This is a multipart message in MIME format. ------=_NextPart_000_0065_01D270C3.5B324340 Content-Type: multipart/alternative; boundary="----=_NextPart_001_0066_01D270C3.5B324340" ------=_NextPart_001_0066_01D270C3.5B324340 Content-Type: text/plain; charset="us-ascii" Content-Transfer-Encoding: 7bit Maria While it was unfortunate that you could not attend our meeting yesterday, your obvious understanding of how the issue of polypharmacy impacts seniors was rather impressive. As you are undoubtedly aware this condition, affecting anywhere from 40 to 70% of community based seniors is the number one modifiable risk factor for loss of autonomy, and most of the time passing under the radar of family physicians and pharmacists who often lack the knowledge, understanding of this issue and the clinical information on their clients to address it. I am currently running two polypharmacy pilot projects (one in a CHSLD and one in an autonomous seniors residence) which consist of three parts, which has been very successful in stabilizing and in some cases reversing declining autonomy; 1. Risk Assessment - Done on patient/client metrics, check listed symptoms & the pharmacy profile 2. Remediation - Done internally with our medical staff, with a geriatric pharmacist as required and with the treating physician making the required changes 3. Follow up - Ongoing, but for a finite period of time as medications are slowly and gradually adjusted So often timing is a funny thing, as today I received your excellent brief on Alzheimer Disease and noticed one crucial missing tidbit of information. The changes outlined in Stage 2 and 3, so often attributed to 'just aging' or early dementia may in fact be due to polypharmacy, as are so many of the other signs and symptoms afflicting seniors, reducing their autonomy and causing adverse drug reactions, hospitalization and other co-morbidities; * Confusion * Incontinence * Agitation * Insomnia * Falls * Sleepiness * Decrease in appetite or thirst * Increase in appetite or thirst * Depression * Walking difficulties I would imagine that close to 85% of your clients with declining autonomy have these issues which can be reduced and/or stabilized with appropriate polypharmacy remediation and follow up. For homecare providers focused on providing their billable hour services without even a cursory glance to understand causation, this brings to mind one of the best commercials, from my perspective as a physician, that I have recently seen. Its one of those MasterCard commercials - https://www.bing.com/videos/search?q=mastercard+commercial+priceless &qpvt=mastercard+commercial+priceless&view=detail&mid=098BA5DB740E88633DDD09 8BA5DB740E88633DDD&FORM=VRDGAR Helping a parent with loss of autonomy with homecare; * Orderly $1X/hr * Nursing assistant $2Y/hr * RN $3Z/hr * Assisted living centre $4TTT/month * Deluxe assisted living centre $6TTT/month * Reversing or stabilizing their loss of autonomy by addressing polypharmacy - PRICELESS I'd