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Articles by Michael A. Steinman
Armchair Critics, Angry Purists, and Other Garden Pests
I’ve been a YouTube watcher for a long time, and I’ve been posting video since 2009. If YouTube could collect a penny from every anonymous critic who knows how it should be done, every artistic purist who knows what the truth is, and every abusive derider, it would be an enterprise richer than Croesus. What follows, to be clear, is not about any comments I’ve received on video-ed performances I have created. If you think the drawing above is ageist, I understand.
Tamsulosin Deprescribing for Lower Urinary Tract Symptoms in Older Men : A Randomized Clinical Trial
Supplement 1. eTable 1. Group-Level and Individual-Level Effects of Tamsulosin Versus Placebo on Daily Lower Urinary Tract Symptoms Severity and Side Effects Estimated Using Linear Mixed Models eTable 2. General Characteristics of 30 Study Participants Who Attempted the Full Protocol, Stratified by Tamsulosin Treatment Response eTable 3.
Deprescribing Inappropriate Medicines Across a Health System—Can We Improve the Care of Both Patients and Physicians?
In 1860, the physician Oliver Wendell Holmes Sr told the Massachusetts Medical Society “if the whole materia medica … could be sunk to the bottom of the sea, it would be better for mankind and all the worse for the fishes.”1 Today, of course, the toxic medicines of 1860 have been scuttled and new medicines have been proven to cure diseases or extend life.
Deprescribing and its non-inferiority complex
CommentVolume 7, Issue 5100862Open access Affiliations & Notes aDivision of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA bSection of General Internal Medicine, US Department of Veterans Affairs Portland Health Care System, Portland, OR 97239-2964, USA cDivision of Gerontology, Geriatrics and Palliative Care, University of Alabama, Birmingham, AL, USA dGeriatrics Research, Education, and Clinical Center, US Department of Veterans Affairs...
Medication Management Among Older Adults Living Alone With Cognitive Impairment
Key Points Question What are the barriers and facilitators to medication management experienced by older adults living alone with cognitive impairment and their social contacts?
Rethinking clinical trials in the multimorbidity era: The imperative for patient-centered tailored approaches
1Department of General Practice and Family Medicine, Medical School OWL, University Bielefeld, Bielefeld, Germany; Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Madrid, Spain 2Division of Internal Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy 3Department of General Practice and Family Medicine, Medical School OWL, University Bielefeld, Bielefeld,...
Concordance of Discharge Materials and Older Adult Patient Understanding Cardiometabolic Medication Changes During Hospitalization
1 Introduction Hospitalized older adults are often discharged with changes to their home medications [1, 2]. Despite substantial attention to reconciling admission and discharge medication lists, less attention has been paid to communicating the rationale for medication changes. To ensure medication understanding and avoid errors, it is important for the reason for medication changes to be consistently and clearly communicated to older adults and their outpatient clinicians.
‘We Go for That’: The Redwood Coast Music Festival (Oct. 2-5, 2025)
My title comes from a Thirties phrase for “I really like that,” found in a wonderful Frank Loesser left-handed love song (“Your fuzzy hair, your vacant stare / I go for that”) deftly sung by Dawn Lambeth at the Redwood Coast Music Festival, Eureka, California. The RCMF is a deluge: 120 sets of hour-long music from Thursday to Sunday, often simultaneously in eight venues, most with dance floors.
A Joyous, Magical Jazz Bash in Monterey, California
My festival reports start with apologies for what I didn’t see. This time, I trust readers will let me to atone in private. The Jazz Bash by the Bay celebrated its 45th anniversary at the Portola Hotel and Conference Center in Monterey, California. The music began on Thursday night and came to a stop Sunday afternoon. I counted 154 sets, usually eight venues at once, half on the hour, half thirty minutes later, so an eager audience could see many performances.
Locked Doors and Silences
Here are two points of view expressed by poets of unequal stature: Heard melodies are sweet, but those unheard / Are sweeter . . . (John Keats) Sharing is caring. (Barney the Purple Dinosaur.) Most human beings have some possessiveness, necessary if we are to survive. We want to find our shoes where we left them last night, because walking to the bus without shoes is not going to be easy or comfortable. So a certain amount of “That’s mine, and it belongs to me,” is understandable.
