For many seniors, medications are how they survive day-to-day life. Everything from diabetic insulin injections, blood pressure medications, and pain management drugs keep their bodies working like well-oiled machines, taking them where they need to go and allowing them to perform necessary tasks. Yet for some seniors–perhaps even for most of them–medications can also be a hindrance. Because of the shape and behavior of the United States healthcare system, it appears that many seniors are being over-prescribed medications. Indeed, researchers Gallagher, Barry, and O’Mahoney reported that inappropriate prescriptions affect some 12% of the elderly dwelling in the community and a full 40% of seniors in nursing homes. This means that significant numbers of seniors have more medications on a daily or weekly basis than is healthy for them. Research shows that such “polypharmacy” is very dangerous for two major reasons: drug interactions and side effects.
The Dangers of Over-Prescribing
Even if they can keep up with complicated medications regimens without mixing up dosages (a danger in itself) many older people, especially those suffering from chronic and/or severe illnesses, run the risk of unhealthy drug interactions by taking multiple medications at once. Such interactions could range from some medications neutralizing other medications’ effectiveness to putting seniors in the hospital after a fall due to the fainting or dizziness that can result when drugs interact poorly inside of someone’s body.
Researchers Gallagher, Barry, and O’Mahoney reported that inappropriate prescriptions affect some 12% of the elderly dwelling in the community and a full 40% of seniors in nursing homes.
The seriousness of one drug canceling out another may be seen, for example, in someone who has circulation issues. Medications to thicken or thin blood, if canceled out by another medication, could cause serious cardiovascular damage, and for seniors, such effects are particularly dangerous.
Drugs interacting so as to cause dizziness or faintness may be all right for a person in his or her thirties, who can probably suffer a fall without breaking bones or suffering a long-term injury. For seniors, falls like this could result in death, or at least in long-term pain, injury, or disability.
Side effects are similarly dangerous. If an elderly loved one visits many specialists and uses more than one pharmacy in order to fill prescriptions (which many seniors do in order to price shop for the cheapest prescription), no one may be noticing how their full medication regimen might react to a new medication. These side effects can be just as serious as drug interactions, causing fainting, confusion, and cardiovascular complications. Although most people taking a given medication are not at severe risk of death, every medication has possible, dangerous side effects.
How to Remedy Over-Prescription
Visiting with a primary care physician and consistently keeping him or her abreast of new medication regimens can prevent side effects or drug interactions that can happen as a result of too many medications. Especially if the number of different medications on it reaches the double digits, this list should be evaluated regularly for adjustments. Seniors and their caregivers can search for ways to solve the problems naturally without medication, or to cut down on dosages safely, which can reduce the risks associated with too many medications per day. Natural pain management, for example, or a nutrition regimen that helps more effectively maintain healthy blood sugar can both be ways to reduce or eliminate common medications and de-escalate risk.
Especially if the number of different medications reaches the double digits, this list should be evaluated regularly for adjustments.
It is important to bring a complete list of medications and dosages to each doctor’s visit; many doctor’s offices will ask for this information, but it is important that this list is accurate. Double-checking this list for accuracy and updating it when necessary can help doctors make informed changes to medication regimens.
Caregivers providing direct care to a loved one do well to visit the doctor with the senior, at least for some of the visit. Concerns about drug interactions and side effects should be brought up to the doctor, whether he or she is a specialist or primary care provider, and options should be discussed. If nothing else, this will serve to keep physicians aware of possible red flags in a list of medications. Asking to see what medications can be reduced or eliminated, or wanting to know about frequent side effects to watch out for, such as confusion or sudden drops in blood pressure leading to fainting, can keep everyone on their toes as far as medications go.
Knowing that a specific symptom could be directly related to a medication can help caregivers and doctors recognize the cause of a problem and help any emergency room personnel to evaluate the situation more accurately. Caregivers may plan specific dates to check in about possible side effects and interactions and regularly ask for evaluations of medications regimens. Such updating might find and prevent problems before they become apparent in a negative health event for a senior due to adverse drug interactions or side effects.
Gallagher, P., Barry, P., and D. O’Mahoney, D. (April 2007). Inappropriate prescribing in the elderly. Journal of Clinical Pharmacy and Therapeutics, 32(2): 113-121. Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2710.2007.00793.x/full. Retrieved August 28, 2016.
Gorman, A. (August 15, 2016). America’s other drug problem: Giving the elderly too many prescriptions. The Washington Post. Available at https://www.washingtonpost.com/national/health-science/americas-other-drug-problem-giving-the-elderly-too-many-prescriptions/2016/08/15/e406843a-4d17-11e6-a7d8-13d06b37f256_story.html. Retrieved August 28, 2016.
Hughes, S. G. (December 1998). Prescribing for the elderly patient: why do we need to exercise caution? British Journal of Clinical Pharmacology, 46(6): 531-533. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1873806/. Retrieved August 28, 2016.
Liu, G. G., and Christensen, D.B. (November-December 2002). The Continuing Challenge of Inappropriate Prescribing in the Elderly: An Update of the Evidence. Journal of the American Pharmaceutical Association, 42(6): 847-857. Available at http://www.sciencedirect.com/science/article/pii/S108658021530142X. Retrieved August 28, 2016.
Spinewine, A., Schmader, K. E., Barber, N., Hughes, C., Lapane, K. L., Swine, C., and Hanlon, J. T. (July 14, 2007). Appropriate prescribing in elderly people: how well can it be measured and optimized? The Lancet, 370(9582) 173-184. Available at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61091-5/abstract. Retrieved August 28, 2016.