If you're over 65, odds are you're taking at least five or six medications every day. Do you know what they're doing to your body? You probably don't, and your doctor might not either.
"The average person over 65 now uses seven different medications per day, four prescribed and three over-the-counter," says Andrew Duxbury, MD, associate professor of geriatrics at the University of Alabama at Birmingham and director of the senior care clinic at UAB's Kirklin Clinic. "There's never been a controlled study on a human being involving more than three drugs circulating in the body at the same time. So no one knows, scientifically, exactly what's going on in your body when you take seven, 10, or a dozen at a time."
Some people are able to split their pills in half in order to save money on prescription drugs. If your doctor can double your normal dose, and you split the pills, you may be able to get a 2-month supply of medicine for the price of one.
But many medications cannot be split safely. The FDA has issued warnings about the risks. So have professional societies representing pharmacists and doctors. This article looks at when pill splitting is safe, and when it’s not.
Medication errors in seniors are among the most common preventable errors in the healthcare system today. About one in every three people over 65 will have some sort of adverse medication event that requires a hospital visit, according to Duxbury, and some 10% to 15% of all emergency room visits are related to medication reactions or drug interaction problems in seniors.
One Patient, Many Doctors
Part of the problem is that many people over 65 see multiple physicians. A typical 70-year-old man might see a family doctor for regular checkups, a kidney specialist to control his diabetes, and a cardiologist for his irregular heartbeat. "In some cases, one doctor will be treating a condition and add a medication, but fail to tell a patient that they should discontinue a different medication prescribed by another doctor, so they end up taking both," says Wayne K. Anderson, PhD, dean of the University at Buffalo School of Pharmacy and Pharmaceutical Sciences, which has a specialized program in geriatric pharmacotherapy. "One doctor may not be aware of what other doctors are prescribing."
Good medications in bad combinations can be dangerous and even deadly. Statistically, a person taking eight medications can expect at least one drug interaction problem that will negatively affect his or her health, Anderson says. For example, if you're taking a medication that has blood-thinning properties and then begin to take aspirin on a regular basis, and your doctor doesn't know about both, it can put you in danger of uncontrolled bleeding. Some herbal medications -- which many doctors don't know their patients are taking -- can also influence the blood's ability to clot, causing further problems. That's just one possible set of interactions.
The wrong medications, or the right medications in the wrong combinations, can lead to a "cascade effect." Anderson recalls the story of a man whose doctor prescribed pain medication for his osteoarthritis. The medication caused nausea, for which he was prescribed anti-nausea medication. That drug caused tremors that looked like Parkinson's disease -- and things spun out of control. "The man was being treated by two or three different physicians. One of them prescribed medication for Parkinson's, which caused more nausea and more tremors, and an inability to sleep. So he was prescribed sedatives, which led to absent-mindedness, more shakiness, and dementia-like behavior," Anderson says. "He went from a gentleman who enjoyed his walks and getting the Sunday paper at the corner store to a man who was bedridden with a diagnosis of end-stage parkinsonism and senile dementia." Ultimately, a pharmacist discovered the out-of-control drug combination and notified the man's doctors. Fortunately, he regained normal function and was released from the hospital taking nothing more than Tylenol.