One Hundred Sets Amidst Tall Trees: The Redwood Coast Music Fest
“If I had the wings of an angel,” goes the old song. I would have needed wings to enjoy all the music at the 2024 Redwood Coast Music Festival. It would have taken five energized angels, their wings in top form, to see everything. One hundred sets, six venues in lovely Eureka, California: a musical banquet or perhaps a deluge from Thursday night to Sunday night, October 3-6.
Hierarchical endpoints analyzed using the win‐ratio method as a practical innovation for deprescribing trials
CONFLICT OF INTEREST STATEMENT Dr. Goyal has received consulting fees from Agepha Pharma, Akros Pharma, Axon therapies, Bayer HealthCare Pharmaceuticals, and Sensorum Health; and has received personal fees for medicolegal consulting and expert testimony related to heart failure.
Meet Them in St. Louis: Valerie Kirchhoff and Ethan Leinwand
The traditional jazz world pays homage to the blues, but often in a narrow way. There are glimpses of famous streets in fabled cities, tin roofs, and royal gardens. But few musicians in that world now seem to have given themselves wholly to the blues and the music of that often overlooked city, St. Louis. And no one is doing what the singer Valerie Kirchhoff (perhaps known to some readers as “Miss Jubilee”) and her husband, pianist Ethan Leinwand, are doing right now.
Further Study Needed on Antihypertensive Medications and Fracture Risks
Further Study Needed on Antihypertensive Medications and Fracture Risks Antihypertensive Medication and Fracture Risk in Older VA Nursing Home Residents Chintan V. Dave, PharmD, PhD; Yongmei Li, PhD; Michael A. Steinman, MD; Sei J. Lee, MD, MAS; Xiaojuan Liu, MS; Bocheng Jing, MS; Laura A. Graham, PhD; Zachary A. Marcum, PharmD, PhD; Kathy Z. Fung, MS; Michelle C. Odden, PhD Further Study Needed on Antihypertensive Medications and Fracture Risks—In Reply Chintan V. Dave, PharmD, PhD; Michelle C.
Further Study Needed on Antihypertensive Medications and Fracture Risks
Further Study Needed on Antihypertensive Medications and Fracture Risks Antihypertensive Medication and Fracture Risk in Older VA Nursing Home Residents Chintan V. Dave, PharmD, PhD; Yongmei Li, PhD; Michael A. Steinman, MD; Sei J. Lee, MD, MAS; Xiaojuan Liu, MS; Bocheng Jing, MS; Laura A. Graham, PhD; Zachary A. Marcum, PharmD, PhD; Kathy Z. Fung, MS; Michelle C. Odden, PhD Further Study Needed on Antihypertensive Medications and Fracture Risks—In Reply Chintan V. Dave, PharmD, PhD; Michelle C.
Eureka! The Redwood Coast Music Festival
I’ve been attending jazz parties and festivals for twenty years, and each one has its own character. So to call one “the best” would be foolish. But the Redwood Coast Music Festival, held at the beginning of October in Eureka, California, is a musical banquet. No, make that several musical banquets all at once. I’ve been there in 2019, 2022, and 2023 (there was an interruption of service in there) and I’m ready for October 3-6, 2024.
A Subversive in Sedalia
I could be the wrong person to report on a ragtime festival. My first piano hero was Teddy Wilson, so the crowd at the Scott Joplin International Ragtime Festival, celebrating its fiftieth anniversary, might eye me with skepticism. I heard one musician, perhaps whimsically, apologize for playing a song written in 1939. Fifty years ago, I had records by Max Morath and Joshua Rifkin.
Intravascular Microaxial Left Ventricular Assist Device Manufacturer Payments to Cardiologists and Use of Devices
Intravascular Microaxial Left Ventricular Assist Device Manufacturer Payments to Cardiologists and Use of Devices Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump Sanket S. Dhruva, MD, MHS; Joseph S. Ross, MD, MHS; Bobak J. Mortazavi, PhD; Nathan C. Hurley; Harlan M. Krumholz, MD, SM; Jeptha P. Curtis, MD; Alyssa Berkowitz, MPH; Frederick A. Masoudi, MD, MSPH; John C. Messenger, MD; Craig S. Parzynski, MS; Che Ngufor, PhD; Saket Girotra, MD, SM; Amit P.
