Whitney Downard / The Meridian StarAzhar Pasha, an anesthesiologist with the Pain Management Center of Meridian, discusses options for treating pain in geriatric populations during the conference on Tuesday.  

As the body ages, taking medications for various ailments becomes part of the routine. But many patients aren’t prepared for how the effectiveness of medication changes as their body changes and the development of conditions such as dementia or Alzheimer’s.

For the social workers and nursing home directors trying to treat these patients, Priscilla Mathis, part of Alliance Health Center’s Milestones Program, discussed how caretakers needed to start at intake to find the best treatment plan for patients during Alliance’s biannual conference, held on Tuesday at NorthPark Church in Meridian. 

“What sort of questions do we need to ask family members?” Mathis asked the audience of more than 100 medical professionals. “In the geriatric population, sometimes they are not able to give us that information.”

Mathis suggested asking family members about changes they notice in their loved ones, which she does during intake for Milestones, a geriatric psychiatric unit that offers immediate mental stabilization and short-term treatment for the elderly.

The question about sending a patient to a nursing home depended on whether or not caretakers felt it was safe for the patient to live on their own.

“We weigh the benefits versus the side effects,” Mathis said about certain treatment options. “And we work with them to do that.”

Alliance invited healthcare professionals and caretakers for the elderly from all over the state to participate in the conference, a part of the continuing education credits professionals must receive each year. Topics included elder abuse, mental health, updates on Alzheimer’s clinical trials and more.

Azhar Pasha, an anesthesiologist at the Pain Management Center of Meridian, discussed the different pain treatments available with Priscilla Miller, a family nurse practitioner at the center. They discussed using interventional pain management versus the more widely known opiate pain management, which are two different approaches to pain management. 

“Twenty-one percent of geriatric patients have been found to have pain that is untreated,” Miller said. “Many may not be able to express that pain.”

Miller described how medical professionals prescribing medicine for pain are hesitant to use opioids following national concerns about addiction, but that all prescribers should avoid relying on medication for long-term use. 

“I have a 99-year-old patient who’s on what, according to some people, is a high dose of opioids,” Miller said, discussing the need to weigh risk against benefits. “But if I took them away form her, her quality of life would drastically change.”

When it comes to pain management issues for the elderly population, Pasha said getting geriatric patients to describe their pain is difficult. 

“The challenge is, number one, when talking to elderly patients you need to understand that some of them are not as forthcoming about their pain as younger generations,” Pasha said. “A lot don’t even seek care.”

Additionally, medication doses change as the body ages, because fat and muscle compositions change.

“After 65, our bodies cannot break down medication properly,” Pasha said. “The same pills that were working earlier become too high of a dose now.”

Pasha said pain medications can also make patients disoriented on top of developing memory loss, which causes concerns for families.

“Family members get upset when their loved one doesn’t know where they are,” Pasha said. “Any amount of pain can be treated with medication, but pain medication can make a patient confused. So it’s a balance.”

Pasha also discussed alternative procedures, such as epidural steroid injections or “burning the nerves” for pain care such as arthritis.

“You heat the tip of the needle to create a lesion on the nerve,” Pasha said, simplifying the process. “The idea is that if you create a lesion on the nerve then the nerve is dead and there is no pain.”

However, the effectiveness of this procedure depends on the type of pain and may not be permanent, Pasha said. 

One of the benefits for conferences such as this is the opportunity to network and build a system for referrals, according to Cindy Dyess, Alliance’s director of business development.

“It just helps them when they go back to their jobs,” Dyess said of the audience, who came from across the state. “It helps give them more tools for caring for the elderly.”

Jennie Bobo, with Fresenius Kidney Care, agreed.

“It’s good for networking, to stay current on the latest advances for Alzheimer’s treatment and treatments for the geriatric population,” Bobo said. “Today has been a lot of coordinating the clinical, medical and psychosocial aspects to treat the whole patient.”

Tabatha Powell works at the Alliance Health Center directly with geriatric patients and knows how complicated aging and a developing psychosis can be for treatment.

“I do assessments and I need to know what I’m working with,” Powell said.