Hardly a week goes by when we don’t read about some crisis in the world of medicine – from skyrocketing premiums to rural hospitals shutting down, not to mention cuts to Medicare and Medicaid and a looming shortage of family practice doctors. The sad reality is that, if American medicine were a sick patient, the prognosis would be guarded at best.
But in a time of medical shortages, there’s one category of patients who seem to be receiving too much of a good thing. Recent reports have confirmed that millions of American seniors are dangerously overmedicated – so much so that roughly 16 percent of seniors are taking eight or more prescription drugs at the same time. Many of these drugs should not be taken together or prescribed for long periods of time, but too often doctors aren’t paying proper attention.
It has been a while since we have presented an article on this vital topic, so this recent report from the Wall Street Journal comes at an opportune time. We hope this article by reporter Anna Wilde Mathews will cause families to sit up and take action. (Note that a subscription may be required to access the Wall Street Journal article.)
New Year’s Resolution: Scrutinize Your Prescriptions
Mathews begins: “Here’s a good New Year’s resolution for older patients and their families: Figure out if their prescriptions pose a health risk, because often they can.”
To illustrate her point, she introduces us to Barbara Schmidt, an 83-year-old Delaware resident and great-grandmother who found out about the dangers of over-medicating before it was too late.
“She had been suffering repeated tumbles, leading to broken bones and bruising,” Mathews writes. “Her doctor told her the problem was probably tied to some of her prescriptions, so she pulled back on taking the painkiller gabapentin and the muscle relaxant methocarbamol.”
When she reduced her doses of these medications, the falls stopped. “I didn’t know it was from the drugs,” Schmidt says. “I do now.”
Too Many Drugs, Including Those Known to be Dangerous
“A Wall Street Journal analysis of Medicare drug-benefit data found that one in six seniors were prescribed eight or more drugs at the same time,” Mathews explains. “More than 3.5 million were getting at least one medicine that the American Geriatrics Society recommends older patients should generally avoid. Many Medicare enrollees were prescribed more than one.”
The following are steps that pharmacists and doctors say that older patients and their families can take to make sure that they are taking their medications as safely as possible.
Take Stock of What You’re Taking – and Why
First: take an inventory of your medications at least once a year, Mathews tells us: “What drugs are you taking, for what reasons and at what doses?”
Furthermore, medical professionals say that you should have a written list—either in paper form or online—of your roster of medicines. (Here’s one form you can use, says Mathews.)
“The inventory will help you and your doctor spot issues like duplicative medications from the same class of drugs,” she writes. “The list can also help you make sure you follow directions on when and how to take your meds, which helps ensure they are as effective as possible.”
Use Technological Reminders, and Beware of Auto-Refill Options
If you need extra help with making sure you stay on top of the right dosages at the right time, Mathews says, it’s important to utilize the options available, such as setting an alarm or using a digital device to keep you on track, filling a pill scheduler, or even asking a loved one to check in or monitor. It’s a matter of safety.
Also, make sure that auto-refill programs from your pharmacy aren’t actually sending you too many pills. This is another area where a loved one or family member could assist.
Do Your Homework Concerning Drug Interactions, Side Effects
Next, Mathews says, it’s important to take your list of medications and do a bit of sleuthing about each one. She writes, “You can find a drug’s label—the Food and Drug Administration-approved description of its uses, makeup and side effects—at this FDA website. These are dense, but complete and definitive.”
Drugs can also behave differently in patients as they age, she tells us. You may need a different dose or even a different prescription as you get older, even if your diagnosis is the same.
“A medicine that was right for you at one point in time, may not be the best thing for you” anymore, says Cynthia Boyd, a Johns Hopkins University geriatrician.
Finding a practitioner who specializes in older patients can help ensure you’re taking the right doses. Mathews provides this searchable list of geriatricians, and one of geriatric pharmacists.
Authoritative Source Urges Seniors to Avoid Some Common Drugs
It’s also important to acquaint yourself with the Beers Criteria drug guidelines for seniors. (Find the guidelines here, and an abbreviated version here.)