Monterey by the Bay: The Bash Was a Smash!
NASA hasn’t perfected the robot that would be the ideal reviewer for a jazz festival like the Jazz Bash by the Bay in Monterey, California, that happened February 29 – March 3, 2024. It would have multiple heads, each equipped with audio and video recording equipment as well as the ability to monitor the audience’s reactions.
The U.S. deprescribing research network: Catalyzing research and action to optimize medication use in older adults
Deprescribing is an essential component of safe and effective health care for older adults, with particular relevance to older adults with vulnerabilities such as multimorbidity and dementia that place them at high risk of adverse consequences from unnecessary, harmful, and goal-discordant medication use.1 Yet, deprescribing is much easier said than done.
Reply to: Comment on the 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults
We thank Drs.
EUREKA! From The Redwood Coast Music Festival!
The Redwood Coast Music Festival was an ecstatic experience, an overwhelming banquet of music and friendship. (If that seems hyperbolic, I can adopt Eddie Condon’s highest praise, “It didn’t bother me.) Before we get to the music, something about transportation and the town. If one flies to the festival, the closest airport is Arcata, with two gates, one luggage carousel, an intermittently-closed snack bar: a charming reminder of what air travel must have been in 1958.
Reply to: The importance of assessing the safe and effective use of oral anticoagulants in older adults
To the Editor: We thank Drs.
Reply to: Comment on: 2023 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults
To the Editor: We thank Dr. Burnett and colleagues1 for their interest in the 2023 AGS Beer Criteria® and for their recognition of the efforts by its panel. The AGS Beers Criteria® seek to identify safety concerns for frequently prescribed medications to identify those best avoided or used with caution by older adults in most circumstances.
Cognitive, physical, and sensory deficits that can affect everyday medication use among older adults: A national view
Corresponding Author Belinda Tang BS State University of New York (SUNY) Upstate Medical University, Syracuse, New York, USA Medical Student Training in Aging Research (MSTAR) Program, Division of Geriatrics, School of Medicine, University of California, San Francisco, USA Correspondence Belinda Tang, State University of New York (SUNY) Upstate Medical University, 750 East Adams Street, Syracuse, NY 13202, USA. Email: tangbe@upstate.edu Search for more papers by this author
Systolic blood pressure, antihypertensive treatment, and cardiovascular and mortality risk in VA nursing home residents
CLINICAL INVESTIGATION This work was presented at The Gerontological Society of America (GSA) 2021 Annual Scientific Meeting.
History of Incarceration and Its Association With Geriatric and Chronic Health Outcomes in Older Adulthood
[Skip to Navigation] Figure. Prevalence of Geriatric Syndromes and Chronic Health Conditions, Stratified by History and Length of Incarceration Table 1. Participant Characteristics and Health Outcomes Stratified by History of Incarceration Table 2. Health Outcomes Associated With History of Incarceration Among Older Adults Original Investigation Geriatrics January 6, 2023 JAMA Netw Open. 2023;6(1):e2249785.
Development and validation of novel multimorbidity indices for older adults
Abstract Background Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. We sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease-disease interactions, and by tailoring measures to different outcomes.
Practical tips for deprescribing in older adults
Source/Disclosures Source: Steinman M. Deprescribing for care of older adults. Presented at: ACP Internal Medicine Meeting; April 28-30, 2022; Chicago. Disclosures: Steinman reports employment with Claude D. Pepper Older Americans Independence Center, University of California San Francisco, and the U.S. Department of Veterans Affairs. He also reports receiving honoraria from the American Geriatrics Society, Research Grant Advisory Panel, Kaiser Permanente and the Robert Wood Johnson Foundation.
Who Killed History?
I first wanted to call this post “The Death of Historical Consciousness,” but that title, although accurate, seemed too ponderous to be chewed and swallowed. So the BBC-mystery title shall stand. Maybe it’s collective amnesia, but can people forget what they never acknowledged to begin with? What do I mean?
