE TYPES OF THERAPY, CURATIVE THERAPY, STREP THROAT, ANTIBIOTICS, GONE NEVER.

DOESN'T COME BACK.

AND PALLIATIVE CARE WHICH THERE IS NOTHING WE CAN REALLY DO.

AND REHABILITATIVE THERAPY, THE MACHINE YOU BRING ME IS BROKEN AND WE MAKE IT AS OPTIMUM AS WE CAN.

BACK TO D-1 VOLLEYBALL AT A HIGH LEVEL OR GETTING YOU TO OPERATE YOUR WHEELCHAIR WITH A STRAW AND GET MOVEMENT.

WE TAKE THE MACHINE YOU BRING US AND TURN IT INTO THE BEST POSSIBLE YOU YOU CAN BE.

PAIN IS A SIGNAL.

SO FOR ME, PAIN IS A SIGNAL THAT SOMETHING ELSE NEEDS TO BE TAKEN CARE OF.

IS IT BECAUSE A JOINT DOESN'T MOVE REALLY WELL, BECAUSE YOU HAVE LOST STRENGTH?

IS IT BECAUSE YOU HAVE HAD AN INJURY?

SO COVERING PAIN WITH A PAIN PILL GETS YOU TO THE SIGNAL DOESN'T NECESSARILY GET RID OF THE CAUSE.

FOR PHYSICAL THERAPY, MY JOB IS TO DIG IN DEEPER.

IS THERE A MECHANICAL CAUSE GETTING A SIGNAL TO THE BRAIN SAYING SOMETHING IS WRONG AND CAN I MITIGATE THAT SIGNAL BY GETTING RID OF THE CAUSE.

WHEN YOU THINK ABOUT PAIN RECEPTORS, PAIN RECEPTORS USUALLY ARE ALONG THE SAME LINE AS A WIRING DIAGRAM AS YOUR PAIN , AS YOUR MOVEMENT.

PAIN AND MOVEMENT FOLLOW THE STAGE STREET.

BUT THEY CAN'T BE ON THE SAME STREET TOGETHER.

SO THINK ABOUT YOU HIT YOUR THUMB WITH A HAMMER.

YOU USUALLY DON'T JUST LOOK AT IT.

YOU USUALLY GO OH THAT HURTS BECAUSE THE MECHANICAL RECEPTORS OF MOVEMENT CAN FLOOD THAT STREET BASICALLY AND MITIGATE SOME OF THE PAIN YOU ARE FEELING.

DOESN'T NECESSARILY HELP AT ALL BUT IT CAN START MITIGATING IT.

FOR JOINTS, MOANGS IS LOTION.

WHAT I MEAN BY THAT IS A JOINT IS PRETTY SPECIFIC.

YOU HAVE THE JOINT ITSELF, LIKE THE TOP BONE MEETS THE BOTTOM BONE AND IN BETWEEN IS THE JOINT, LIKE A HINGE ON A DOOR.

INSIDE THAT IS WRAPPED AROUND WITH A CAPSULE AND INSIDE THE CAPSULE IS FLUID WHICH ALWAYS THINK ABOUT LIKE WD40 OR 3D OIL OR SOMETHING AND EACH SURFACE IS COVERED WITH CARTILAGE.

HIGHLAND CARTILAGE.

WHAT IS IMPORTANT ABOUT THAT, SLIPPERY, SLIPPERY STUFF LIKE TAKE AN ICE CRUB AND RUB IT TOGETHER ANDITE IS NOT AS SLIPPERY AS THOSE TWO GUYS TOGETHER WITH THE FLUID IN BETWEEN YOU ABOUT STOP MOVING, YOU START TO RUST.

GETTING THAT FLUID WHISKING THROUGH THE ENTIRE JOINT COVERING THE JOINT SURFACES IS IMPORTANT TO KEEP THE JOINTS HEALTHY.

THE BODY IS THE ULTIMATE LOSE IT OR-- USE IT OR LOSE IT.

IF YOU STOP MOVING, IT FIGURES YOU DON'T NEED IT AND GETS RID OF IT AND THE CYCLE BECOMES BIGGER AND BIGGER AS TIME GOES ON.

SO IF I CAN GET PEOPLE MOVING AGAIN, A LOT OF TIMES PAIN GETS OUT OF THE WAY.

BUT SOMETIMES YOU JUST HURT.

I CANNOT HARDLY WALK IN.

THEN, YES, IF I CAN USE A TOPICAL ANTIINFLAMMATORY, THE BCBG, BIO FREEZES THINGS LIKE THAT.

IF I CAN GET SOMETHING TO INTERRUPT THE PAIN CYCLE ALONG THE WAY TO GET YOU MOVING AGAIN AND GET YOUR BRAIN OUT OF THAT, HEY, I'M IN DANGER, THEN THAT'S A GOOD THING.

EXERCISE, PRESCRIPTION IS THE MEAT AND POE POTATOES OF THE PLATE.

60 TO 70% OF THE GOAL FOR ME TO GET YOU MOVING QUICKLY BETTER.

THE GELS, THE COLLAGEN SUPPLEMENTS, THE FISH OILS, ANYTHING THAT CAN GET GLOBAL INFLAMMATION UNDER CONTROL ARE THE DIFFERENT SIDES AND SEASONINGS THAT GO INTO MAKING THE WHOLE THING BETTER.

THE OTHER THING I LOVE TO TALK ABOUT IS INADVERTENT EXERCISE, FOR LOSING WEIGHT OR FOR STAYING IN GREAT SHAPE OR STAYING MOBILE, DOING STUFF ACCIDENTALLY THAT HAPPENS TO WORK IS ONE OF MY FAVORITE THINGS TO DO.

INSTEAD OF PARKING MY ELDERLY MOTHER-IN-LAW RIGHT UP AGAINST THE DOOR IN A HANDICAP SPACE, I PARK 10 SPACES BACK AND WE WALK AND WE WALK ALL THE WAY BACK AND WE MAKE SURE WE GO UP ON THE CURB AND WE GO DOWN ON THE CURB, JUST TO GET THAT LITTLE EXTRA EFFORT AND ENERGY MAYBE YOU HAVE A FAMILY MEMBER THAT IS A LITTLE MORE FORGETFUL OR THEIR BALANCE IS AN ISSUE, WE MIGHT PLAY SOMETHING LIKE STANDING ON ONE FOOT, HEY, WE ARE GOING TO BRUSH OUR TEETH.

TRY TO STAND ON ONE FOOT WHEN YOU DO IT.

OR WHEN YOU GET OUT OF THE CHAIR, TRY TO GET UP USING YOUR LEGS WHICH IS SIMPLE WAYS TO GET SOMEBODY TO DO SOMETHING THAT IS EXERCISE THAT MAY HELP WITH THE BOTTOM LINE.

FOR CAREGIVERS, IT'S REALLY IMPORTANT TO HAVE THE CUES THAT WICK GIVE THEM, WE CAN GIVE THEM PAPER OR DIGITAL, EDUCATION IN THE CLINIC, AND THEN TURNING THAT INTO SOMETHING THAT IS NOT A BATTLE, YOU KNOW, HOW AM I GOING TO MAKE MY KID DO THEIR HOME WORK OR MY PARENT DO THEIR HOME WORK, SOMETHING THAT BECOMES EASY TO DO ON A REGULAR BASIS WITHOUT HAVING TO THINK ABOUT IT TOO MUCH.

