Too many seniors taking too many medications
The pharmaceutical industry has created many wonderful and effective drugs that have allowed seniors and their healthcare providers to control a variety of health conditions. This has led to situations where seniors are taking so many different medications that even their own healthcare providers can’t keep track of all their medications.
The rise of polypharmacy.
The medical community has even coined a phrase to describe the preponderance of drugs being taken by seniors, many of which may not actually be necessary. It’s called polypharmacy.
Nearly 90 percent of people over 60 take at least one prescription drug; 30 percent take five or more. This results in about one-third of seniors annually experiencing a serious adverse effect, like a bone-breaking fall, mental confusion, organ failure, and unexpected sensitivity reactions requiring hospitalization.
The data confirms the problem
Drug interactions increase with the number of medications that are taken. Some statistics from the literature confirm this. If a senior is taking two medications, the potential for drug interaction is 6%. If five medications are taken, the odds increase to 50%. If eight or more medications are taken, the risk is 100% of drug interaction. Remember that medication is a generic term and includes over the counter, prescriptions, herbal and natural remedies and complementary and alternative treatment alternatives. This also includes medication taken on the skin and by other routes.
Now Dutch researchers have combined data from 19 separate studies conducted in 11 Western countries, which found approximately one in five prescriptions written for elderly patients were inappropriate. And, the analysis showed, common drugs were among the most overprescribed, and also the ones most likely to produce adverse reactions.
Dr. Barbara Paris the director of the division of geriatrics at Maimonides Medical Center in Brooklyn estimates that about 30 percent of hospital admissions of elderly patients are related to medication adverse effects.
The Beers Criteria
A New York Times story reported that an interdisciplinary panel of 11 experts in geriatric care and pharmacology has updated the so-called Beers Criteria, guidelines long used to minimize such drug-related disasters in the elderly. “After reviewing more than 2,000 high-quality research studies of drugs prescribed for older adults, the team highlighted 53 potentially inappropriate medications or classes of medication and placed them in one of three categories: drugs to avoid in general in the elderly; drugs to avoid in older people with certain diseases and syndromes; and drugs to use with caution in the elderly if there are no acceptable alternatives.”
Be your own best advocate. If you are not able to advocate for yourself, ask someone to assist you. You can access information from many sites on the Internet. For instance, one site lists the Beers Criteria: https://www.dcri.org/trial-participation/the-beers-list/. Check your medications against the list and ask your provider or pharmacist to help you understand your medications.
What families can do to address polypharmacy
To help families and caregivers address the dangers of polypharmacy, some steps can be taken to protect a senior loved one:
• Bring all medications your loved one is taking to every physician office visit, including those over the counter and natural or herbal remedies. Do not leave anything home, even if it includes a sack of medication bottles. This is a good way to help ensure that unknown interactions don’t result in hospitalization.
• Make sure that all the healthcare providers you are working with are communicating with one another; that includes specialty physicians.
• Request a medication review with your loved one’s healthcare team to help you understand which medications a loved one is taking, recommended doses, and possible side effects.
• Whenever a medication is prescribed, ask about side effects to watch for. If an unexpected reaction occurs, the prescribing healthcare provider should be notified immediately.
• If a medication is not working, do not wait until the next office visit. Notify the healthcare provider as soon as you can.
• Ask about side effects of medication so that you know what to watch for and report.
• Review the dosage labels on the medication bottles — an estimated 90 million adults in the United States misunderstand drug labels or have trouble following their directions, according to the Institute of Medicine.
• Until you have checked with a health professional, do not stop taking a prescribed medication.
• Over the counter medications are not harmless. Many of these medications were prescription medications earlier in their life. They are usually over the counter because of altered dosing regimen or tablet strength. They are the same medication and can have the same interactions that they had when they were prescription strength.
• The senior and their advocate must have discussions with the healthcare provider about the necessity of medications and safer alternatives. Often seniors go to their healthcare providers with complaints and are given medication to manage or control the complaint. Each medication is a chemical and has unique properties and side effects. The side effects of the medication may cause more side effects leading to other complaints and more medication to deal with the new side effects.
New drugs present new challenges
The pace of new drugs entering the market is important to the pharmaceutical industry. Healthcare providers continue to collect and report medication side effects long after a medication has been released to the market place. Prior to release of medications to the market, the medications go through many phases of testing. The problem is that few medications are tested on seniors prior to release. Most of the side effect profile of medications for seniors is based on actual use. A senior’s body handles a medication differently than a younger person because of the changes that occur in organs due to the aging process. Not only do we not know how a medication will react in isolation for a senior, but the senior is on multiple medications so we do not know which one is actually causing difficulty.
Mardy Chizek, RN, FNP, BSN, MBA, AAS
President of Westmont’s Charism Elder Care Services.