With another M, medications, the provider remembers to consider possible medication adverse events, optimal prescribing and deprescribing, as needed. Published by the American Geriatrics Society, the Beers criteria provide a helpful list of medications to consider avoiding in older adults (now also available as an app).5
A fifth critical M is matters most, which reminds providers to adapt their care to an individual’s specific healthcare goals and care preferences. By identifying what matters most to a patient, Dr. Makris helps the patient identify specific, achievable goals that align with those values. Often these targetable goals focus on psychosocial aspects that are important to the patient (e.g., having a low enough level of pain to go to church using a cane).
“Older people have different priorities,” Dr. Yung added. “Understanding that is helpful, not just for the patient and for us [clinicians], but also for the family, so they can understand what their loved one actually wants.” Clarifying these priorities and values leads to better patient rapport, improved compliance and better all-around care.
Assessments
Dr. Bühring pointed out that although a comprehensive geriatric assessment can be very helpful in a geriatric clinic, it can be time intensive, and it may not be practical to do as a rheumatologist in a busy practice. In many cases, shorter assessments can provide what is needed in that setting.
The rheumatologist needs to assess disease activity level, and a patient’s pain and how it is affecting a patient’s activities of daily living: walking, eating, performing housework, etc. For this, a PEG3, which assigns scores to the disease’s impact on a patient’s pain, enjoyment and general activity levels, can be helpful.6 “I find that understanding how the pain impacts function is more important than the pain intensity score alone,” said Dr. Makris.
Delirium, Dementia & Depression Screening
The cognitive assessment (mind) is also important, especially in a patient who appears to be confused or in a patient with a relevant past medical history. Clinicians can employ a number of different tools in this context. For example, physicians can use a tool like the Confusion Assessment Method (CAM) to quickly screen for delirium and a brief instrument, such as the Mini-Cog, to screen for cognitive impairment.7,8
Another part of mind is screening for mental health challenges, such as depression. Quick, validated tools, such as the Patient Health Questionnaire-2 (PHQ-2), can provide some preliminary information, as can the short-form version of the Geriatric Depression Scale (GDS-15).9,10