Association of Social Support With Functional Outcomes in Older Adults Who Live Alone
Original Investigation November 15, 2021 JAMA Intern Med. Published online November 15, 2021. doi:10.1001/jamainternmed.2021.6588 Key Points Question What is the association between social support and functional outcomes (ie, activities of daily living dependence, prolonged nursing home stay, death) in older adults who live alone?
PERSONAL: Feasibility Study Protocol for Placebo-Controlled, Randomized n-of-1 Trials of Tamsulosin for Lower Urinary Tract Symptoms.
Scott R Bauer,Benjamin N Breyer,Akinyemi Oni-Orisan,Michael A Steinman,Ida Sim,Charles E McCulloch,Stacey A Kenfield Scott R Bauer Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States. Department of Urology, University of California, San Francisco, San Francisco, CA, United States. Veterans Affairs Medical Center, San Francisco, San Francisco, CA, United States.
Deprescribing and deimplementation: Time for transformative change
Commentary Michael A. Steinman MD, Corresponding Author mike.steinman@ucsf.edu @mikesteinman orcid.org/0000-0002-9564-9480 @ Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, San Francisco, California, USA Correspondence Michael A. Steinman, Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, 4150 Clement St, SFVAMC Box 181G, San Francisco, CA 94121, USA.
Phil Schaap (1951-2021) and His Worlds
Phil Schaap, who moved on to another bandstand yesterday, was an unusually complex figure: he was his own novel, someone who deserves a Moliere or Henry James. Readers might know him as a tireless worker in the jazz vineyard: radio broadcaster, professor, writer, producer, enthusiast, and much more. Indeed, I can’t envision a Phil-moment that isn’t connected with the music: I cannot imagine him eating a sandwich, for instance, although I am sure he did.
Use of High-risk Medications Among Lonely Older Adults
Loneliness, the emotional distress resulting from a discrepancy between one’s actual and desired level of social connection, is associated with physical and psychological symptoms in older adults, including pain, insomnia, depression, and anxiety.1 The relationship of loneliness to these symptoms is likely bidirectional; in some situations it acts as a risk factor for the symptoms and in others it is the consequence of symptoms.
Expanding Evidence for Clinical Care of Older Adults
For many years, clinicians who care for older adults have raised concern about the underrepresentation, and often exclusion, of older adults from clinical trials.
Polypharmacy among older adults with dementia compared with those without dementia in the United States
Clinical Investigations Matthew E. Growdon MD, MPH, Corresponding Author matthew.growdon@ucsf.edu @matthew_growdon orcid.org/0000-0001-5997-4406 Division of Geriatrics, University of California, San Francisco, California, USA San Francisco VA Medical Center, San Francisco, California, USA Correspondence Matthew E. Growdon, UCSF Division of Geriatrics, 4150 Clement St., VA181G, San Francisco, CA 94121, USA.
Adverse Drug Events After Hospitalization-Are We Missing the Mark?
Original Investigation Medication Safety After Hospitalization in Persons Prescribed High-risk Medications Jerry H. Gurwitz, MD; Alok Kapoor, MD, MSc; Lawrence Garber, MD; Kathleen M. Mazor, EdD; Joann Wagner, MSW; Sarah L. Cutrona, MD, MPH; Sonal Singh, MD, MPH; Abir O. Kanaan, PharmD; Jennifer L. Donovan, PharmD; Sybil Crawford, PhD, MS; Kathryn Anzuoni, MPH; Timothy J. Konola, BA; Yanhua Zhou, MS; Terry S.
Improving the American Diabetes Association Framework for individualizing treatment in older adults: evaluating life expectancy
Epidemiology/Health services research Improving the American Diabetes Association Framework for individualizing treatment in older adults: evaluating life expectancy http://orcid.org/0000-0001-9525-3833Alexandra K Lee, Michael A Steinman, Sei J Lee Division of Geriatrics, University of California San Francisco, San Francisco, California, USA Correspondence to Dr Alexandra K Lee; alexandra.lee{at}ucsf.edu Abstract Introduction For older adults with type 2 diabetes, the American Diabetes...
