Medication can be a life-saver. No sane person would want to return to the days before antibiotics could prevent simple infections from taking a life. And yet, all medications come with unwanted side-effects and some have potentially devastating consequences. Even life-saving antibiotics have brought about the growth of resistant “super bugs” that are difficult to treat and can be deadly.
For the frail, aging person, medications are of particular concern. Unfortunately, it is the frail older patient that is most likely to be a victim of polypharmacy. Polypharmacy is a term used to describe the situation where patients, who have multiple medical problems, are prescribed many medications. Of particular concern are drugs that have been known to be of high-risk to older patients. As we age, our bodies process medications differently and the more medications an older person takes increases their risk for adverse drug reactions. These reactions can resemble problems that many older people could develop anyway:
falling, anxiety, confusion, insomnia, upset stomach, diarrhea, constipation, incontinence, and lack of appetite, among others. Therefore, an adverse drug reaction may go undiagnosed.
Many experts recommend that any new symptom that is experienced by an older patient who takes multiple medications should be first thought of as an adverse drug reaction. For each medication that is taken, the odds of having an adverse reaction increase. And for those people who are taking 5 or more medications, the likelihood of an adverse drug reaction is increased by 50%.
If you or your loved one has been in the hospital recently, you likely were prescribed new medications. If you are sent home with instructions to continue on a new medication it is important that your list of meds be reviewed periodically. I have seen patients who are on ten or more medications because of past hospitalizations or because they are seeing different specialists. One patient in particular was on nine different prescription drugs and was having episodes of dizziness. When we looked at his list of medications it was clear that no one had done a review and saw that he was taking three medications that were not necessary. At his next appointment he asked his primary physician to reevaluate his list of meds. He left that appointment with only four medications to take everyday. That alone, cut his risks for an adverse reaction in half. Additionally, he no longer is experiencing those episodes of dizziness.
It may seem that it should be automatic for doctors to review your medication list and to eliminate unnecessary or harmful prescriptions. It is not. Often, there simply is not enough time in an appointment to have these careful conversations. Also, when patients are seeing a cardiologist for heart failure, an endocrinologist for diabetes and a nephrologist for kidney disease, it can be confusing as to who should be responsible for a medication review. In fact, it is the responsibility of each person who prescribes a medication for that patient.
If you or your loved one are taking more than one medication, you need to have a review. A great resource for this is someone you probably see at least once a month: your pharmacist. Stop in your pharmacy and ask the pharmacist when you can come back and have a careful review of your prescription list. Be sure to ask if any of the medications you are taking have been identified to be “high-risk medications” for people over the age of 65. They may not be able to take the time right on the spot-but they should be able to tell you when to come back at a less busy time. The more medications you are on, the more urgent it is that you have this type of review.
Medications are often life-savers, but anything that powerful can also cause problems. Be sure that you are proactive with your health and get your medication review done soon.
