As the pandemic wore on, Ardie, 78, and Bill, 82, were becoming increasingly inactive and isolated, spending their days alone in the apartment, in their recliners watching TV. Their daughters were worried about their parents’ declining health and the number of medications they were on, but living several hours away, they hadn’t been able to visit in three months, and then, due to COVID, only from afar. Concerned that Ardie and Bill weren’t managing on their own, the family reached out to Cedar Creek, a Lifespark Community, part of Lifespark Senior Living.
Biggest “aha”
In the middle of a snowstorm, the Lifespark team met with Ardie and Bill at their apartment in Alexandria, MN, with one of the daughters on the phone, to get to know them and do an initial discovery. For LuAnn Nulsen, RN, Director of Senior Living Clinical Operations at Lifespark, the biggest “aha!” was polypharmacy, defined as the simultaneous use of five or more prescription drugs, over-the-counter (OTC) medications, or dietary supplements. “Ardie and Bill were on at least ten medications each—including several expired OTC drugs—and both had multiple providers but no follow-up appointments,” she said. “It was a perfect storm.”
Given the couple’s complex medical histories—diabetes, stroke, pulmonary embolism, tremors, osteoarthritis, depression, hypertension, asthma—their daughters were thrilled that Lifespark offered on-site primary care by geriatric experts and a pharmacy. The family approved orders for physical and occupational therapy, but the move-in orders for Cedar Creek had to come from a clinician. Lifespark made multiple calls to determine which provider had seen the couple last, but finally, on Nov. 30, 2020, with orders in hand, Ardie and Bill moved into their new home.
Polypharmacy take-down
Two days later, Kyndra Steffes, NP, and Tina Belscher, LPN, part of Lifespark Health (whole person primary care), met with their new clients to talk about their goals, review their medications, add safety bars in the shower, and start them on a physical therapy program. At the top of Ardie and Bill’s list of goals was reducing the number of medications they were taking—a goal shared by their daughters and by Lifespark.
“Polypharmacy is a huge concern for the senior population,” said Sarah Johnson, APRN, CNP, Lifespark Health Associate Medical Director. “When an older adult isn’t feeling well—they’re dizzy, confused, constipated, or nauseous—the medication list is the first place I go. Medications can cause side effects or drug interactions that may be the only cause of their symptoms.”
That was the case for Ardie whose diabetes was being overtreated. “Ardie’s blood sugars were being too tightly controlled, which could cause her to feel dizzy and put her at an increased risk of falls,” Sarah said Kyndra relaxed her client’s blood sugar goals and took her off sliding-scale insulin—a reactive, labor-intensive intervention that doesn’t help long-term—and instead, started her on long-acting insulin.
In reviewing Bill’s medications, Kyndra discovered that he was still taking an anticoagulant prescribed after a pulmonary embolism in February of 2020. Because it was a first-time blood clot with no additional bleeding, his provider should have discontinued the drug in August. Kyndra caught the oversight and deprescribed it.
After making several other adjustments, Kyndra and Tina continued to meet with Ardie and Bill every two weeks for the first two months to monitor their medications and continue to improve their care experience.
More active, more social, more spark
Kyndra and Tina also helped Ardie and Bill with their other goals: becoming more active and social. As soon as the couple finished their two-week quarantine, they took their exercise plans down to the Cedar Creek Wellness Center and now spend time working out on the NuStep exercise machines. They’ve also started eating meals in the dining room which has helped stabilize Ardie’s blood sugars. Even with COVID restrictions, they’re beginning to socialize more and participate in small group activities. Their daughters are delighted with the changes they’ve seen in their parents, which has been great for their own peace of mind.
“What I love about geriatric medicine, and specifically Lifespark’s whole-person approach, is diving into all the elements that impact quality of life,” Sarah said, adding that in more traditional medical practices, these types of issues aren’t usually elevated to a high level of importance. “Ardie and Bill still have years in front of them,” she said. “By focusing on their quality of life, family connections, social interactions, and physical health, we can help make those years more enjoyable.”
To learn more about Lifespark and how our whole-person approach can help your loved one age magnificently, schedule a free consultation.