As we get older, we are likely to take more medication. Multiple medication use (prescription or over-the-counter OTC) is a common concern in relation to seniors’ health. According to Health Canada, In 2005 pharmacists dispensed an average of 35 prescriptions per person aged 60 to 79, and 74 prescriptions per person aged 80 or older, compared with an overall average of 14 prescriptions per Canadian. People who take several medications at once are more likely to have adverse drug reactions; seniors are particularly vulnerable because of co-morbidity and physiological changes that come with age.
It’s a problem that tends to build on itself. One medication is prescribed, then side effects appear and another medication is added to counter them. While the current mantra for prescribing to seniors is “go low, go slow”, the medications can still add up.
Why Older Adults Are at Greater Risk
This practice, called polypharmacy, has increased risks for older adults. Seniors are more likely to be living with multiple chronic conditions such as diabetes and high blood pressure, and they have greater rates of anxiety, pain, and sleep disorders. Treating these diverse conditions can involve complex drug therapy by multiple doctors.
Older adults may have a hard time remembering to take their medications at the right time and in the correct dose. Hearing and vision loss can interfere with reading or understanding medication instructions. Using a variety of specialists or different pharmacies increases the chance for unintended drug interactions.
It gets worse. Older adults, especially those experiencing serious health issues, are more likely to have emotional, physical, cognitive, social and functional changes that may encourage them to seek out more medications to cope. In addition, it’s estimated that 14% of adults aged 50 and up have a mental illness such as depression or anxiety. Left untreated, depression can lead to drug abuse. The number of older adults taking three or more psychiatric or pain medications has more than doubled in the last decade, according to a Centers for Disease Control and Prevention (CDC) study of data collected from primary care physician visits.
Additionally, changes in metabolism, weight, and body fat that often happen as part of the aging process can affect how a medication works in the body. Older adults cannot detoxify and eliminate medications as quickly as their younger counterparts, leading to adverse reactions to drugs that used to work.
Finally, care facilities may dole out powerful antipsychotics to elderly residents to keep them manageable by staff. A Health Ministry study commissioned after the Toronto Star began investigating the practice found nearly half of Ontario nursing home residents aged 65-79 are being given “dangerous” drugs consisting of sedatives such as diazepam and lorazepam. Despite warnings that the medications can kill elderly patients who suffer from dementia, the report further reveals that some long-term-care homes, often struggling with staffing shortages, are routinely doling out antipsychotics to calm and “restrain” wandering, agitated and sometimes aggressive patients.
Adverse Consequences of Overprescribing
Every year, Canadian hospitals admit thousands of older adults do to adverse medication reactions according to several recent studies. And one of the biggest health hazards for seniors is falling and breaking a hip – often a result of multiple medications which can cause cognitive difficulties and affect balance.
The good news is awareness of the scale of the problem is growing. More and more physicians are initiating “deprescribing” discussions with their older patients. “Deprescribing” is exactly how it sounds — the deliberate and conscientious stopping or tapering of prescriptions to help improve health outcomes.
Some long-term care facilities are now required to do periodic medication reviews and weed out unnecessary, ineffective or hazardous pills. A recent massive Canadian Foundation for Healthcare Improvement demonstration project has shown how to reduce the inappropriate prescribing of antipsychotic medications to seniors with dementia.
Programs, research initiatives and physician education activities on deprescribing are being carried out in most provinces. Canada’s new Deprescribing Network is developing tools and information to help make deprescribing commonplace and part of the prescribing culture.
This is all a step in the right direction. Unfortunately, there’s still reluctance in some quarters to cut back on medications.
If you want to join the deprescribing revolution, don’t do it by yourself. Have a conversation with your doctor or pharmacist who will be able to help you decide if you are on the appropriate medications, which medications could be safely reduced or eliminated and how to do so.
As people get older they should constantly ask if a new medication is going to affect the things that are important to them: their mobility, cognitive abilities and capacity to enjoy life.
Caregivers and seniors, most importantly, have to be ready to assert their wishes when it comes to taking too many medications and always be alert to the possibility that more medication might mean more problems.
What else can you do to manage your medications?
Tips for Effective Medication Management
1. Ask your provider if the dosage is right for your age.
You may need to start with a lower dose and taper up.
2. Some medications are unsafe for older adults.
Consult the Institute for Safe Safe Medication Practices Canada website for a list of potential harmful medications.
3. Bring a list of your medications to the doctor.
Include vitamins, herbs, and any other over-the-counter medications you take.
4. Help cognitively impaired adults to monitor medications.
Avoid potentially harmful or fatal consequences by assisting cognitively impaired seniors with medications.
5. Create and maintain a current medication list.
Write a list of all medications with generic and brand names, dosage amount and frequency, and what it treats.
6. If in doubt, get a second opinion.
When you don’t feel confident about a medication that has been prescribed, don’t hesitate to check with another professional.
7. Know the side effects of your medications.
Use the internet to check on side effects so you can be prepared if one arises.
8. Check if the pharmacy label states what the medication is for.
This will help keep track of medications if one for a specific problem needs to be changed or adjusted.
9. Use the same pharmacy and pharmacist whenever possible.
This provides another layer of review to avoid drug interactions, over-prescribing or prescribing more than one drug to treat the same problem.
10. Ask your pharmacist questions.
Your pharmacist can tell you what to watch for, how to store the drug, and if the dose looks appropriate.