Grand Forks-based company studies benefits of less medication for the elderly
GRAND FORKS — Michael Johnson, an executive with Grand Forks-based Edgewood Management Group, and his colleagues set out in 2013 to determine what they could do to reduce the number of falls in the company's senior living facilities.
They wanted to find out if the medications residents were on might be contributing to the incidence of those falls.
The Edgewood company owns and operates about 60 senior living facilities—including independent and assisted living and memory care facilities—in seven states throughout the Upper Midwest.
"We wanted to improve the overall well-being of residents in our communities," Johnson said. "Falls are pretty prevalent in the geriatric population."
He and his team launched a "medication reduction initiative" to analyze the type and quantity of drugs and supplements residents were taking.
"This population tends to be overmedicated," he said. "They may be on medications for congestive heart disease, diuretics and sometimes potassium supplements. ... Some residents are seeing several doctors for different health concerns."
At the start of the study, Edgewood residents "were averaging about 12 meds each," Johnson said. Some were on multiple medications for the same purpose.
Looking at medication side effects, "we found common themes, such as loss of appetite, general malaise and not feeling like eating or drinking," he said.
"We found that people who were taking more than four medications can increase their likelihood of falls."
The initiative also took into account the "stockpile" of nutritional supplements residents were taking—supplements that are not regulated by the federal Food and Drug Administration, he said.
The marketing of vitamins and nutritional supplements is a "billions-of-dollars industry," he said. "We grow up thinking, 'If something's not working, you can take this pill.' "
"This is all part of a giant recipe contributing to falls or not feeling well."
Falls and medications
Falls are a big concern as people age.
Each year, one-third of community-dwelling elderly people and 60 percent of nursing home residents fall, according to the American Academy of Family Physicians, which cites medication use as one of several risk factors for falls among the elderly.
Among older Americans, falls are the No. 1 cause of fractures, hospital admissions for trauma, loss of independence and injury deaths, the NIH reports.
Studies show that the prognosis for people after a fall, especially from a hip injury, can be "grim," Johnson said. Quality of life and longevity are usually compromised.
When Johnson first tackled this issue, he assembled a task force, tapping a registered nurse from one Edgewood facility and a pharmaceutical representative in each state where the company has facilities.
"We asked them, 'What are you challenged with about falls?' And, 'Do you think meds contribute to falls?' " he said.
"The answer was an overwhelming 'yes.' "
The group compiled the medications residents were taking and grouped them by classes, such as those for high blood pressure and pain.
Bev Kostrzewski, a registered nurse who is director of clinical services at Parkwood Senior Living, an Edgewood property in Grand Forks, has seen firsthand the effects of prescription drugs.
"Some medications can cause dizziness, which can lead to falls," she said.
Every year, during the residents' annual physical exam, "we look at their meds," Kostrzewski said.
"Some people can be on three blood pressure medications."
She and nurses in her position at other Edgewood properties also review over-the-counter medications and nutritional supplements residents are taking.
"You can take in too many vitamins, too," she said.
Residents decide if they want to participate in the medication reduction program.
"We ask the resident, 'Would you like us to visit with your doctor or pharmacist to see if these meds you're taking are still of value?' " Johnson said.
"Sometimes one pill calls for another pill, and that calls for another pill, and so on," said Marilyn McIlwain, 90, a resident at Parkwood Senior Living.
"Each person comes to the table with their own set of preconceived ideas. They're committed to their own (drug) regimen," Johnson said. "We don't intrude on that. At the end of the day, it's up to the resident and their physician.
"Our best tool is opening that dialogue."
Johnson remembers a woman at a senior living facility where he had worked as a nurse.
"She was reclusive, isolative, not responsive; she complained a lot—one of the most cantankerous residents I've met in my 30-year career," he said.
Her doctor had advised a hospice evaluation.
Johnson asked the doctor, "Do you realize she's on four pages of meds?" That amounted to 30 or 40 medications.
As a result of that conversation, all her meds were stopped and, a few days later, the woman showed up at Johnson's office door and said, "I don't know what you did, but I feel like I'm 72 again."
"She was in early late 80s or early 90s," he said. "There was a marked change in her general attitude. She was sort of transformed."
Three months later, she was "a markedly different person—she was overall feeling better. She was more receptive to others, and participated in social activities."
Her story is an example that "to make people feel better, giving pills is not always the answer," he said.
"As a company, we're administering 13 million meds a year," Johnson said. "That's 36,000 a day."
The medication reduction initiative "has been remarkably successful," he said.
"We're four years into this now, and I'm impressed every day when we look at the value of this."
One of the Edgewood facilities has seen an 80 percent reduction in medications and supplements. The average reduction, among all facilities, is 30 percent.
Since the initiative was launched, the fall rate at Edgewood facilities has decreased, Johnson said.
In 2015-16, the total number of falls decreased by 11 percent.
Of those who experienced frequent falls and were put on a "fall reduction protocol," slightly more than 60 percent did not experience a fall within the next 30 days, and 50 percent did not have a fall within 90 days.
"We have heard from residents (who have participated in the medication reduction initiative) that their quality of life has improved," said Erica Kalis, corporate quality assurance manager for Edgewood.
In the last year, the total number of medications residents were taking dropped by 8.2 percent, or 1.3 million pills.
Residents have benefited financially, too, Johnson said. Average out-of-pocket expense for medications has decreased by $580.20 per year.
"Companywide, that amounts to $1.6 million" in savings for residents, he said.
"And we don't know that impact on private insurance and Medicare which, I presume, would be much higher."