IT'S ABOUT FINDING THOSE THINGS THAT WORK.

AS MANY JOINTS AS POSSIBLE AND AS MANY CORRECTION DIRECTIONS AS POSSIBLE.

ONCE YOU GET GOOD AT IT, HAVE YOU TO CHALLENGE IT BY CHANGING IT UP AND FINDING A DIFFERENT WAY TO DO IT.

>> Dr. MAZLOOMDOOST, WHILE WE ARE WAITING FOR YOUR BOOK 50 SHADES OF PAIN TO BECOME A MOVIE, TELL ME A LITTLE BIT ABOUT PAIN MEDICATION, PARTICULARLY THE USE OF OPIOIDS.

ARE WE USING THOSE WRONGS AND CAN THEY BE USED IN THE OLDER PAIR?

>> WE ARE IN LARGE PART USING THEM WRONG BECAUSE A LOT OF OUR KNOWLEDGE OF OPIOIDS AND PAIN MANAGEMENT WAS REALLY DRIVEN BY PHARMACEUTICAL KNAVE TIFFS AND-- NARL TIFFS AND IT OVERPLAYED THE BENEFITS AND DOWNPLAYED THE RISKS.

THE BIGGEST CONCERN WITH OPIOIDS, TO ME, IT'S NOT NECESSARILY ADDICTION.

IT'S MORE OF THE PHYSIOLOGICAL CHANGES THAT HOSPITAL WHEN YOU USE OPIOIDS FOR A PROLONGED PERIOD OF TIME.

OPIOIDS ARE REALLY DESIGNED OR BENEFICIAL FOR TWO SCENARIOS: SHORT-TERM USE LIKE PERI OPEN RATIVE ENVIRONMENT AND EVEN THAT, YOU CAN USE LESS OF IT AND GET AWAY WITH MORE BENEFIT AND THE TERMINAL STAGES OF LIFE.

THE PROBLEM IS THAT WHEN YOU INTRODUCE THEM TOO EARLY AND TOO LONG IN LIFE, IT HAS A REALLY REVERBERATING EFFECT THROUGHOUT THE BODY BECAUSE IT DOESN'T JUST EFFECT THE NERVOUS SYSTEM FOR PAIN RECEPTION.

OPIOIDS ARE REALLY A STRESS RESPONSE HORMONE.

AND IT AFFECTS EVERYTHING FROM YOUR HEART TO YOUR ENDOCRINE OR HORMONE SYSTEM TO YOUR BREATHING, TO GUT MOTILITY.

IT HAS PRETTY WIDESPREAD EFFECT.

AND WHEN YOU ARE TAKING THEM FOR PROLONGED PERIOD OF TIME, YOUR BODY ADAPTS TO WHERE IT NO LONGER PRODUCES IT'S OWN INTERNALLY DERIVED OPIATES.

IT IS RELIANT ON THE EXTERNAL SOURCES.

THAT'S PROBLEMATIC.

AS A RESULT OF THAT, PEOPLE DEVELOP POLYPHARMACY BECAUSE THEY'RE HAVING TO TAKE OTHER MEDICATIONS TO REALLY TREAT THE LONG-TERM SIDE EFFECTS OF THE OPIOIDS.

>> DANIELA, IF YOU WOULD, BUT I HAVE PAIN AND I WANT IMMEDIATE RELIEF FROM MY PAIN.

WHAT AM I GOING TO TAKE THEN?

>> WELL, I WISH I HAD THE MILLION DOLLAR, YOU KNOW, ANSWER, THIS IS A MILLION DOLLAR QUESTION.

I DON'T KNOW THAT I HAVE THE ANSWER TO GIVE YOU.

I THINK IT REALLY DEPENDS ON WHAT ELSE THAT YOU ARE TAKING.

AND WHETHER YOU KNOW, TAKING AN OPIOID OR SOME OTHER MEDICATION WILL CAUSE MORE HARM THAN GOOD.

AND WHETHER THERE ARE OTHER ALTERNATIVES THAT ARE MAYBE NON-PHARMACOLOGICAL.

MAYBE YOU NEED TO SEE YOU KNOW, P.T.

TO HELP YOU AND IT MIGHT NOT BE A QUICK AND EASY FIX.

AND THAT'S SOMETHING THAT NEEDS TO BE COMMUNICATED TO THE PATIENT.

THE PROBLEM WITH, IN ADDITION TO WHAT WAS SAID EARLIER WITH THE OPIOIDS IS REALLY WHEN THEY ARE TAKEN ALONG WITH OTHER MEDICATIONS, SO, FOR INSTANCE, WE SEE A LOT OF OPIOIDS AND BENZODIAZEPINES USED TOGETHER AND THAT CAUSES A LOT OF PROBLEMS.

ISSUES LIKE RESPIRATORY DISTRESS AND THINGS LIKE THAT.

SO IT IS REALLY IMPORTANT TO LOOK AT EVERY MEDICATIONS THAT IS BEING CONSIDERED TO BE INCLUDED IN THE-- INCLUDED FOR THE PATIENT IN BALANCE.

RISKS AND BENEFITS.

AND WHAT ELSE THE PATIENT IS TAKING TO MITIGATE THE RISK AND WHILE, YOU KNOW, BRINGING THE BENEFIT THE PATIENT NEEDS.

I'M SORRY, I'M NOT ABLE TO GIVE YOU A STRAIGHTFORWARD ANSWER BECAUSE I DON'T THINK THERE IS ONE THAT CAN BE GIVEN WITHOUT HAVING INFORMATION ABOUT THE PATIENT THAT NEEDS THE MEDICATION.

>> DANESH, PLEASE GO AHEAD.

>> WHEN WE ARE TALKING ABOUT PAIN, WE CAN THINK OF IT AS TWO DISTINCT TYPES OF PAIN.

ONE IS ACUTE.

THE OTHER IS CHRONIC.

AND FOR ACUTE-RELATED PAIN, THERE ARE A LOT OF MEDICATIONS THAT YOU CAN TAKE.

IF YOU ARE IN THE DIRE SCENARIO, AND YOU NEED SOME RELIEF, THERE ARE A LOT OF MEDICATIONS THAT CAN BE BENEFICIAL.

THE PROBLEM IS YOU DON'T WANT TO BECOME RELIANT ON JUST THAT BECAUSE, AS OUR PHYSICAL THERAPY COLLEAGUE SAID EARLIER, PAIN IS NOT A CONDITION OR A DISEASE.

IT'S REALLY THE SYMPTOM OR THE MESSENGER OF ANOTHER PROBLEM.

SO THINGS LIKE ANTIINFLAMMATORIES, TYLENOL, EVEN IN RARE INSTANCES, CAN BE BENEFICIAL BUT FOR MAYBE SHORT PERIODS OF TIME.

AND I WANT TO EMPHASIZE THAT WHILE PEOPLE BRING A LOT OF CONCERNS ABOUT ANTIINFLAMMATORY AND ACETAMINOPHEN OVER-THE-COUNTER MEDICATIONS, OPIOIDS HAVE HIGHER CARDIAC RISK THAN ANTI--INFLAMMATORIES DO BUT WE DON'T REALLY REMARK ON HOW CONCERNING THEY CAN BE.

