By Deborah Jeanne Sergeant
The older patients become, the more likely they need prescription medication. According to the AARP, people 45 and older on average take four prescriptions daily. While needed medications improve length and quality of life, taking too many unnecessary prescriptions can have the opposite effect.
Joanne Wu, board-certified integrative and holistic medicine and rehabilitation physician, specializes in wellness and sees clients in Rochester and other places in Upstate New York.
She believes that one reason that some older adults take unnecessary medications is that their care providers lack the time to comb through their patients’ medical records and discuss their health goals.
Many also don’t re-evaluate how well medication is working.
“We’re striving for better cholesterol, diabetes, and blood pressure numbers, which can prevent mortality in the long run, but if you’re taking three to four drugs and the numbers are not well controlled, at some point, the primary care team may need to sit down and review it,” Wu said.
The patient’s physicians may not realize all the medication taken. At this age and stage, many patients see numerous specialists who may not always communicate with one another. Despite the prevalence of electronic medical records, the systems don’t usually transfer data between them. By law, they also require signed paperwork from patients to transfer data.
Older patients also seldom self-advocate.
“A lot of older adults don’t have the medical literacy to understand that a drug may cause harm,” Wu said. “It takes a strong primary care team and support for that older adult so they can understand they have a choice in the matter as to whether they take that drug or not.
“If people take time to talk about those goals with the family and patient, we’d probably cut down on polypharmacy.”
Wu added that some older adults taking over-the-counter herbs and supplements don’t realize the potential for negative drug interactions.
Older adults who travel or spend winters South use different providers and pharmacies, making it more difficult to keep track of what they’re taking. For elderly adults, taking multiple medication may become difficult — and more dangerous — because of cognitive impairment.
Physician Jennifer D. Muniak, board-certified in geriatrics and aging, practices at University of Rochester Medical Center. She said that patients can become “attached” to medication that they may have needed in the past but continue to take even after their issue has resolved or requires different management.
“The list of medication gradually gets longer through the years,” Muniak said. “Doctors are reluctant to decrease the medical risk because we don’t perceive immediate harm. Harm can be gradual and cumulative.”
Younger patients may well tolerate medication that a middle-aged or older person may not. As the body ages, it’s less capable of efficiently processing and metabolizing medication.
Some patients may take medication to counteract a side effect of another medication; however, if the side effect is that bothersome, patients need to ask about alternatives that could help mitigate the original problem.
Muniak advises patients to bring every prescription bottle, over-the-counter medication and supplement to every visit with every provider, even if the medication wasn’t prescribed by that provider.
“’I take a green pill’ doesn’t help much,” Muniak said. “But the bottle can help.”
She encourages patients to regularly assess their medication with their providers, since one’s health and body change constantly.
“It’s reasonable to try getting off a medicine,” Muniak said. “Medicine’s use is not absolute. It’s contextual.
“A lot of times, medication may stay on the list forever and it may not need to be on the list forever. The first thing I look for with a patient with a new symptom is, ‘Do they have a medication that may be causing it?’”