Maximising health of older people

Peer group discussion points

1. Assessing for frailty and individualising an approach to the changing health needs for our older patients is an important part of caring for the aging population of New Zealand. The Clinical Frailty Scale is a validated and useful tool that is simple to use for assessment.
   • What tools do you use in your clinic for diagnosing frailty? Can you audit your practice to see how commonly these are used?
   • There is an ageing population of Māori and Pacific people, complicated by earlier frailty, comorbidities and increased disability. What resources can you use in your practice to reduce inequity in this space? Do you encourage conversations with your patients about their priorities as they age?
   • Cognition and mobility, mood, and maintaining independence all have an impact on preserving good health as we age. How can we encourage our older patients to maintain these aspects of our lives despite the presence of frailty and/or disability?
2. New approaches to aging are focusing on the nexus of cognition and mobility, building up cognitive reserve through middle age, and encouraging falls prevention strategies.
• Can you use more of the non-pharmacological methods to help your patients age well? Examples mentioned here are Tai Chi and Qigong, what are some others that you can think of?
• How do you introduce your discussions around aging and health prevention to your patients? Does this usually go well – or not – and why? What are some key messages you could develop to encourage conversation and engagement around this with your older patients?
3. Prescribing in the older person can be complex, and as the primary care giver we need to rationalise and optimise what medications our older patients are taking.
• How often do you perform medication reviews on your patients over the age of 65 years? Is there a recall system in your clinic for regular medication checks?
• Physiological changes with age can change how medications are processed in an individual. Do you routinely check renal and/or liver function in your frail patients? What is your approach to following this after starting a new medication?
• Misdiagnosing adverse drug reactions for a new condition is a common problem in managing older patients. Have you ever treated symptoms with a new medication, and later found the cause was an already prescribed drug? How did this change your practice?
• A combination of pain medications, anticholinergics and CNS depressants have compounding cognitive effects and are related to increased morbidity and mortality. Do you routinely review your prescribing of these medicines in your older patients? Are there alerts in place in your prescribing systems for patients on a combination of these drugs?
4. Reflecting on the MedTalk and the peer group discussions you have had, what could you do differently (if anything) in your practice to maximise the health for your older patients?