THAT'S ACUTE PAIN.

AND THE TREATMENTS FOR THAT ARE REALLY PALLIATIVE MEANING LET'S MITIGATE THE SYMPTOMS GET YOU THROUGH THE ACUTE SCENARIO.

THEN THERE IS CHRONIC PAIN.

IF THERE IS A PROBLEM THAT IS RECURRENT AND CONTINUING, WE THINK OF GENTLEMEN DENY TIFF ARTHRITIS, FOR INSTANCE, AS THIS MOVING TRAIN THAT WE CAN'T SLOW DOWN OR STOP.

AND THAT'S NOT TRUE.

THE PROBLEM WITH PAIN MANAGEMENT HAS BEEN THAT WE HAVE TAKEN THIS PALLIATIVE MIND SET FOR ACUTE ISSUES AND WE HAVE APPLIED THEM TO THE CHRONIC SETTING.

AND THAT DOESN'T WORK.

WE REALLY NEED TO TAKE A MORE COMPREHENSIVE PERSPECTIVE TO UNDERSTAND WHY IT IS THAT THIS PROBLEM IS NOT ABLE TO HEAL OR WHY IT IS THAT THIS JOINT IS BECOMING DECAYED.

AND A LOT OF TIMES IT'S BECAUSE, YOU KNOW, WE'VE GOT WRINKLES ON OUR FACE THAT IS REFLECTIVE OF CONNECTIVE TISSUE BREAKING DOWN.

THE SAME THING IS HAPPENING ON THE INSIDE, JOINTS START TO LOSE THEIR INTEGRITY AND THE ROLE OF REGENERATIVE PAIN MANAGEMENT IS TO UNDERSTAND THE BIO MECHANICS OF WHAT IS HAPPENING USING PAIN AS THE SYMPTOM AND REVERSE ENGINEER THE PROBLEM SO YOU CAN ACTUALLY SLOW DOWN ARTHRITIS OR EVEN REVERSE ARTHRITIS.

AND THAT'S VERY FEASIBLE.

>> YOU KNOW, LAURA, I KNOW WE WERE TALKING AND YOU SAID THAT OLDER PEOPLE ARE NOT JUST WRINKLED LITTLE KIDS SOUNDS LIKE MAYBE WE ARE WRINKLED LITTLE PEOPLE AFTER ALL.

BUT PERSONAL EXPERIENCE OF SEEING SOME WORK WITH ACUPUNCTURE, I WAS IMPRESSED.

HAVE YOU HAD ANY EXPERIENCE WITH THINGS LIKE THAT IN SOME OTHER TREATMENTS AS FAR AS TRYING TO ALLEVIATE PAIN AND DISCOMFORT FOR PEOPLE IS THIS.

>> REALLY IT'S ALL ABOUT FINDING WHAT WORKS FOR THAT INDIVIDUAL PERSON IN FRONT OF YOU, BUT ACUPUNCTURE WORKS VERY WELL, IS A GREAT MODALITY, CAN BE AJUCTIVE OR HELP PEOPLE ENOUGH THAT THEY DON'T NEED THE OTHER MEDICATIONS MAYBE IS MUCH.

MASSAGE THERAPY IS ANOTHER THING THAT I THINK WE DON'T THINK ABOUT.

AND MOVEMENT.

I THINK THERE CANNOT BE ENOUGH EMPHASIS ON GETTING UP, MOVING AND BEING ACTIVE.

I THINK THE MORE YOU MOVE, THE BETTER YOU ARE GOING TO FEEL.

AND I THINK MOTIVATING PEOPLE TO REALLY BUY INTO THAT IS VERY IMPORTANT.

>> YOU KNOW, ANGELA, WE ALSO ARE STARTING TO SEE MORE AND MORE COMMERCIALS ABOUT MEDICATIONS FOR MEMORY.

AND THERE ARE BOTH OVER-THE-COUNTER AND THINGS PRESCRIBED.

CLEARLY AS WE ARE GETTING OLDER, THE BIG CONCERN FOR ALL OF US, ALZHEIMER'S OR JUST DEMENTIA THAT OCCURS AS WE AGE.

WHERE ARE WE AS FAR AS THE MEDICATIONS GO?

>> WE ARE FARTHER THAN WE USED TO BE.

I WOULD SAY FIRST, KEEP YOUR MIND SHARP.

THERE ARE PHYSIOLOGICAL THINGS AND CHEMICAL CHANGES TO THE BODY THAT MAY MAKE DEMENTIA OR ALZHEIMER'S AN INEVITABILITY AT SOME POINT BUT EVEN AFTER FOLKS RETIRE AND AFTER YOU HIT A DIFFERENT POINT IN YOUR LIFE AS YOU TALKED ABOUT LIFE IS A JOURNEY, KEEPING YOUR MIND SHARP, PUZZLES, KEEPING YOUR MIND FRESH, LEARNING NEW THINGS, A LANGUAGE, ANYTHING YOU CAN CAN DO, PICK UP AN INSTRUMENT, YOU KNOW, THOSE KINDS OF THINGS, I WOULD SAY NOT NON-FARM LOGIC FIRST BUT WE DO HOORM HIVE NORNLG FARM CA LOGIC FIRST.

>> THERE MAY BE LAB TESTS YOU NEED TO DO FIRST BUT THERE ARE INFUSIONS THAT HOLD PROMISE FOR CERTAIN KINDS OF DEMENTIA.

WE CAN STAVE THAT OFF, ARREST IT A LITTLE BIT THERE ARE ORAL MOD INDICATIONS THAT CAN BE TAKEN AND WE SEE MODEST BENEFIT WITH THOSE BUT DO EVERYTHING YOU CAN TO DEEP YOUR MIND SHARP, BE IN COMMUNICATION WITH YOUR PHYSICIANS ABOUT WHAT OPTIONS ARE AVAILABLE TO YOU AND REMEMBER THAT ALL MEDICATIONS HAVE SIDE EFFECTS AND WE HAVE SEEN FOLKS THAT TAKE CERTAIN MEDICATIONS FOR DEMENTIA THAT IT THEN CAUSES ANOTHER SYMPTOM UNDERSTAND THEN THAT SYMPTOM GETS RECOGNIZED INCORRECTLY AS A NEW CONDITION, AND IT GETS TREATED WITH ANOTHER MEDICATION AND THEN WE HAVE ANOTHER PRESCRIBING CASCADE, WHERE YOU ARE GETTING A MEDICINE, A SIDE EFFECT AND TREAT IT WITH ANOTHER MEDICINE AND IT HAS A SIDE EFFECT AND YOU KEEP GOING AND GOING.

SO PREVENTION IS KEY THERE AND I REALLY LIKE WHAT THE OTHERS HAVE SAID ABOUT DIET AND EXERCISE AND KEEPING YOUR MIND ENGAGED AND DOING THINGS THAT YOU ARE INTERESTED IN AND HAVING AN INTEREST IN THINGS AND KEEPING EVERYTHING SHARP AS YOU CAN AND THEN THERE ARE SOME NEW HOPEFUL THERAPIES OUT THERE, SOME INFUSIONS AND THINGS THAT WE HELP FOLKS WITH AT THE HOSPITAL IN OUR INFUSION CENTERS THAT OFFER SOME PROMISE AND WE ARE SEEING-- I THINK WE WILL SEE GOOD THINGS ON THE HORIZON.

