Episode 34: the 4M’s  4M’s to discuss with your physician: Medications, Mobility, Mentation, Matters Most (what Matters Most) Help shape patient-centered care Reduce hospitalizations, decrease the need for care Mobility - evaluate yearly Measures: Gait speed is one measure (slower than 1 m/s increased risk of falling, increased risk of hospitalization) Timed get up and go Balance evaluation by physical therapy Getting up from chair without using arms Next step:  Home exercise program (NIH healthy aging) Physical therapy Multi-disciplinary falls and stability clinic Driving - Multiple falls indicate increased risk for driving safety issues Everyday movement is important to maintain mobility Home exercises, Youtube exercises  Medications Beer’s list - potentially inappropriate medications for older adults due to risk of side effects Examples include benadryl, benzodiazepines, narcotic pain medications, some seizure medications Need to look at benefits versus side effects Evaluate for “prescribing cascades” - one medication is used to treat a side effect of another medication, and then another medication is used to treat side effects of that medication.  Polypharmacy - more than 6 medications is polypharmacy. More medications = more side effects and medication interactions. Deprescribing can help with this.  Goals of care can help determine which medications are adding value Matters Most It’s important to discuss what’s important and what makes life worth living, then delve deeper.  “What could you live without and still feel you have good quality of life?” Focuses on quality of life rather than just quantity Patients can bring this topic up by bringing in an Advance Care Directive or Polst form, or mentioning this as a goal of the visit Evolves depending on stage of life Mentation  Assessment of memory and cognition, as well as mood Generally we evaluate cognition when family brings up a concern or clinician notices a change Can be done as part of Medicare Wellness Exam Depression and anxiety can look like physical symptoms and cognitive changes in older population Next steps if a concern is present:  Evaluate medications, which can impact cognition and mood Obtain more information from screening tests, family members Consider referral for further testing; this isn’t required to make a diagnosis Neuropsych testing can distinguish between depression, anxiety, dementia References NIH National Institute on Aging: https://www.nia.nih.gov/health/exercise-physical-activity Deprescribing: http://www.deprescribing.org https://www.cdc.gov/aging/pdf/acp-resources-public.pdf https://polst.org/ Health pearl: Get your influenza vaccines! They’re very important this year.