Taking multiple medications unnecessarily is perhaps the best definition of polypharmacy. Older adults use 34% of all prescription medications and 40% of all over-the-counter medications. According to one study, as many as 28% of hospitalizations in the U.S. were related to medication errors and 2/3 of these could have been prevented. Another study in the Veterans Administration health system focused on patients 65 years and older found that in more than 40% of patients there was inappropriate medication use and underuse for patients taking more than 5 medications per day.
The more medications a person is taking, the risk for mistakes in medication dosing occurs. Also, as the body ages, medications are processed differently. The liver and kidneys are the main organs involved in metabolizing medications and these organs function differently as a person ages. Medications remain in the system longer than they should because absorption rates are slower, medications are highly concentrated due to poor circulation, the liver shrinks and there is decreased hear function, which affects metabolism, and decreased kidney function affects how the drug flushes from the body.
Another concern for the elderly is adverse drug reactions. Oftentimes, adverse drug reactions are mistaken for normal signs of aging such as loss of appetite, unsteadiness, falls, confusion, and urinary incontinence. However, these symptoms are not just connected to aging. It's the combination of age, multiple medications, and adverse drug reactions is cause for concern.
It is important to explore alternatives to medication to solve the problem whenever possible. For example, some drugs may cause dizziness when first taken, but this reaction subsides once
A person has been on the medication for a few weeks. The doctor may instruct your loved one to get up slowly from a seated or lying position or take the medication with food, or he may recommend another nondrug therapy until this effect subsides. If the reaction is severe, one solution could be switched to another medication that doesn't have the same effect. But prescribing another medication to combat dizziness shouldn't be the first action taken.
It's important when helping your loved one with the medications and possible side effects to go to the doctor with them. It's difficult to remember instructions and all the details of the dialogue with the doctor.
- Take a list of all the medications he or she currently is using, even if another doctor prescribes that medicine, or even if it is an herb or over-the-counter medication.
- Take a list of your questions with you to the appointment. This will help make sure all of your questions are addressed as conversation can cause you to be side-tracked and forget something you thought was important.
- Ask the doctor to write the brand and generic name of the drug on the list and why it is prescribed.
- Double check how often and when it should be taken and whether it should be taken with a meal, whether or not she or he should avoid alcohol or any particular foods and if there are any over-the-counter medications to avoid.
- Find out what side effects to watch for
- Ask when to call the doctor if adverse effects develop.
- Ask the doctor what medicine your loved one can stop taking, especially if the doctor wants to prescribe a new medication
When filling new prescriptions, ask the pharmacist for a printout of instructions. At home, write out a medication schedule for your loved one to follow at home. It may also be important to use a medi-set, or medi-planner to be sure that the drugs are taken when prescribed.
Medications help older people to overcome life-threatening acute illnesses and to live successfully with chronic diseases. But with the benefits can come risks. By knowing what drugs your loved one is taking and their potential dangers, watching carefully for untoward effects, communicating your concerns to the doctor, and taking the time to check how the medications are working, you can help your loved one get the better part of the medication bargain.
