The article highlights the issue of polypharmacy in older adults, where they take multiple medications that may not be necessary or appropriate. Many older adults assume that their healthcare providers will review their medications and check for interactions, but this is not always the case. As a result, patients may be taking medications that are unnecessary or could be causing harmful side effects.
Polypharmacy can lead to complications such as blurred vision, moodiness, organ failure, and even death. It is important for doctors to conduct medication reviews with their older adult patients to ensure they are taking the right medications at the right dosages. However, some doctors may simply add more medications to manage the side effects of unnecessary drugs, rather than addressing the root cause.
A study mentioned in the article found that 57% of people aged 65 and older take five or more medications regularly. While medications are meant to help manage various ailments, taking too many medications can be detrimental. Older adults may not even know what medications they are taking or why, and there may be a lack of communication between patients and doctors regarding medication regimens.
Finding the right balance of medications is essential. Older adults should consult their doctors for a medication review to reassess their medications over time. By doing so, they can reduce the risks of harmful side effects and prevent further prescriptions from being added.
Caregivers and older adults can also play an active role by requesting medication reviews and asking questions about the necessity of certain drugs. Doctors may need prompts from patients to start these conversations, as clinical inertia often prevails.
Pharmacists can also provide valuable insights and information. Local pharmacies can serve as a starting point for older adults to consult with pharmacists about potential harmful drug combinations. In some states, pharmacists can even prescribe medications or advise patients to stop taking unnecessary drugs.
Overall, it is crucial for older adults and caregivers to actively engage in discussions about medications and advocate for medication reviews. Being passive about healthcare can be dangerous, and collaboration between patients, caregivers, and healthcare providers is essential.
Additional Piece: Why Medication Reviews are Vital for Older Adults
Medication reviews are a crucial aspect of healthcare for older adults. As people age, the likelihood of developing chronic conditions increases, leading to the need for multiple medications. However, taking too many medications can have adverse effects and may not be necessary for every individual.
The primary goal of medication reviews is to ensure that older adults are taking the right medications at the right dosages. This involves analyzing the current medication regimen, assessing the appropriateness and effectiveness of each drug, and identifying potential interactions or side effects. Medication reviews also aim to streamline medication regimens, reducing the number of medications or adjusting dosages as necessary.
There are several reasons why medication reviews are vital for older adults:
1. Preventing Polypharmacy: Polypharmacy refers to the use of multiple medications, and it is particularly common among older adults. Taking multiple medications increases the risk of adverse drug interactions, side effects, and medication errors. Medication reviews help identify unnecessary or duplicative medications, eliminating the risk of polypharmacy.
2. Individualized Care: Each older adult has unique medical needs and may respond differently to medications. Medication reviews allow healthcare providers to tailor treatment plans to the specific individual, considering factors such as medical history, current symptoms, and lifestyle. This individualized approach ensures that medications are optimized for each person’s health and well-being.
3. Minimizing Side Effects: Older adults are more susceptible to the side effects of medications due to age-related changes in metabolism and organ function. Medication reviews help identify medications that may be causing adverse effects and allow for adjustments to be made. By minimizing side effects, older adults can improve their quality of life and overall well-being.
4. Simplifying Regimens: Older adults often have complex medication regimens, involving multiple drugs taken at different times and dosages. This can lead to confusion and potential non-adherence. Medication reviews aim to simplify regimens by reducing the number of medications, combining drugs when appropriate, and prescribing long-acting formulations to minimize the frequency of administration. Simplifying regimens enhances medication adherence and reduces the risk of medication errors.
5. Cost Optimization: Medications can be costly, and older adults may face financial constraints when managing their healthcare expenses. Medication reviews provide an opportunity to assess the cost-effectiveness of different medications and explore alternative options that are equally effective but more affordable. This ensures that older adults can access the necessary medications without experiencing financial burden.
To make medication reviews more effective, it is crucial for older adults and caregivers to actively engage in discussions with healthcare providers. They should actively participate in medication reconciliation processes, ensuring that their medication lists are accurate and complete. It is also important to communicate any concerns or issues related to medications during appointments, as doctors may not always initiate medication reviews without prompting.
In conclusion, medication reviews are essential for older adults to optimize their medication regimens, prevent polypharmacy, minimize side effects, simplify regimens, and optimize costs. By actively engaging in conversations about medications and advocating for medication reviews, older adults and caregivers can play a proactive role in their healthcare and ensure that they receive the most appropriate and effective treatments for their unique needs.
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June 16, 2023 – Joanne Lynn, MD, has lost count of the number of times in her 40 years as a geriatrician that she has seen a new patient arrive at her office with a bucket full of prescription drugs, many of which are not they need. .
Lynn, who is on the faculty at the George Washington University School of Medicine and Health Sciences in Washington, DC, recalled a woman who was unknowingly taking two blood pressure medications with different names.
“The risks included all the side effects that come with an overdose,” Lynn said, ranging from blurred vision and moodiness to organ failure and even death.