CAN WE CURE IT YET, NO, SIR, WE CANNOT.

>> DANIELA, I WANTED YOU TO COMMENT ON THAT ALSO, NOT SO MUCH ON THE MEDICATIONS FOR MEMORY BUT I LIKE THE TERM CASCADE, THE PROGRESSION.

SHOULD WE BE LOOKING AT NOT ONLY STARTING A PESH ON MEDICATION-- STARTING A PERSON ON MEDICATION FOR ANY PROBLEM BUT SHOULD WE LOOK AT WHEN WE STOP THE MEDICATIONS?

>> THANK YOU FOR ASKING THIS QUESTION.

IT IS VERY MUCH IMPORTANT BECAUSE WE ARE FACING PROBLEMS BECAUSE OF POLYPHARMACY PRESCRIBING CASCADES.

WE TALK ABOUT PRESCRIBING TO BE HELPFUL BUT IT CAN BE HARMFUL.

STOPPING A MEDICATION SHOULD BE A CONVERSATION WHEN A MEDICATION IS BEING INITIATED SO THE FIRST TIME A MID INDICATION IS PRESCRIBED, IT WOULD BE IMPORTANT FOR THE PHYSICIAN THAT IS PRESCRIBING THE MEDICATION TO HAVE CONVERSATIONS WITH THE PATIENT ON WHEN MAYBE IT MIGHT BE TIME TO STOP IT.

WE CALL THAT DEPRESCRIBING.

I LIKE TO CALL IT MEDICATION OPTIMIZATION BECAUSE IT REALLY IS ABOUT BENEFITS AND RISKS.

AND THE SAME MEDICATION CAN BE APPROPRIATE TODAY, BUT IT CAN BECOME INAPPROPRIATE TOMORROW.

SO HAVING THOSE CONVERSATIONS AND REALLY EDUCATING THE PATIENT THAT TAKING A MEDICATION AWAY IS NOT NECESSARILY A BAD THING.

IT ACTUALLY MIGHT BE HELPING THEM IS IMPORTANT TO CREATE THE RIGHT MIND SET AND GIVE THEM THE SENSE THAT IT IS ALL ABOUT RISK AND BENEFITS AND WHAT WORKS FOR THEM AT THE MOMENT THIS IS BEING EVALUATED.

I WOULD ALSO LIKE TO SAY THAT EVALUATION OF WHAT SOMEBODY IS TAKING SHOULD BE SOMETHING THAT IS BEING DONE MULTIPLE TIMES.

IT CANNOT BE JUST ONE TIME WHEN IT IS A PRESCRIPTION, THAT'S WHY IT IS SO IMPORTANT FOR PATIENTS TO BE FULLY ENGAGED AND KNOWING WHAT THEY'RE TAKING, INCLUDING PRESCRIPTION AND OVER THE COUNTER.

BECAUSE IT REALLY CAN, THE PROFILE CAN CHANGE.

THE CONDITIONS CAN DEVELOP, NEW CONDITIONS CAN DEVELOP, THE PRESCRIBING CASCADE IS AN IMPORTANT CONTRIBUTOR TO POLYPHARMACY.

AN IMPORTANT CONTRIBUTOR TO DRUG INTERACTIONS AND IMPORTANT PROBLEM FOR THE PATIENT.

SO MEDICATION OPTIMIZATION AS A PROCESS IS IMPORTANT.

THE CONVERSATIONS AROUND STOPPING MEDICATIONS OR MAYBE CHANGING THOSE OR MAYBE SWITCHING FROM ONE MEDICATION TO ANOTHER ARE IMPORTANT TO HAVE AT THE TIME A NEW MEDICATION IS BEING PRESCRIBED.

SO, YES, I CANNOT EMPHASIZE ENOUGH HOW IMPORTANT THIS IS.

AND I THINK IT IS ALSO IMPORTANT TO BRING THIS UP AS AN EDUCATOR MYSELF, CONVERSATIONS WITH OUR STUDENTS AND THE WAY WE TEACH MEDICAL STUDENTS, THE WAY WE TEACH PHARMACY STUDENTS, THE WAY WE TEACH EVERYBODY THAT IS IN OUR HEALTHCARE PROFESSION, IS IMPORTANT SO THEY ARE AWARE OF THE PROBLEMS WITH POLYPHARMACY, THE PROBLEM WITH INAPPROPRIATE MEDICATION USE AND WHEN I SAY INAPPROPRIATE, I'M SAYING IT FROM A RISK-BENEFIT PERSPECTIVE NOT ABUSE OR HOAFERREDZ AND THINGS LIKE THAT.

BUT IT IS-- OR OVERDOSE BUT IT IS IMPORTANT FOR THEM TO BE AWARE OF THESE PROBLEMS AND HAVE THE MIND SET OF OPENING CONVERSATIONS WITH THE PATIENTS WITH REGARD TO STOPPING MEDICATIONS.

>> FANTASTIC.

THANK YOU, THANK YOU FOR THAT.

LAURA, I WANT TO ASK YOU ABOUT A NON-CONTROVERSIAL TOPIC.

WHAT ABOUT THE USE OF VANE VACCINES IN OLDER PATIENTS.

>> I STRONGLY RECOMMEND THE USE OF VEERNS.

>> WHICH ONES SHOULD WE BE TAKING.

>> OLDER ADULTS YOU WANT TO GET THE ANNUAL FLU VACCINE, THE COVID VACCINE, OLDER ADULTS WHO HAVE NOT HAD THE RSV VEERN WHICH IS ANOTHER RESPIRATORY ILLNESS, THE VACCINE HAS BEEN OUT A YEAR OR A LITTLE MORE.

WE NEED THAT ONE AT LEAST ONCE.

OTHER VACCINES IS THE PNEUMONIA VACCINES AND FOR THOSE YOU NEED TO GO TO YOUR PCP TO SEE WHICH ONES HAVE YOU HAD BEFORE BECAUSE YOU HAVE PROBABLY HAD AT LEAST ONE DOSE AND THERE ARE NEW ONES THAT HAVE COME ON THE MARKET OVER THE YEARS AND YOU NEED TO WORK WITH YOUR DOCTOR ABOUT WHICH ONES YOU NEED BUT THOSE YOU NEED ANOTHER VACCINE FOR SHINGLES AS WELL, FOR SHINGLES PREVENTION.

SO THOSE, WE RECOMMEND FOR OUR OLDER ADULTS AND FOR THOSE WHO HAVE CONDITIONS THAT MAY SUPPRESS THEIR IMMUNE SYSTEM OR MAKE THEM MORE SUSCEPTIBLE.

>> DOES ANYONE CENTER A DIFFERENT PERSPECTIVE, SOMETHING YOU WANT TO ADD TO THE USE OF VACCINES?

>> I LIKE THAT PNEUMONIA VACCINE, IT HAS BECOME A LITTLE MORE SIMPLE THAN BEFORE BECAUSE WE HAVE SLOWLY ADDED TO THAT AND NOW WE HAVE A COUPLE OF OPTIONS OUT THERE THAT ARE VERY INCLUSIVE THAT HAVE THE STRAINS THAT WE ARE AT RISK FOR RIGHT NOW AND THE PRESCRIBING THE ADMINISTERING OF THOSE HAS GOTTEN MUCH MORE SIMPLE AND I BACK UP WHAT THE PHYSICIANS SAY, CHECK WITH YOUR PHYSICIAN, PHARMACY HAVE THE RECORDS AND ARE ABLE TO GIVE THOSE VACCINES AND GET YOURSELF UP TO DATE.

