Prescribing and the 4Ms: How to prevent harm to older Americans

By Judith Garber | May 21, 2019

The Lown Institute recently published the report, “Medication Overload: America’s Other Drug Problem,” highlighting the growing trend of multiple medication use among older adults and related harms. Medication overload is an issue of special interest to the John A. Hartford Foundation (JAHF), a foundation dedicated to improving the care of older adults. In a new Grantwatch blog post in Health Affairs, Lown Institute Senior Vice President Shannon Brownlee and JAHF President Terry Fulmer describe how Lown and JAHF are working together to reduce medication overload.

With the help of an expert working group and advisory committee (of which Dr. Fulmer is a part), the Lown Institute is developing a comprehensive action plan to eliminate medication overload, to be released in early 2020. This action plan will expand on the JAHF’s signature initiative, Age-Friendly Health Systems, which is based on the 4Ms—What Matters, Medications, Mentation, and Mobility—which should be at the forefront of all treatments for older adults. In Grantwatch, Brownlee and Fulmer describe how the 4Ms can guide careful prescribing:

At the clinical level, the “What Matters” component of the 4Ms should be the guiding principle for prescribing for all older adults. Have we clearly explained to the patient and caregivers what any given medication can and cannot do, as well as the side effects that might result from taking it? Have both prescriber and patient fully considered how such side effects as delirium, dizziness, bleeding, or even more serious side effects affect quality of life? When prescribers and patients think about medication, they must put it in the context of what matters to the older adult and how it will ultimately affect mobility and mentation.

Read the full Grantwatch blog at the Health Affairs website!

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.