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."
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.
Get Your Drugs in Order
The message is clear: It's time to get your medication in order. Here are a few key principles of medication management for seniors and their families. (If a family member shows any evidence of memory problems, someone else should be in charge of their medications.)
- First, make sure all your healthcare providers know all of the medications you're taking. "Every person, of any age, should carry a complete list of all the medications they take, by name and dose and dose schedule," says Anderson. Your list should include not only prescription medications, but also over-the-counter drugs and herbal remedies. Many herbal preparations can have significant interactions with prescription medications.
- When a new medication is prescribed, ask what it's supposed to do and you're your dosage is. "The general rule is that you should start with the lowest possible dose and work up," Duxbury explains. "Ask your physician if he's starting with the smallest dose."
- Be honest with your doctor about what you're taking. "You might get a prescription for blood pressure medication and find that you can't afford it, so you stop taking it -- but you don't tell your doctor," Duxbury says. "So you go back for a checkup and your blood pressure is still high, so you're prescribed a second medication. Eventually you'll end up in the hospital and the doctor has you listed as taking three or four different medications when you're really not taking anything. So the nurse administers all four at once, and you have a catastrophe."
- Get to know your pharmacist. "It's a good idea to fill all your prescriptions at a single pharmacy, and elders may be better off at a 'mom and pop' drugstore than a chain," says Duxbury. "If it's the same pharmacist behind the counter every time, who knows who their customers are and something about them, that person is much more likely to catch a problem."
- Purge your medicine cabinet on a regular basis. "Every six months to a year, take all your medications -- prescription, over-the-counter, herbal, everything -- out of your medicine cabinet, throw them into a brown paper bag, and take them to your doctor," Duxbury advises. "What he thinks you're taking, what's in your chart, and what's going down your throat are often three different things."