THERE MAY BE A CHANCE THAT YOU MAY NEED ANOTHER VACCINE AND IT IS VERY IMPORTANT AND I AGREE WITH EVERYTHING THAT WAS SAID ABOUT RSV AND THAT'S RELATIVELY NEW AND WE DON'T KNOW HOW MANY YOU MIGHT NEED TO GET LATER.

RIGHT NOW GET THE ONE AND THEN WHEN WE HAVE MORE INFORMATION, WE'LL KNOW IF THAT IS NEEDED, BUT PATIENTS HAVE ASKED ME, ISN'T THAT JUST FOR LITTLE BABIES?

OR MOMS THAT ARE GETTING READY TO HAVE A BABY?

NO, RSV CAN BE VERY SERIOUS FOR OUR OLDER ADULTS ABSOLUTELY.

>> I WANT TO TALK ABOUT EATING BECAUSE AS I HAVE GOTTEN OLDER, IT'S ONE OF THE THINGS I LIKE.

BEYOND THE PLEASURES ASSOCIATED WITH EATING A GOOD MEAL, WE KNOW THAT A GOOD NUTRITIOUS DIET IS AN IMPORTANT CONTRIBUTOR TO MAINTAINING OUR HEALTH.

THIS IS ESPECIALLY TRUE AS WE AGE, BECAUSE AS WE GET OLDER, WE OFTEN WILLINGLY, OR MORE LIKELY, UNWILLINGLY MUST MAKE CERTAIN DIETARY CONCESSIONS.

I GIVE THAT THE BIG BOO.

THESE CONCESSIONS ARE NECESSITATED BY EITHER LIMITED OR UNRELIABLE TRANSPORTATION TO STORES; INCREASING FOOD COSTS; PHYSICAL LIMITATIONS WITH COOKING; DIETARY AND FLUID RESTRICTIONS BECAUSE OF MEDICAL ILLNESSES; FOOD MEDICATION INTERACTIONS; DIFFICULTY IN CHEWING AND OR SWALLOWING; AND CHANGES IN TASTE, CAUSED BY SOME MEDICATIONS.

DESPITE, OR PERHAPS BECAUSE OF THESE IMPEDIMENTS, WE MUST BE VIGILANT IN INSURING THAT OUR DIETS ARE ADEQUATE FOR OUR DAILY HEALTH NEEDS.

TO PROVIDE INSIGHT INTO THE THINGS THAT WE CAN DO TO ENSURE THAT WE ARE GETTING NUTRITIOUS MEALS WE SPOKE TO DR. KAREN MCNEES.

DR. MCNEES EARNED HER BACHELOR'S DEGREE IN DIETETICS AT SYRACUSE UNIVERSITY, AND HER DOCTORATE IN HEALTH PROMOTION AT THE UNIVERSITY OF KENTUCKY.

DR. MCNEES IS NOW A PRACTICING REGISTERED DIETITIAN AT UNIVERSITY OF KENTUCKY HUMAN RESOURCES WORKLIFE AND WELLNESS OFFICE.

>> WHAT WE KNOW ABOUT HOW NUTRITION AFFECTS HUMAN HEALTH IS ACTUALLY PRETTY BASIC AND HAS BEEN KNOWN TO US FOR A WHILE AND IS NOT LIKELY TO CHANGE.

SO SOME OF THOSE BASICS ARE EATING MINIMALLY PROCESSED FOODS, PREPARING MORE OF YOUR OWN FOOD AT HOME, FOCUSING ON HIGH FIBER WHOLE GRAIN HEALTHY CARBOHYDRATES, FRUITS AND VEGETABLES, PLANT-BASED PROTEINS, LEAN ANIMAL BASED PROTEINS AS WELL AS HEART HEALTHY FATS.

IF PEOPLE FOCUS ON THOSE TYPES OF FOODS THAT HAVE A HIGH NUTRIENT DENSITY, THEY'RE GOING TO PRETTY MUCH COVER THEIR BASES IN TERMS OF HOW NUTRITION CAN HELP PROMOTE THEIR HEALTH.

FOR OLDER ADULTS, SOME OF THE ISSUES THAT THEY MAY RUN INTO IS ONE, THAT THEY HAVE DECREASED ENERGY NEEDS.

MEANING THEY DON'T NEED TO CONSUME AS MANY CALORIES.

AND THIS USUALLY, UNFORTUNATELY BEGINS IN OUR 30S AND 40S EVEN BUT CONTINUES AS WE GET OLDER.

THE OTHER ISSUE IS, ESPECIALLY FOR FOES MAYBE 65 OR OLDER, THEY MAY NOTICE A REAL DECREASE IN THEIR APPETITE.

IN BOTH OF THESE SITUATIONS IT MAKES IT REALLY IMPORTANT TO CHOOSE AS MANY NUTRIENT DENSE FOODS AS POSSIBLE BECAUSE YOU ARE CONSUMING LESS FOOD AND YOU NEED TO NEWSMAKERS SURE THAT FOOD IS WORKING FOR YOU AS BEST IT CAN SO YOU WANT TO MAKE SURE THAT EVERY BITE COUNTS.

IT IS TRUE THAT OLDER ADULTS SOMETIMES TEND TO NEED A LITTLE MORE PROTEIN OR TO BE A LITTLE MORE CAREFUL WITH THEIR DIET TO ENSURE THEY'RE GETTING PROTEIN.

SOMETIMES IT JUST COMES DOWN TO A TASTE PREFERENCE OR AN EASE PREFERENCE FOR OLDER ADULTS.

IT CAN BE A LITTLE BIT MORE TIME CONSUMING AND A LITTLE BIT MORE ENERGY DEMANDING TO PREPARE PROTEINS, ESPECIALLY ANIMAL PROTEINS, RIGHT?

SO THEY MAY TURN TO EASY THINGS LIKE EATING SOME TOAST AND THAT'S WHERE MAYBE THE CANNED TUNA AND SALMON AND GRAND CHICKEN AND TURKEY THAT ARE EASY TO PREPARE OR THE CANNED BEANS THAT ARE READY TO EAT COME INTO PLAY.

I RECOMMEND WHEN PEOPLE ARE AT THE GROCERY STORE, THEY LOOK FOR A FEW SPECIFIC ITEMS WITHIN EACH KIND OF FOOD GROUP.

SO I THINK WHEN IT COMES TO FRUITS AND VEGETABLES, THAT'S ONE OF THE BIGGEST COMPLAINTS I HEAR FROM PEOPLE IN TERMS OF COST.

TRYING TO BUY FROZEN FRUITS AND VEGETABLES IS ECONOMICAL AS WELL AS CANNED VEGETABLES THAT HAVE NO SODIUM ADDED OR CANNED FRUIT WITH NO SUGAR ADDED AND FOCUS STAPLE FRUITS AND VEGETABLES ALWAYS AVAILABLE AND LOW COST LIKE POTATOES, CABBAGES, CARROTS, APPLES, GRAIPTS, BANANAS, THOSE ARE ALL GOING TO BE EASY TO FIND AND AFFORDABLE ALL YEAR LONG.