Meeting the Care Needs of Older Adults Isolated at Home During the COVID-19 Pandemic
The dramatic shift toward social distancing measures presents important challenges to the health and well-being of community-dwelling older adults, particularly those who are frail, very old, or have multiple chronic conditions. Such older adults are at high risk of dying from COVID-19.1 Yet they also have high rates of morbidity and mortality from other acute and chronic conditions—and may adapt poorly to aggressive physical distancing and the changing health system structures that accompany it.
Deprescribing in Older Adults With Cardiovascular Disease
Ashok Krishnaswami, MD, MASa,b,∗ (ashok.krishnaswami{at}kp.org), @cardskrish@KPSanJose, Michael A. Steinman, MDc,d, Parag Goyal, MD, MSce, Andrew R. Zullo, PharmD, PhDf,g, Timothy S. Anderson, MDh, Kim K. Birtcher, PharmD, MSi, Sarah J. Goodlin, MDj,k, Mathew S. Maurer, MDl, Karen P. Alexander, MDm, Michael W.
The Proper Use of the AGS Beers Criteria
Table 1. Key principles to guide optimal use of the American Geriatrics Society Beers Criteria ® Medications in the 2019 AGS Beers Criteria® are potentially inappropriate, not definitely inappropriate. Read the rationale and recommendations statements for each criterion. The caveats and guidance listed there are important. Understand why medications are included in the AGS Beers Criteria®, and adjust your approach to those medications accordingly.
Using Wisely: A Reminder on How to Properly Use the American Geriatrics Society Beers Criteria®
Goldilocks was hungry. She tasted the porridge from the first bowl. “This porridge is too hot!” she exclaimed. So, she tasted the porridge from the second bowl. “This porridge is too cold,” she said. So, she tasted the last bowl of porridge. “Ahhh, this porridge is just right,” she said happily, and she ate it all up. Consensus criteria (as well as clinical practice guidelines) have potential to improve quality of care and outcomes that are important to patients.
Reducing hospital admissions for adverse drug events through coordinated pharmacist care: learning from Hawai’i without a field trip
Reducing hospital admissions for adverse drug events through coordinated pharmacist care: learning from Hawai’i without a field trip Free Michael A Steinman Division of Geriatrics, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA 94121, USA Correspondence to Michael A Steinman, Division of Geriatrics, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA 94121, USA; mike.steinman{at}ucsf.edu...
Reducing hospital admissions for adverse drug events through coordinated pharmacist care: learning from Hawai’i without a field trip
Reducing hospital admissions for adverse drug events through coordinated pharmacist care: learning from Hawai’i without a field trip Free Michael A Steinman Division of Geriatrics, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA 94121, USA Correspondence to Michael A Steinman, Division of Geriatrics, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA 94121, USA; mike.steinman{at}ucsf.edu...
Overcoming Inertia to Improve Medication Use and Deprescribing
Inertia is a powerful force. Stopping or starting is difficult in health care as well as in other sciences. Ineffective or potentially harmful treatments are often not stopped, even years after they have been started, and effective treatments are too often not started at all. Once started, medications can be difficult to stop.
Medication burden attributable to chronic co-morbid conditions in the very old and vulnerable
Citation: Moore KL, Patel K, Boscardin WJ, Steinman MA, Ritchie C, Schwartz JB (2018) Medication burden attributable to chronic co-morbid conditions in the very old and vulnerable. PLoS ONE 13(4): e0196109. https://doi.org/10.1371/journal.pone.0196109 This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
Current Approaches to Measuring Functional Status Among Older Adults in VA Primary Care Clinics
The ability to perform activities of daily living (ADLs), commonly called functional status, is central to older adults’ quality of life (QOL) and independence.1,2 Understanding functional status is key to improving outcomes for older adults.
Association of β-Blockers With Functional Outcomes, Death, and Rehospitalization in Older Nursing Home Residents After Acute Myocardial Infarction
Key Points Question What effect do β-blockers have on functional decline and death in older nursing home residents with acute myocardial infarction? Findings In this cohort study, use of β-blockers was associated with a 26% lower rate of death but 14% higher odds of functional decline. Functional harms were particularly pronounced in nursing home residents with poor cognitive and functional status at baseline.
Polypharmacy-Time to Get Beyond Numbers
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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