What instead? Alternatives to Beers: Todd Semla and Mike Steinman

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GeriPal - A Geriatrics and Palliative Medicine Podcast 44 min 3 speakers 8 chapters transcribed 10 hours ago
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What is the overall purpose of the “alternatives to Beers” podcast episode?

Eric Widera 0:00
Welcome to the JerryPow Podcast. This is Eric Wadera. This is Alex Smith. And Alex, who do we have with us today?
Alex Smith 0:08
We are delighted to welcome back co-chairs of the AGS Beers Criteria Panel. Uh first we have Todd Semla, who's a clinical pharmacist and is at Northwestern University. Todd, welcome back to the JerryPo podcast.
Todd Semla 0:24
Great to be here. Thank you, Alex and Eric, for inviting us.
Alex Smith 0:27
And we're delighted to welcome Mike Steinman, who's a geriatrician at UCSF, and also a co chair of the AGS Beers criteria panel and is co director of the US Deprescribing Research Network. Welcome back, Mike.
Eric Widera 0:42
Thank you. So we're gonna be talking about not an alternative to beers criteria, but alternative treatments to the medications that the beers criteria says we shouldn't put people on. Before we go into that topic, I think uh who has the soccer quest for Alex? That was me. Uh Mike, what's the song request? Uh how about Getting Better by the Beatles? Why did you choose the song other than Alex likes singing the Beatles?
Unknown 1:10
Well, that was one reason. Uh two other reasons. Uh first is that, you know, the goal of the alternatives list is to help people get better, feel better, live longer, happier and and more productive lives. And then the second thing is, you know, as as clinicians and scientists, it's been a rough few months and um We can kind of hope for a note of optimism that things will will get better as uh as the months and years pass. Love it. Here's a little bit.
Unknown 1:40
It's getting better all the time I used to get mad in my school. The teachers that taught me weren't cool. You're holding me down. Turning me round, filling me up with your rules. I've got to admit it's getting better, a little better all the time. I have to admit it's getting better, it's getting better. Since you be my
Alex Smith 2:22
Uh, Beatles are fun. Thank you, Mike. Right.
Unknown 2:25
You've got the education policy debates in there too.
Eric Widera 2:31
Okay, so I'm gonna start off with a case. 80-year-old patient who is uh has a lot of medical problems, probably like many of the patients we care for. There are di they have diabetes, they're on a sulfur metformin, they have insomnia, which they take ambien pretty much daily for. They have GERD and they've been on a PPI for the last three years. They got lower back pain and they're on pick your skeletal muscle relax. That they're on uh and PRN NSAIDs. They have neuropathic pain from their diabetes, they're on gabapentin. Uh and then they have seasonal allergies, which they take some over the counter drug, which you're not a hundred percent sure is, but you're pretty sure it's Benadryl. But they can't really tell you what they're taking.
Eric Widera 3:20
They just go to C V S and pick it up. Alex, any other ones that you want to throw out there? Does that sound pretty good? You you're covering
Alex Smith 3:28
it pretty well there. I cover
Eric Widera 3:29
it pretty well. Oh yeah. No, yeah. They're they're the ambient's working pretty good. They love their ambient though. I just wanted to make sure we had delirium in there. Yeah,
Todd Semla 3:40
yeah, yeah.
Eric Widera 3:41
Okay. When you hear about this list as a leader in the beers criteria, what are you thinking? Well, before that, what is the beers criteria and how does it apply to this list?
Todd Semla 3:55
So the Bears criteria has been around since the 90s. Um, started out for nursing home patients about medications to avoid, not to use, or to use with extreme caution, um, particularly either by themselves or if the person has a comorbidity or c condition that could you could make worse by that medication. And um for the past uh twelve or fifteen years, the American Geriatric Society has been responsible for updating it. When it applies not just to nursing home patients, but to all older adults, with the exception of palliative care, you know, end of life situations. Uh but it really looks at medications that we we really should think twice about using, maybe avoid using them at altogether. Um in older adults, also drugs that need to be adjusted for renal function that people may forget about.
Todd Semla 4:49
and drug drug interactions that um could happen to anybody, but in an older adult, um, they're more likely to cause morbidity or mortality.

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