IN TERMS OF PROTEINS, THAT'S ANOTHER THING I THINK WHERE PEOPLE FEEL LIKE THAT'S VERY EXPENSIVE, ESPECIALLY IF THEY'RE MEAT EATERS BUT NOWADAYS EVEN WITH THE PRICE OF EGGS, THAT IS A BIT OF A CONCERN, BUT IN TERMS OF PROTEINS, PEOPLE CAN, I THINK, STILL LOOK FOR DAIRY PRODUCTS LIKE COTTAGE CHEESE AND YOGURT, THOSE ARE GENERALLY UNCHANGED IN TERMS OF PRICING.

YOU CAN ALSO LOOK FOR CANNED VERSIONS OF THINGS LIKE SALMON, TUNA CHICKEN, GROUND TURKEY AND CHICKEN ARE VERY AFFORDABLE SOURCES OF PROTEIN AS WELL AS DRY BEANS OR CAN BEANS OF ANY KIND OF AND HEALTHY FAT CATEGORY, NUTS ARE USUALLY TOUTED AS BEING VERY HEART HEALTHY.

BUT PEANUTS ARE THE MOST INEXPENSIVE NUT, I FIND AND BE JUST AS HEALTHY AS MORE EXPENSIVE ALMONDS.

PEOPLE SHOULD FEEL FREE TO USE PEANUTS FOR THAT AND THINGS LIKE PEANUT BUTTER AS WELL.

IN MY OPINION, I THINK A LOT OF THE HEALTH PROBLEMS THAT FOLKS HAVE THAT ARE RELATED TO NUTRITION ARE MORE AN ISSUE OF OVER CONSUMPTION THAN UNDER CONSUMPTION.

WE'RE NOT HAVING THESE HEALTH PROBLEMS BECAUSE WE ARE HAVING TOO FEW BLUEBERRIES AND TOO LITTLE KALE.

WE ARE HAVING THESE HEALTH PROBLEMS LARGELY BECAUSE WE ARE CONSUMING TOMB CHIPS AND TOO MUCH CANDY AND SODA.

SO THIS IS REALLY THE FIRST THING PEOPLE SHOULD FOCUS ON WHEN IT COMES TO DIET AND ANY HEALTH RELATED CONCERNS IS ELIMINATING OR MINIMIZING ULTRAPROCESSED FOODS, FOODS WITH VERY HIGH ADDED SODIUM SUGARS, TRANSFATS, SATURATED FATS.

THAT'S STEP ONE.

BEYOND THAT, I THINK THINKING ABOUT THOSE INTERACTIONS WITH MEDICATIONS, YOU CERTAINLY HAVE STATINS ABGRAPEFRUIT WE KNOW HAS AN INTERACTION, BLOOD THINNERS AND VITAMIN K WHICH IS USUALLY FOUND IN LEVY GREENS AND WE WANT PEOPLE EATING THAT BUT THAT'S SOMETHING THEY SHOULD TALK WITH THEIR DOCTOR ABOUT TO MAKE SURE THEY'RE KEEPING A CONSISTENT INTAKE OF THOSE LEVY GREENS.

ALSO HAVE SOME CONTRAINDICATIONS WITH HIGH FIBER FOODS AND THYROID MEDICATIONS AS WELL AS SOME BLOOD PRESSURE MEDICATIONS THAT AFFECT POTASSIUM LEVELS IN THE BLOOD AND USING SALT SUBSTITUTES THAT CONTAIN SOMETHING CALLED POTASSIUM CHLORIDE.

THOSE ARE SOME OF THE BIG ONES THAT OLDER FOLKS ON MEDICATIONS SHOULD BE AWARE OF.

>> SO DANESH, FROM YOUR PERSPECTIVE WITH REGENERATIVE MEDICINE, WHAT IS THE HOLISTIC APPROACH HOW YOU PLACE FOOD INT THAT?

I'M A FAT KID INSIDE AND I WILL ALWAYS BE A FAT KID INSIDE.

I LOVE FOOD.

AND PART OF THE REASON I LOVE IT IS THAT IT FASCINATES ME THAT I CAN PUT SOMETHING IN MY MOUTH AND IT GO INSIDE OF ME AND MAGICALLY IT BECOMES A PART OF ME, SO LITERALLY EVERYTHING THAT I EAT, I WANT TO BE MINDFUL ABOUT AND I ADVOCATE MINDFUL EATING TO MY PATIENTS.

WHEN YOU ARE INSERTING THE BUILDING BLOCKS OF YOUR BODY INTO YOURSELF AND IF YOU ARE EATING, YOU KNOW,HIGH PROCESSED FAST FOODS, THINGS THAT ARE REALLY FORMULATED TO BUILD AN ADDICTIVE APPETITE, THEY'RE NOT DESIGNED TO BE BUILDING BLOCKS.

IF IT IS MEANT TO SIT ON A SHELF FOR WEEKS OR MONTHS, IT'S NOT REALLY DESIGNED TO BE BIO AVAILABLE FOR YOU ON THE INSIDE.

I THINK CONTEXT SPECIFIC NUTRITION IS ALSO REALLY IMPORTANT.

I'M GLAD THAT THE NUTRITIONIST MENTIONED PROTEIN CONSUMPTION FOR OLDER ADULTS BECAUSE ONE OF THE BIGGEST OR ONE OF THE MOST RAPID REASONS THAT PEOPLE HAVE DECLINING QUALITY OF LIFE IS THE LOSS OF MUSCLE MASS OR A-- YOUR MUSCLES HAVE AN ENDOCRINE FUNCTION.

THEY ACT LIKE HORMONE PRODUCERS IN THE BODY AND IF YOU ARE LOSING MUSCLE MASS, YOUR ABILITY TO REGENERATE IS EVEN MORE COMPROMISED.

SO THINGS THAT WILL INCREASE THE AVAILABILITY OF THOSE BUILDING BLOCKS IN THE CONTEXT OF THE ACTIVITIES THAT HELP UTILIZE THOSE BUILDING BLOCKS.

SO, FOR INSTANCE, YOU ARE NOT VERY PHYSICALLY ACTIVE, YOU MAY NOT NEED THE AMOUNT OF PROTEIN BUT YOU ARE ALSO GOING TO HAVE A DECLINE IN QUALITY OF LIFE AS A RESULT OF THAT.

WHEREAS IF YOU ARE PHYSICALLY ACTIVE, AND YOU CONSUME PROTEIN, THEN YOUR BODY CAN CAPITALIZE ON THE BUILDING BLOCKS WITHIN THAT PROTEIN SO BUILD NEW HEALTHY STRONGER MUSCLES WHICH WILL THEN IMPROVE YOUR QUALITY YOU HAVE LIFE IF YOU KEEP UP WITH IT.

DIET IS REALLY ONE OF THE MAIN DRIVERS OF QUALITY OF LIFE AND I'M MUCH MORE CONCERNED ABOUT PEOPLE LIVING A GOOD QUALITY LIFE THAN EXTENDING THE LIFE FOR 120 YEARS.

>> WELL, LAURA, THAT'S A VERY INTERESTING PERSPECTIVE, HAVING A GOOD QUALITY OF LIFE.

