By Anita Kamiel, RN, MPS
The term polypharmacy refers to the taking of multiple drugs concurrently–often five or more–and it is a trend on the rise. While cause for alarm in the young, in the elderly, who usually take a panoply of medications prescribed to them by their stable of specialists along with their internist or geriatrician, the effects can be extremely serious. With so many doctors and healthcare professionals managing the patient, it is easy to both rack up the number of drugs at play as well as fall into the “prescribing cascade” where drugs are prescribed to counteract the side effects of another prescribed drug.
As with most things, the problem of drug interaction is more acute in the elderly than in their younger counterparts. If dizziness is a side effect, as with beta blockers, and a fall occurs, the results can be catastrophic. Higher medication use in the elderly has been cited as responsible for some falls, and doctors have been advised to avoid medications that have been linked to falling.
Older patients seem to use their own discretion when taking their medications. They don’t easily cede their independence, and this attitude often extends to this area of their lives as well. The senior patient may also be loath to tell the doctor about a complementary therapy or remedy, having experienced a closed-minded or judgmental reaction in the past.
According to a Harvard study, polypharmacy has seen a 70% increase over the last 12 years. A longitudinal study in JAMA Internal Medicine (http://jama.jamanetwork.com/article.aspx?articleid=2467552) found that more than 33% are taking five or more medications, 66% are taking dietary supplements, and 40% are taking over-the-counter drugs.
In 2006, 8% of seniors were at serious risk for drug interaction, but that number rose to over 15% in 2011. Adverse drug interactions include the combination of aspirin with the blood thinner Plavix. Taken together, they create an increased risk of abdominal bleeding. Taking fish oil for heart health combined with the blood thinner Coumadin can also cause bleeding.
Most elderly patients don’t bother to tell their doctors about the nonprescription drugs or supplements they are taking for the simple reason that their doctor often neglects to either ask them about it or inform them that there could be risks of drug interaction. If the elderly will be choosing which medication they want to take (or can afford–a whole other topic), it is important to educate them about the purpose of each and the possible interactions, so they, their families, and their doctors can make informed decisions.
A serious problem is that medications are often prescribed by specialists who don’t necessarily communicate with each other. A clinical pharmacist specializing in geriatric care can help. They are often the repository for all the prescriptions for the patient and can be a central clearinghouse. They can perform a drug reconciliation to make sure the patient is not combining substances with negative interactive effects. Consult the American Geriatric Society’s Beers Criteria of Potentially Inappropriate Drugs (http://geriatricscareonline.org/toc/american-geriatrics-society-updated-beers-criteria-for-potentially-inappropriate-medication-use-in-older-adults/CL001). There is a handy “Tips on Polypharmacy Management” list available at the Cleveland Clinic’s website (https://consultqd.clevelandclinic.org/2016/06/polypharmacy-elderly-patient/).
Another problem is that once we start medications, we almost never stop them. Money is poured into efficacy tests for a course of drug treatment, but we almost never study how and when treatment is to end. A study out of the VA hospitals showed that 44% of elderly patients were given at least one unnecessary medication upon discharge (“Unnecessary Drug Use in Frail Older People at Hospital Discharge,” Journal of the American Geriatrics Society, 53: 1518—1523).
In the meantime, go along with your senior loved one to the next checkup or doctor visit and bring every prescription and non-prescription over-the-counter remedy or supplement with you so you can do a comprehensive review. It will be a good time to revisit the necessity of the medications as well as a time to tweak dosages.
If elderly patients are confused about what to take or are in the beginning stages of dementia, it’s easy to mismanage the arsenal of medications they are prescribed or recommended. A caregiver or family member must step in to avert what can sometimes become a life-threatening disaster.
Let me know if I can help!
Anita Kamiel, R.N., M.P.S., is the founder and owner of David York Home Healthcare Agency and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+ and LinkedIn.