June 16, 2023 – In her 40 years as a geriatrician, Dr. Joanne Lynn has lost count of the variety of times she has seen a latest patient come into her office bringing with them a bucket stuffed with prescription medications – lots of which they didn't need.
Lynn, a lecturer on the George Washington University School of Medicine and Health Sciences in Washington, DC, recalled a lady who unknowingly took two blood pressure medications with different names.
“The risks included all the side effects that come with an overdose,” Lynn said, from blurred vision and irritability to organ failure and even death.
For doctors whose patients are unaware they're taking an excessive amount of of a medicine, “you wonder if the medication is causing the health problems and if this is a symptom of the wrong medication” relatively than a symptom of an undiagnosed illness, she said.
Many adults over 65 with chronic conditions could also be taking too many medications and may gain advantage from a medicine review by their primary care physician. Patients often assume that their doctor will monitor for interactions or determine if a medicine is not any longer needed and request additional prescriptions. This might be a dangerous assumption.
Some doctors may prescribe yet one more medication to treat the unwanted side effects of an unnecessary medication relatively than performing a medicine review and potentially “writing off” or discontinuing a treatment that is not any longer needed.
About 57% of individuals aged 65 or older often take five or more medications – an idea often known as polypharmacy. A study published in 2020 in Journal of the American Geriatrics Society shows. Doctors prescribe medications to their patients to alleviate their various ailments. However, because the list of medicines grows, so do the potential complications.
An older adult might forget to inform their doctor what they're taking, or they may not even know what they're taking or why, Lynn said.
“In some cases, a doctor has simply added a drug to treat something without realizing that the patient is already taking something else for it,” she said. “Of course, the question of whether these patients can even afford all of these drugs also plays a big role.”
Some older people may select their medications based on cost without knowing what prescriptions are mandatory, Lynn said.
Finding the “right balance”
In fact, as much as 80% of older adults aged 50 to 80 can be willing to stop taking a number of of their prescribed medications in the event that they had the selection, based on a survey by researchers on the University of Michigan.
“Many drugs that people take may have been appropriate at one time but have since lost their usefulness for that patient,” said Dr. Michael Steinman, professor of drugs and geriatrician on the University of California, San Francisco and co-leader of the study. US research network on prescription waiversa physician group focused on improving medication adherence in older adults.
“Taking fewer medications can actually be beneficial,” he said. “You can take too many medications, you can take too few. The best thing is to find the right balance for yourself.”
The definition of what number of medications are too many relies on every person. Therefore, caregivers and older adults can ask their doctor for a review of medication which have multiplied over time.
By reviewing their medications, older people can actually reduce their risk of probably dangerous unwanted side effects and avoid being prescribed increasingly more drugs, says Sarah Vordenberg, PharmD, MPH, associate professor of clinical medicine on the University of Michigan College of Pharmacy in Ann Arbor.
“It’s not really about the number of drugs, but [about] are inappropriate or unnecessary medications for a patient,” she said.
Patients and caregivers should want to have an open conversation with their doctor. University of Michigan survey found that greater than 90% of older adults who took prescription medications expected their doctor to ascertain their medications during a routine visit.
But doctors often need input from patients to initiate an examination.
“Unfortunately, clinical inertia or maintaining the status quo is often easier than time-consuming discussions,” said Vordenberg.
ask questions
Sara Merwin helped her parents manage their medical appointments and health for a few years as they moved from independent living in Colorado to a senior residence and eventually to a nursing home. Merwin, co-author of The informed patientsaid her father was taking an extended list of medicines and she or he often asked his GP to ascertain his medication intake.
“I felt that my father, at his age and his frailty, didn't need as much medication as he was taking,” said Merwin, who lives in Long Island, N.Y. “So we went through his medications and I asked, 'Does he really need to take this?' 'Does he really need to take this?'”
In particular, she questioned one drug, a statin, to lower his cholesterol and his risk of heart attack.
“I thought the statin might be causing myalgia and muscle pain in his legs, so I advocated discontinuation,” she said.
The family doctor stopped the cholesterol-lowering medication.
Local pharmacies will also be some extent of contact for older people and caregivers. The pharmacist there can provide further information on whether a certain combination of medicines taken might be harmful. In states that allow pharmacists To prescribe specific medications, pharmacists may give you the option to group among the medications together or advise a patient to stop taking a number of medications, Vordenberg said.
“All pharmacists are trained to do a comprehensive medication review,” she said. “All pharmacists have the ability to contact the patient to find out how the medication withdrawal is going.”
Merwin's parents got their prescriptions from a “small pharmacy where they were on first-name terms with the pharmacist who really cared about them. So they had that expertise at their disposal,” she said.
When information is offered about potentially unnecessary medications, the work to discontinue those medications needs to be done in collaboration with the healthcare professionals, a few of whom originally prescribed the medications.
Many older people live in geographically isolated areas without pharmacies or receive prescriptions from mail-order pharmacies. In this case Medicare plans offer free medication reviews by a health care provider or pharmacist – a so-called medication therapy management program – and supply recommendations on how one can take individual medications.
Merwin's father died in early 2020. Sometimes she wonders if he must have taken the statin longer or if the doctor agreed too quickly without doing more research. But overall, she doesn't regret raising the problem together with his healthcare providers, and she or he advises other caregivers and older people to listen to medication lists.
“It's dangerous to remain passive when it comes to your own health care these days,” Merwin said. “That's a difficult message to send to older adults because they've grown up with the dominance and authority of the doctor, as opposed to a collaborative relationship.”