​Seniors Matter(s): Too many medications?

My medicine cabinet has started to look like a pharmacy! I have slowly accumulated a plethora of medications to help my aging body.

I am confident in my doctor and pharmacist as they both look carefully at my needs and the compatibility of the combinations thereof.

I suspect many seniors may not be so lucky. They access numerous doctors and/or pharmacists who may not get the same information.

I have actually reduced two medications over the last while (change of diet and living style).

Many seniors take multiple drugs, which can lead to side effects, such as confusion, light-headedness and difficulty sleeping. Doctors who specialize in the care of the elderly often recommend carefully reducing the medication load.

Over-medication is a health hazard for older adults that their doctors can often overlook.

"It's easier for doctors to simply start another medication than it is for them to evaluate each [current] medication," says Leah Rorvig, a geriatrician and an assistant professor of medicine at the University of California, San Francisco.

The problem is that we become increasingly sensitive to the side effects of drugs as we age, says Rorvig. For instance, older adults are sometimes prescribed a drug class known as proton pump inhibitors to treat heartburn. Rorvig explains that this type of medication, over time, can cause weakening of the bones, which puts older people at a higher risk for falls and fractures. That seems to be an oxymoron of healing one symptom while causing another.

The more prescription drugs you take, the higher your risk for adverse reactions, says Michael Steinman, a geriatrician and professor of medicine at the University of California, San Francisco.

These include unexplained symptoms, such as diarrhea, constipation, light-headedness, weight loss, nausea, confusion, difficulty sleeping or sleeping too much, Steinman says.

"This does not guarantee that any of the symptoms are due to [a particular] medication. But if you don't consider it, oftentimes this won't be recognized," he adds.

Although some older adults really do need to take multiple prescription drugs, this is not always the case. That's why some clinicians who work with the elderly suggest they consider de-prescribing — reducing the dose of medications that might be causing harm or stopping them altogether under the guidance of a doctor.

Family members of elderly adults may want to keep an eye on their prescriptions, says Barbara Farrell, a pharmacist and clinical scientist with the Bruyère Research Institute in Ontario, who co-leads a project that publishes de-prescribing guidelines for the elderly.

A good time to talk to your loved one's doctor about possibly eliminating some meds is when you notice a significant change in the person’s health. For example, take note if they suddenly become frailer or are diagnosed with a serious illness. If they start skipping medications or hiding pills, that's also a warning sign, Farrell says.

But reviewing prescriptions is not only about stopping them, says Steinman. "We're really optimizing medications, stopping those that are causing harm, but also recognizing if there's anything missing that we should think about prescribing that's going to be helpful," he says.

Preliminary research shows that de-prescribing might reduce cognitive decline as well as referrals to acute care facilities and mortality. Anecdotally, Farrell says, she sees her patients' quality of life improve when she stops certain medications.

Here are some simple ways you can assess and manage your prescription drug use— or help a loved one do so — including talking to your doctor to find out if de-prescribing is the right move.

"One of the reasons why people let these problems linger is that when people go to their doctor, the visits often revolve around a medical problem," says Steinman. Schedule a doctor visit to specifically go over your medications. Ask questions about what each prescribed drug is for and whether there are any that are not necessary. You should also talk about any new symptoms and ask whether drugs could be causing them.

To prepare for a meeting with your doctor, you will need to make a list: the drug name, the reason for taking it, who prescribed it, when you started taking it, whether it's working, and the side effects.

You also want to make sure you know how long you're supposed to be taking medications. Some are just meant to solve short-term problems.

De-prescribing requires some commitment from the patient to follow a plan. Treatments other than drugs can be a good alternative for some conditions. For example, switching to decaffeinated coffee instead of taking sleeping pills which might cause drowsiness and increase the risk of falls.

You may also want to see a geriatrician rather than a primary care doctor. A geriatrician will automatically review all of your meds and start taking away things that he does not think will be of benefit.

The bottom line seems clear. We have regular reviews of our car’s machinery and so forth. Our bodies deserve the same opportunity.

Stay safe!

‘Till next time!