Mathews writes, “The Beers guidelines urge seniors to generally steer clear of certain commonly used drugs, including benzodiazepines such as Xanax and Valium, muscle relaxants and sleep aids like Ambien that are known as ‘Z-drugs.’”
Despite this caution, current studies show that about ten percent of U.S. seniors have a prescription for one of these compounds.
Use Particular Caution When Combining Drugs
Sometimes the drugs are safe by themselves, but the combination of two or more drugs can be the real problem.
“When researching the drugs you are taking, make sure to look at the effect of combining them,” Mathews writes. “Geriatricians warn, for example, against taking too many drugs that act on the central nervous system—including combinations involving the widely used gabapentin.”
According to the Beers guidelines, “anticholinergic” drugs can commonly lead to confusion as a symptom, especially when combined with other drugs. Mathews adds, “You could easily wind up taking multiple anticholinergics, because doctors prescribe them for many different conditions. Anticholinergics also include diphenhydramine, the active ingredient in over-the-counter products like Benadryl.”
Thankfully, there are online tools to help parse this common problem, such as a anticholinergics calculator. If you suspect you may be taking too many anticholinergic drugs, be sure to bring it up with your doctor, says Mathews.
Consult Reputable Online Tools, or Ask Your Pharmacist
Another useful online tool is the website Drugs.com, Mathews tells us. It offers a “drug interaction checker” that can help you understand some of the side effects tied to taking medications in combination with each other.
“Pharmacists and geriatricians also say patients should watch for ‘medication cascades,’ in which drugs are prescribed to counter the side effects of others,” Mathews writes.
For example: North Caroline pharmacist Jered Yalung recounted to Mathews a situation in which a patient with dementia began to refuse his medications, finding a large potassium pill difficult to swallow without choking.
“The patient needed those pills to restore potassium reduced by the diuretic Lasix, which itself was prescribed to deal with swollen ankles caused by yet another drug, amlodipine, that he was taking for his blood pressure,” Mathews explains. “When the man was prescribed a different blood-pressure treatment, the entire issue went away.”
Talk to Your Doctor – Not “Doctor Google”
Crucially, Mathews warns against making any tweaks to your medications or dosages on your own, even if online research raises questions or concerns. Online sources can be unreliable.
“The internet doesn’t know what you’re being treated for, your labs, your coexisting medical conditions,” says Nicole Brandt, a University of Maryland School of Pharmacy professor.
Experts say that the next best step is to bring your entire complement of medications with you, bottles and all, the next time you talk to your doctor or pharmacist. Even the over-the-counter stuff.
This way, you can directly ask why you are taking a particular medication, whether you still need it, and find out if any of the medications you’re taking could be causing side effects. Mathews points out that a lot of physicians are clueless about their patients’ full list of treatments; if you don’t bring it up, it won’t come up.
Once you’ve presented your treatments to your doctor, it’s possible that you may benefit from deprescribing, Mathews says, which is a careful process of reducing and halting some medications under the supervision of a professional.
Make Sure to Get Rid of Pills You No Longer Need
The final step? Get rid of the pills you no longer need, but do it safely.
“Many seniors have hoards of old pills, including expired doses,” Mathews writes. “A Wall Street Journal data analysis showed that pharmacies routinely send more than patients can take. Pharmacists say these are dangerous to leave around.”
Thankfully, there are resources to dispose of medications properly, including “Take Back Days” hosted by the Drug Enforcement Administration or programs hosted by pharmacies that accept unused medications. (Mathews offers this FDA website with ideas on where to try.)
Medications can sometimes be donated for patients in need, too. “RemediChain, which is part of a nonprofit, is one option, and there are others here,” Mathews writes, concluding her article. “If you can’t manage to take prescription drugs to a drop-off site or a charity—typically the best options—the FDA offers some information about the safest choices for disposing of the rest.”
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(originally reported at www.wsj.com)
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