SO WHAT DO YOU TELL YOUR PATIENTS WHO ARE HYPERTENSIVE, HAVE PRERENAL DISEASE OR DIABETIC SINCE THAT IS A BIG PROBLEM HERE, ABOUT DIET.

WHAT IS THE USE OF MY LIVING IF I CAN'T EAT THE FOODS THAT I WANT?

HOW DO YOU COACH THIS?

>> THAT IS A GREAT QUESTION AND ONE WE DEAL WITH EVERY DAY.

AND I THINK IT'S VERY IMPORTANT TO TALK TO OUR PATIENTS AND FIGURE OUT WHAT MATTERS MOST TO THEM.

IT'S REALLY IMPORTANT WHAT IS IMPORTANT.

IS IT QUALITY OF LIFE?

IS IT HAVING THAT ONE DESSERT ONCE A WEEK.

IT'S TRYING TO FIND A BALANCE.

AND IT'S NOT THAT WE HAVE TO SAY OH YOU CAN NEVER HAVE ANY OF THOSE OTHER THINGS THAT ARE TREATS THAT YOU LIKE.

IT'S ABOUT TRYING TO EAT WELL MOST OF TIME.

BUT YOU ALLOW YOURSELF THOSE TREATS BECAUSE THAT IS A QUALITY OF LIFE THING, AND IF YOU TRY TO GO MOST OF THE TIME IF YOU GO THE NO, WE CAN'T HAVE ANY OF THOSE TYPE OF FOOD, PEOPLE DON'T WANT TO BUY INTO IT.

IT'S TOO HARD TO DO THAT SO WE START WITH THE SMALL STEPS AND SAY OKAY, WHY DON'T WE ALLOW OURSELVES ONE DRINK, ONE SODA, AND REALLY TRY TO CUT DOWN FROM THERE.

AND THEN WORK TO THAT MORE IDEAL DIET.

>> MY WIFE ALWAYS CALLED IT CREATIVE CHEATING AND I'VE-- I TEND TO BE LESS CREATIVE AND MORE CHEATING THAN ANYTHING ELSE SADLY.

SO TELL ME, ANGELA, WHAT DO YOU TELL FAMILY MEMBERS WHEN WE ARE TALKING ABOUT MEDICATIONS THAT PEOPLE ARE DOING?

HOW DO YOU BRING THIS CONVERSATION TO THEM?

>> I THINK IT'S SO HELPFUL, ESPECIALLY AS WE AGE, THAT WE HAVE FAMILY MEMBERS THAT ARE WILLING, FAMILY MEMBER OR CAREGIVER THAT IS WILLING TO HELP US OUT WITH THIS.

AND IT'S A COLLABORATIVE.

THE PATIENT, THE CAREGIVER AND THE PHARMACIST, WE CAN HELP EXPLAIN WHAT THE MEDICINES ARE FOR; WHAT THEY SHOULD LOOK FOR, WHAT THE MOST COMMON OR SERIOUS SIDE EFFECTS OF THE MEDICINE MIGHT BE SO THAT THEY CAN KNOW WHAT TO DO IF THAT OCCURS AND TELL THEM WHEN IS IT TIME TO CALL YOUR DOCTOR?

WHEN IS IT TIME TO DO SOMETHING ABOUT IT.

SO ALL OF THAT IS SUCH VALUABLE EDUCATION.

SOME OF IT CAN BE PRINTED BUT IT'S SO GOOD TO HAVE THE CONVERSATION WITH YOUR PHARMACIST, FOR EXAMPLE, AGAIN, THE BROWN BAG APPROACH, BRING ALL THE MEDICINES AND LET US LOOK AT THEM AND TELL THE CAREGIVER ABOUT THEM.

HOW TO PROPERLY STORE THEM.

I FOUND PATIENTS BEFORE THAT KEPT ALL THEIR MEDICINES IN THE FRIDGE BECAUSE THEY THOUGHT IT WOULD BE BETTER AND THAT IS NOT-- IT'S MOIST IN THERE.

SOMETIMES THE TEMPERATURE IS TOO LOW.

SO ALL OF THAT INFORMATION IS AVAILABLE THAT PHARMACISTS CAN SHARE WITH THE CAREGIVER AND THE PATIENT.

I LIKE THE MEDI PLANNER.

IF YOU HAVE SOMEONE THAT CAN HELP YOU FILL THE PLANNER, IT HELPS WITH ADHERENCE TO THE THERAPY SO THE PERSON CAN HELP REMEMBER TO TAKE THE MEDICATION.

PHARMACISTS CAN HELP OUT WITH THAT.

SOME PHARMACISTS WILL PACKAGE THE MEDICINE IN DOSE CONTAINERS SO IT'S EASIER FOR THE PERSON WHO IS GETTING MORE FOR GETFUL OR JUST LIKES THE CONVENIENCE.

THAT'S A SERVICE AVAILABLE AT YOUR COMMUNITY PHARMACY AT LOT OF TIMES AND THOSE ARE VALUABLE THING YOU CAN DO.

THE MORE YOU KNOW, THE MORE POWER YOU HAVE KNOWLEDGE IS POWER.

>> YOU ARE BOTH UNIQUE THAT YOU ARE BOTH ON FACULTIES IN RESPECTED MEDICAL INSTITUTIONS.

LET'S START WITH YOU, DANIELA.

YOU BROUGHT IT UP.

WHAT ARE THE CHANGES YOU SEE US NEEDING TO MAKE AND HOW WE APPROACH THIS TO OUR MEDICAL STUDENTS, NURSING STUDENTS, PHARMACY STUDENTS, ET CETERA.

HOW DOE SEE THIS RIGHT NOW?

>> I SEE IT VERY MUCH NEEDED CONVERSATIONS ABOUT DEPRESCRIBING MEDICATION OPTIMIZATION ARE IMPORTANT.

I SEE WITH OUR PHARMACY STUDENTS THAT WE TALK A LOT ABOUT, YOU KNOW, MEDICATIONS THAT-- AND THEIR ROLE IN TREATING CERTAIN MEDICAL CONDITIONS.

BUT NOT AS MUCH ABOUT WHEN IS IT TIME TO STOP AND WHAT IS THE ROLE OF PHARMACISTS IN THIS PROCESS.

AND, YOU KNOW, OUR WORK SHOWS THAT PHARMACISTS CAN HAVE A KEY ROLE AND THEY ARE GREAT TEAM MEMBERS IN THIS INTERDISCIPLINARY TEAMS THAT CAN HELP THE PATIENT NAVIGATE THE COMPLEXITY OF PHARMACOTHERAPY.

WE NEED TO DO MORE.

THAT'S WHAT I WILL SAY.

I DO NOT THINK OUR CURRICULA REALLY PROVIDES ANDY QAIPS THEM WITH THE RIGHT SKILL SET-- AND EQUIPS THEM WITH THE RIGHT SKILL SET.

MEDICATION RECONCILIATION IS A GREAT TOOL.

THERE ARE OTHER WAYS THAT ALLOW FOR A MORE COMPREHENSIVE EVALUATION SO THE COMPREHENSIVE MEDICATION REVIEWS ARE IMPORTANT AND THEY CAN BE A REALLY GOOD SEGUE INTO DEPRESCRIBING, BUT AGAIN, IT REALLY SETTING THAT MIND SET AND IT WAS MENTIONED EARLIER THAT COMMUNICATION SOMETIMES IS NOT IDEAL.

