April 19, 2012

The Over-Medication of Us, the Elderly

Over the past months,  several themes keep recurring on my blog. One repeated topic is the key way that diet and exercise affect our health and well-being. Another – and the focus of today’s post – is the potential harm that often results from our increasing tendency to overmedicate ourselves.

A blog posting -- "Too Many Pills for Aging Patients" -- by the New York Times' excellent blogger Jane E. Brody got my attention. In the article, Jane recounts how her own 92-year-old aunt (“a walking pharmacy”) nearly died from overmedication, during a weeks-long hospital episode that added hundreds of thousands of dollars to the American health care tab.
In early March, my aunt was hospitalized for an episode of extreme weakness, sleepiness and confusion. She was found to be taking a number of medications and supplements: Synthroid, for low thyroid hormone; Tenormin and Benicar, for high blood pressure; Lexapro, for depression; Namenda, for symptoms of Alzheimer’s disease; Xanax, for nighttime anxiety attacks; Travatan eye drops, for wet macular degeneration; a multivitamin; vitamin C; calcium with vitamin D; low-dose aspirin; a lutein supplement; and Colace, a stool softener.
For Jane’s dear aunt, THAT was just the beginning.

And her story is certainly not unique. More than 40% of people over 65 take five or more meds – either prescribed or over-the-counter – and every year about one third of us will pay the consequences in adverse effects, including falls, broken bones, disorientation, even heart failure.

We’ve heard this cautionary tale before. On February 24, 2012, I reviewed Dr. David Agus’s warnings about supplements in his best-selling book The End Of Illness. He sees the body as a complex organism that has taken millions of years to evolve... and to develop its own ineffably complicated mechanisms for self preservation. When we, in our own tiny moment of time, introduce some new variable to the delicate chemical mix, our interventions may push that complex chemistry in the wrong direction. Here's that post about Dr. Agus.

A  Resource Guide for the Elderly Patient
But we can be grateful to science for the support it can provide. Here's the one cited by Jane.

A panel of eleven experts in geriatric care recently updated the so-called Beers Criteria, a guide that elderly patients and their healthcare professionals have used to avoid medical disasters – like Jane’s aunt experienced – from misusing and dangerously combining different drugs. This update surely seems comprehensive: it’s based on careful review of over 2,000 well-conducted studies of drugs prescribed for the elderly. As Jane described in her story, “the team highlighted 53 potentially inappropriate medications or classes of medication and placed them in one of three categories: drugs to avoid in general in the elderly; drugs to avoid in older people with certain diseases and syndromes; and drugs to use with caution in the elderly if there are no acceptable alternatives.”

The guideline also assesses the quality of the available evidence and the strength of its own recommendations. I’ve scanned it for drugs I’ve taken and for its cautions regarding medications if you have Parkinson's. Here’s the document: 2012 Beers Criteria.

What We Need To Do
Many of us have different doctors who treat us for different things… and prescribe different meds for those conditions. I’ll state the obvious: it is critically important that ALL our doctors know about ALL our meds – prescribed, over-the-counter… or from the cocktail bar.

Fortunately every medical professional I see these days asks to know drugs and supplements I take. To be prepared and current on this, my Contacts list on my cell phone has an entry for "Meds Schappi." When I call this up, I have readily available the current list of all the prescribed meds and supplements I take, the dosage, and the times per day that I take the med. .  So far I've been very good about keeping the list current and it comes in handy when I'm filling out the forms in a doctor's office.

Need a useful form to share with your docs? This one might do the trick: Drug Diary.

We also need to ask questions when a new medication is prescribed.
  • What is the name of the medicine and what is it supposed to do?
  • What are the benefits versus the risks?
  • Are there options -- e.g. diet. exercise -- that might work as well?
  • Is this the brand or generic name? (Is a generic version available?)
  • When do I take the medicine - and for how long?
  • Should I take this medicine on an empty stomach or with food?
  • What should I do if I forget a dose?
  • What foods, drinks, medicines, dietary supplements, or activities should I avoid while taking this medicine?
  • What are the possible side effects, and what do I do if they occur?
  • When should I expect the medicine to begin to work, and how will I know if it is working?
  • Will this new prescription work safely with the other prescription and non-prescription medicines I am taking?
  • How should I store this medicine at home? 

1 comment:

Tommyelgrant said...

Great advice, especially the laundry list. I would also add that asking the Doctor to tell you when you should be taking these medications to manage your day better. Some do say take at a specific time but for those generic instructions such as twice a day, it is nice to have a game plan, especially when taking multiple drugs. One more thing, I highly recommend centralized care if possible. With all medical treatment from one provider, say a hospital clinic, records are centralized and viewable so it's an exchange with a Doctor, such as I see you have this history along with your recounting. If that is not desired, ask the non-aligned caregiver to either send the report to the internist or give you the report to send to your internist. This maximizes the management of your health care so the left and right hands can know the full story.