We Can Do Better: Personalizing Medication Management for Older Patients
By Adva Tzuk Onn, M.D.
Chief Medical Officer, FeelBetter
All too often, when I meet with new patients and ask about the medicines they take, they list anywhere from 10–15 prescribed and over-the-counter medications. Research shows that the number of prescriptions people over the age of 65 take has doubled in the last 20 years due to a number of factors, including that people are living longer, seeking quick fixes to improve their health, and require additional medications to reduce the side effects of other drugs.
Research conducted by the National Council on Aging (NCOA) shows that “nearly 95% of adults 60 and older have at least one chronic condition, while nearly 80% have two or more.” Symptoms of hypertension, arthritis, diabetes, and depression, for example, range from mild to severe, and are typically treated with a cocktail of medications. Managing them is challenging for both patients and their doctors. As people get older, their bodies absorb and metabolize drugs differently, becoming more sensitive to medication side effects. Taking multiple medications raises the risk of drug-drug interactions and adverse drug events, including worsening cognition and potentially dangerous falls.
In many cases, deprescribing can significantly lower such risks and improve quality of life. I’ve seen this time and time again with my patients, such as one whom I will refer to as Renée, which means “reborn,” to keep her identity anonymous.
When I first met Renée, she was 80 years old and living at home with her husband. A retired headmaster, Renée was well known in her community as a vibrant educator who helped young students find their way in the world. However, she hadn’t felt well enough to be part of the world or leave her home in more than three years. It took Renée’s family a tremendous amount of effort to convince her to visit my clinic.
I quickly learned that Renée was taking multiple types of antipsychotics, antidepressants, benzodiazepine, and anti-Parkinson’s agents. She explained that, after her retirement and her son’s divorce, she began experiencing severe abdominal pain for which medical investigation offered no explanation. Renée lost 35 pounds, and psychiatrists prescribed different combinations of antipsychotics and antidepressants, adding more and more medications that didn’t improve her symptoms or mood. Renée would stay in bed or lie on the couch all day. She said she gradually stopped doing household chores, was always sleepy, and constantly thinking of all the activities and hobbies she could no longer manage to do or enjoy.
With Renée’s permission and her family’s support, we began to slowly taper down her medications. It wasn’t easy to decide which medicines to start with, as there were so many in her regimen. I had to consider the potential side effects of each medication, drug-drug interactions, appropriate dosing for her age, and kidney function, as well her personal preferences and my professional opinions. After two weeks on lower doses of some medications, Renée and her family reported no changes or deterioration in her condition, so I continued de-prescribing, and, over time, she stopped taking all the previously prescribed medications, one by one.
Soon thereafter, Renée’s family noticed that she was more “awake,” motivated to engage in activities around the house, and even willing to leave her home to go to physical therapy. Within two months, she began cognitive behavioral therapy working towards achieving her goal — regularly engaging in activities outside of her home. Renée showed no signs of depression, suicidal thoughts, or psychosis. While she still experiences some difficulty leaving her home, Renée continues to report feeling better and is consistently engaging in hobbies and household chores.
This experience, along with others I have had over the last 10 years, has taught me the importance of taking the time to understand a patient’s story and their full medical history and journey, beyond a single point in time. Geriatric medicine is a “whole person” specialty that involves consideration of psychological, social, functional, and environmental factors, as well as evolving clinical guidelines. This is particularly evident when it comes to medication management. I learned how critical it is to take all these factors into account and make slow, careful changes to medication regimens. At the same time, I discovered where the gaps are in terms of tools that can help physicians expedite this process and effectively manage polypharmacy risks at scale.
With the right technology, I believe that we can help millions of patients like Renee. Today, as Feelbetter’s Chief Medical Officer, I have the opportunity to be part of a team that’s developing solutions to help clinicians make better decisions about medication therapy and improve the lives of patients all over the world. My hope is that in sharing Renée’s story, it will inspire others in the medical community to prioritize careful, personalized approaches to medication management for their patients.
Adva Tzuk Onn, M.D., is a geriatric and family medicine specialist, with more than 20 years of experience across various health systems. In 2018, Dr. Tzuk Onn joined FeelBetter, a technology company that has pioneered pharmaco-clinical intelligence to optimize medication management and drive preventive, personalized care. As Chief Medical Officer, she is responsible for the development and execution of FeelBetter’s clinical strategy, as well as the design of the FeelBetter platform’s clinical capabilities.
Before joining FeelBetter, Dr. Tzuk Onn founded and led an innovative clinic that takes a biopsychosocial approach to healthcare, providing personalized, integrated, and comprehensive care for patients over the age of 65. In previous roles within Israel’s largest HMOs, Dr. Tzuk Onn served as a director of a geriatric clinic affiliated with Maccabi Healthcare Services and a partner of a primary care clinic that is part of Clalit Health Services. She also served as a senior physician in the rehabilitation department of Shoham Center for Geriatric Medicine in Israel.
A graduate of the School of Medicine at Tel Aviv University, Dr. Tzuk Onn co-founded the Society of Lifestyle Medicine within the Israel Association of Family Physicians and is an active member of the Israeli Society for Healthtech.