SOMETIMES THERE IS LACK OF COMMUNICATION.

SOMETIMES IT'S NOT ENOUGH COMMUNICATION.

AND SO THIS OPPORTUNITY IS THERE BUT I DON'T THINK WE ARE FULLY TAKING ADVANTAGE OF THEM.

WE NEED TO REALLY EDUCATE OUR STUDENTS MORE ABOUT THIS.

WHEN I ASK MY STUDENTS IF THEY'RE INTERESTED IN GERIATRICS, SOMETIMES THEY SAY NO BUT THEY DON'T REALIZE THE POPULATION THEY'RE TREATING ARE OLDER ADULTS.

THEY FACE POLYPHARMACY, THEY FACE INAPPROPRIATE MEDICATION SO DEPRESCRIBING IS AN IMPORTANT TOOL TO HAVE IN YOUR TOOL BOX.

>> I THINK THE SAME WOULD BE TRUE AT THE RESIDENT TRAINING LEVEL?

>> THERE IS NOT ENOUGH FOCUS ON GERIATRICS.

WE DON'T HAVE ENOUGH PEOPLE WHO WANT TO GO INTO GERIATRICS.

IT'S NOT GOING TO BE DOCTORS LIKE ME BUT PRIMARY CARE PHYSICIANS.

>> I WANT THE REAL BRIEF ANSWER.

FINAL THOUGHT, ONE THING YOU THINK WE SHOULD TAKE HOME WITH ANGELA, WE'LL START WITH YOU AND THEN TO DANESH.

>> OKAY.

MEDICATIONS CAN BE GREAT.

MEDICATIONS CAN CAUSE HARM.

HAVE A LIST OF YOUR MEDICINES INCLUDING YOUR OVER-THE-COUNTER AND HERBALS AND KEEP IT WITH YOU ALL THE TIME.

YOU NEVER KNOW WHEN YOU ARE GOING TO END UP IN THE EMERGENCY ROOM OR WHAT IS GOING TO HAPPEN OR WHO IS GOING TO ASK YOU.

ALL THE DETAILS ARE IMPORTANT.

GOIT TO SAY-- I GOT TO SAY BECAUSE PEOPLE HAVE CALLED ME A PILL PUSHER IN A JOKING WAY, HEALTHY EATING AND EXERCISE EVERY DAY WILL KEEP THE PILL PUSHER AWAY.

>> DANESH WHAT DO YOU WANT ME TO TAKE HOME WITH THIS?

>> I ECHO THIS.

FOOD IS MEDICINE, EXERCISE IS MEDICINE FAR MORE THAN PILLS ARE MEDICINE.

AND IN HAVING PATIENT AGENCY OR SENSE OF CONTROL OVER YOUR OWN HEALTH, HAVING MINDFULNESS ABOUT YOUR HEALTH, IS MUCH BETTER THAN JUST BEING PASSIVE AND ALLOWING FOR A MEDICATION TO TRY TO FIX SOMETHING THAT IS BROKEN.

IT'S MUCH, MUCH MORE EFFECTIVE TO BE PROACTIVE AND TAKE A PREVENTATIVE MIND SET.

I THINK THAT PREVENT PREVENTATIVE MEDICINE IS NOT AS SEXY AS CURATIVE IS BUT LET'S BRING SEXY BACK AND MAKE PRETENTATIVE MEDICINE SEXY AGAIN.

>> DANIELA ONE TAKE HOME POINT.

>> WILL BE REALLY TO THINK BEFORE TAKING A NEW MEDICATION.

THINK WHETHER THAT WILL #-B SOMETHING THAT WILL HELP YOU OR MIGHT CAUSE PROBLEMS DOWN THE ROAD.

>> LAURA.

BRIEF TAKE HOME MESSAGE FOR US.

>> YOU HAVE TO TALK ABOUT WHAT IS IMPORTANT.

THINK ABOUT WHAT IS IMPORTANT TO YOU AND THEN ASK YOUR PRESCRIBER, WHAT, TELL THEM WHAT MATTERS MOST AND ASK THEM ABOUT THE MEDICATIONS THAT YOU ARE TAKING, SAY WHY DO I NEED THIS AND IS THERE SOMETHING THAT WOULD WORK BETTER FOR ME TO ACCOMPLISH MY GOALS.

>> AND WE THINK WE CAN GET ALL THIS DONE?

>> WE HOPE SO.

>> I HOPE SO, TOO BECAUSE I THINK THIS IS ONE OF THE CLEARLY ONE OF THE MOST IMPORTANT THINGS WE ARE GOING TO BE DEALING WITH.

THE NUMBER OF MEDICATIONS WE ARE ALL TAKING.

UNFORTUNATELY THE LACK OF COMMUNICATION BETWEEN ALL OF US, UNLIKE HERE ON THE PANEL WE ARE ALL TALKING TO ONE ANOTHER, THERE ARE PHYSICIANS OUT THERE WHO REALLY ARE NOT COMMUNICATING WITH THE PHARMACISTS AND THE PATIENT IS STUCK IN THE MIDDLE.

AND WE HAVE TO PUT THEM BACK INTO THE THING.

SO I WANT TO THANK YOU ALL FOR BEING WITH US TODAY.

IT HAS BEEN REALLY, REALLY ENJOYABLE AND I PARTICULARLY ENJOYED HAVE GOTTEN A LOT OF GOOD INFORMATION OUT OF THIS.

THANK YOU FOR BEING WITH US FOR TONIGHT'S "SENIORS AND MEDICATION: A NEXT CHAPTER FORUM".

WHILE IT'S BETTER TO LIVE A HEALTHY LIFESTYLE WHEN WE ARE YOUNG, IT'S NEVER TOO LATE TO START DOING THE RIGHT THING.

I THINK Dr. MAZLOOMDOOST SAID IT BEST WHEN HE SAID THAT WE WANT TO HAVE A GOOD QUALITY OF LIFE, LIVE LONG, BUT WE WANT TO HAVE THE GOOD QUALITY OF LIFE.

THIS MEANS EATING RIGHT; BEING PHYSICALLY ACTIVE, UP TO YOUR LIMITS; TAKING MEDICATIONS AS PRESCRIBED; ASKING QUESTIONS WHEN PRESCRIBED MEDICATIONS; DON'T TAKE OVER THE COUNTER MEDICATIONS OR SUPPLEMENTS WITHOUT CONSULTING WITH YOUR REGULAR PHARMACIST, AND PRIMARY CARE PROVIDER; AND PLEASE KEEP A LIST OF YOUR MEDICINES AND WHEN POSSIBLE, ALSO A PHOTO OF THE MEDICATION.

SO WHEN YOU ARE TRY TO DESCRIBE, YOU CAN'T JUST SAY THE RED PILL.

IF YOU WANT TO SEE THIS PROGRAM AGAIN OR CATCH OTHER SEGMENTS IN THE "NEXT CHAPTER" SERIES PLEASE VISIT OUR WEBSITE, KET.ORG/NEXT CHAPTER ON BEHALF OF THE MEMBERS OF OUR I LOOK FORWARD TO SEEING YOU AGAIN AND TAKE HEART THE ADVICE WE ARE GIVING YOU TODAY AND LIVE WELL AND LIVE LONG WITH GOOD QUALITY.

THANK YOU FOR BEING WITH US.