When More Is Not Better
by Jeannae Dergance, MD
I see it in my practice every day: polypharmacy (prescription/and or use of multiple medications) is an epidemic problem among senior patients. In fact, the average American over the age of 65 takes 7-9 different prescriptions every day. Many drugs can have dangerous or unexpected side effects when they’re combined with other medications. And, patients often continue to take drugs they no longer need after symptoms have changed or resolved. What’s more, the cost of medications, especially unnecessary ones, can put a heavy financial burden on seniors with fixed incomes.
Here’s a perfect example: when I was a resident, a patient walked into the clinic and said she wasn’t feeling well. She dumped a grocery bag full of 26 different medications onto my desk, and told me she was completely confused--she didn’t know which pills she was supposed to be taking for what or when. So, a week before, she’d simply stopped taking everything, including the insulin she needed to treat her diabetes. No wonder she didn’t feel well! She had, for example, three bottles of the same blood pressure medication, two by different manufacturers (one pink and one green—they did not appear to be the same thing), and two in different dosages. Six individual doctors, who were clearly not communicating with one another, had contributed to her bag of woes.
Many factors can contribute to polypharmacy, but it usually happens when you see several different doctors or when you have your prescriptions filled by multiple pharmacies. In addition, patients often self-prescribe over-the-counter medications or herbal/homeopathic remedies or nutritional supplements. All of this combined can lead to problems.
As geriatricians, our philosophy of medicine believes that a longer life is not necessarily a better life. And sometimes being loaded up on medications can make things worse, not better. Our primary goal in treating seniors is to maximize your function and quality of life. And that often means relieving some of your “medication burden” in a thoughtful and logical way. Geriatricians also look at you as a whole person. While sometimes consultations with specialists are necessary and appropriate, geriatricians are often able to treat a wide variety of problems and prescribe the right medications instead of referring you to different doctors for each condition. This also helps to consolidate the knowledge about your medications primarily onto one medical record.
If you are over 65 and have had multiple medical challenges, chances are good that you are currently taking drugs that you do not need. So how can you, the patient, be sure that you are taking the correct medications, only the medications you need, and medications that won’t cause harmful side effects when taken together? Perhaps one day soon there will be a truly universal, nation-wide electronic medical record that will keep track of every medication that’s prescribed for you. In the meanwhile, you must take the initiative to inform your healthcare providers about all of the drugs that have been prescribed for you, as well as any over-the-counter medications and supplements you may be taking.
Now, one thing I’ve observed among some seniors is a reluctance to challenge the physician when you feel uncomfortable with something you’ve been told or feel bad on a medication that’s been prescribed for you. I think this comes primarily from an old belief set that went something like, “the doctor is the authority and is always right.” While we always try to do the right thing, sometimes medicine is ambiguous and sometimes we get it wrong. I want you to know that it is absolutely your right and responsibility as a patient to be your own advocate. If your gut tells you something, it’s probably right. If you don’t feel good on a new medication, you must tell your doctor! The risks of side effects can be significant. Just because it’s mild initially doesn’t mean that it can’t, or won’t, get worse. You’ve lived in your body for all these years, and you’re the one who knows, better than anyone--including the doctor.
A good physician will ask you about your opinions and how you’re adjusting to new or changing medications; they will be open to trying different things until you discover together what’s best for you. So trust what you know about your body, watch for drug-related changes—both pleasant and unpleasant—and speak up!
You should always keep an up-to-date list of all medications that you’re on, including the following information:
- Name of drug
- Reason you’re taking it
- Physician who prescribed it
- When you started taking it
- How often and how much you take
Don’t forget to include any over-the-counter medicine, herbal or homeopathic remedies, and vitamins/nutritional supplements. Take this list with you to every doctor’s appointment. If multiple physicians are prescribing medications to you, be sure they all have the complete, current list. Or, better yet, like my patient who had 26 bottles of meds, throw them all into a grocery bag and bring them along so the doctor can see them firsthand.
Some other tips on being smart about your medications:
- Take your medications exactly as directed
- Don’t stop taking them without talking to your doctor first
- Keep all of your medications in one place (unless they need to be refrigerated)
- Consult with your doctor or pharmacist before you take over-the-counter drugs
- Don’t take medications prescribed for someone else, or share your medications with others
- Stick to one pharmacy if possible, so they know everything you’re taking
And, most important, talk to your primary care doctor about any concerns or questions you have about your medications. Open communication is vital to your health!