For doctors with patients who don’t know they’re taking too much medication, “you wonder if the drug is causing the health problems and if it’s a symptom of the wrong drug,” rather than a symptom of an undiagnosed disease. she said.
Many adults over the age of 65 with chronic conditions may be taking too many medications and could benefit from a medication review with their primary care physician. Patients often assume that their healthcare providers check for drug interactions or assess whether a drug is no longer needed, and will spot additional prescriptions. That could be a risky assumption.
Some doctors may prescribe yet another prescription to manage the side effects of an unnecessary drug, instead of reviewing the drug and potentially “withdrawing the prescription” or stopping treatment that is no longer needed.
About 57% of people 65 and older take five or more medications regularly, a concept known as polypharmacy. a study published in 2020 in the Journal of the American Geriatrics Society shows While doctors prescribe medications to help patients manage various ailments, as the list of medications grows, so do potential complications.
An older adult may forget to tell their doctor what they’re taking, or may not even know what they’re taking or why, Lynn said.
“In some cases, a doctor just added a drug to treat something, not realizing that he was already taking something else,” he said. “Of course, the situation of whether these patients can afford all these drugs is also very important.”
Some older adults may choose which medications to take based on cost, without knowing which prescriptions are needed, Lynn said.
Finding the “right balance”
In fact, given the choice, up to 80% of adults ages 50 to 80 and older would be willing to stop taking one or more of their prescribed drugs, according to a 2023 survey by researchers at the University of Michigan.
“A lot of drugs that people take might have been appropriate at one point, but they might no longer be helpful for that person,” said Michael Steinman, MD, professor of medicine and geriatrics at the University of California, San Francisco, and co-authors. principal investigator of the US Deprescription Research Networka group of physicians focused on improving medication use for older adults.
“Having less medication can actually be beneficial,” he said. “You can take too many medications; you can take very few. The optimal thing is to find the right balance for you.”
Defining how many medications are too many depends on each person, so caregivers and older adults can consult their doctor for a medication review that have multiplied over time.
By reassessing their medications, older adults can reduce their chances of potentially harmful side effects and avoid spiraling into being prescribed even more medications, said Sarah Vordenberg, PharmD, MPH, clinical associate professor at the University of Michigan School of Pharmacy. , in Ann Arbor.
“It’s not really the amount of medication, it’s [about] Are they inappropriate or unnecessary medications for a patient, he said.
Patients and caregivers can request an honest discussion with their doctor. He University of Michigan survey found that more than 90% of older adults taking prescription drugs expected their health care provider to review their medications during a regular visit.
But doctors often need prompts from patients to start a review.
“Clinical inertia, or maintaining the status quo, unfortunately is often easier than having time-consuming conversations,” Vordenberg said.
Ask questions
Sara Merwin spent many years helping manage her parents’ health and medical appointments as they transitioned from living independently in Colorado to a retirement community and ultimately a nursing home. Merwin, co-author of The informed patientShe said her father was taking a long list of medications and would often ask her primary care physician for a medication review.
“I felt like my father at his age and frailty didn’t need as much medication as he was taking,” said Merwin, who lives on Long Island, New York. “So we went over his medications and I asked him, ‘Do you really need to take this?’ ‘Does he really need to be in it?’”
She questioned one drug in particular, a statin drug for lowering cholesterol and the risk of heart attack.
“I thought possibly the statin was causing her some myalgia, some muscle pain in her legs, so I advocated stopping it,” he said.
The primary care physician stopped the cholesterol medication.
Local pharmacies can also serve as a starting point for older adults and caregivers, where a pharmacist can provide more information about whether a particular combination of medications they take may be harmful. In states that allow pharmacists To prescribe some medications, pharmacists may consolidate some of the medications or advise a patient to stop taking one or more, Vordenberg said.
“All pharmacists have the training to do a comprehensive review of medications,” he said. “All pharmacists have the ability to follow up on the patient to see how the deprescription is going.”
Merwin’s parents received their prescriptions from a “small family pharmacy, where they called each other by name with the pharmacist who actually cared for them. So they had that experience available to them,” he said.
With the information available on potentially unnecessary drugs, the drug elimination job must be done in conjunction with the health care providers, some of whom prescribed the drugs in the first place.
Many older adults live in geographically isolated areas without pharmacies or receive prescriptions from mail-order pharmacies. In this case, Medicare plans offer free medication reviews with a doctor or pharmacist, known as a drug therapy management program, and provide recommendations for taking each medication.
Merwin’s father died in early 2020. Sometimes, she wonders if she should have stayed on the statin longer or if the doctor agreed too quickly without further investigation. But overall, she doesn’t regret raising the question with her health care providers and advises other caregivers and older adults to pay attention to medication lists.
“It’s dangerous to be passive when it comes to health care,” Merwin said. “That’s a hard message for older adults to hear because they’ve grown up with the primacy of the doctor and the authority of the doctor, rather than a collaborative relationship.”
https://www.webmd.com/healthy-aging/news/20230616/deprescribing-should-some-older-adults-shed-their-meds?src=RSS_PUBLIC
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