For older adults like Lea Goodwine-Cesarec—one in an exponentially growing population that will eventually triple by the year 2050—good medical care isn’t just a goal, it’s a necessity.
Goodwine-Cesarec practices daily “polypharmacy”: the use of multiple medications by one person. Fifty percent of adults age 65 and older take five or more medications daily, and many take as many as 20. If handled correctly, polypharmacy sustains the health of millions of Americans every year. But if done incorrectly, it can be extremely dangerous.
That’s why Goodwine-Cesarec goes to the The University of Arizona Medical - Wilmot Clinic (formerly University Physicians Healthcare Wilmot Clinic) to see Jeannie Lee, a faculty member at the College of Pharmacy.
“I’m so glad that UPH provides this service for me to see a pharmacist,” Goodwine-Cesarec says. She’s sitting in a cushy recliner with a makeshift desk opened in front of her that’s holding half a dozen medications and herbal supplements.
Specializing in geriatric patients
Jeannie Lee is what you’d call a geriatric pharmacy specialist. In addition to teaching three classes at the UA College of Pharmacy, she divides a portion of her remaining time between the Wilmot Clinic and the Southern Arizona Veterans Affairs Health Care System on the south side of Tucson, helping to control potentially harmful polypharmacy regimens in older adults. Her work is partially supported by the Arizona Geriatric Education Center Grant (AzGEC) from the Health Resources and Services Administration. AzGEC, housed in the Arizona Center on Aging, fuels many of Lee’s interprofessional collaborations in research and education.
Another big part of her job involves traveling to patients’ homes.
“Because older adults take the most medications, and they’re also the ones who take the highest number of over-the-counter products, herbal supplements and vitamin supplements, their regimens easily become complicated,” Lee says. “When we do home visits, it becomes very evident to us how patients manage their medications at home: for instance, whether they keep all their medicines in one place or 10 different places at their house.”
“But when patients are coming to the clinic,” she continues, “I tell them to take out a little suitcase, clean out their medicine cabinets, their drawers, their pantry, and put all the bottles in the traveling case and wheel it in. When we open it up, it’s like a treasure hunt.”
Goodwine-Cesarec—with a giggly, upbeat demeanor and a spunky butterfly tattoo on her right shoulder—looks generally happy to be at the clinic and to be speaking with a pharmacist. But in the elderly population, that’s not always the case. Spending much of their time between clinics and doctors’ offices, many older adults can become frustrated, unwilling to accept change, or incommunicable due to various impairments or illnesses.
Respecting patients' feelings
One of the biggest challenges in geriatric care is figuring out how to balance a patient’s needs with their habits and predispositions. If a patient has been taking a medication for a long time or has paid for a lengthy supply, he may not want to give it up. In that case, Lee must be sensitive to their feelings.
“I try to take away medications and simplify their regimen first, if possible, but often patients are under-treated, and that’s a big problem as well,” she says. “Many providers have ageism. They might say, ‘Oh he’s 80. He doesn’t need this medication or that medication.’ But the evidence shows some medications are beneficial and can be life sustaining even for octogenarians.”
Lee tells the story of Helen Campbell, another patient who visited Lee’s College of Pharmacy Perspectives in Geriatrics class in March to share her experience with the students. Campbell was suffering from multiple chronic conditions including hypertension, heart disease, kidney disease, depression, cancer and chronic pain. When her daughter came to the Wilmot Clinic, she was thrilled to find a geriatrics doctor who would treat her mother. Meeting a pharmacist who would oversee her mom’s numerous (25+) medications was an amazing bonus.
After months of consultations, Lee and the geriatrician managed to bring Campbell to good health. She’s still practicing polypharmacy, but a “more appropriate polypharmacy.”
“She looks so much better! Much, much better than when she first came to see us, for sure,” Lee says. “I love working with older adults because they have such history. They have wisdom they have gained over the years in their lifetime, they have so much to offer, not just to me, but to my students and my residents, who are young professionals training to care for our rapidly aging patient population.”