About 1 in 5 adults between the ages of 40 and 79 take five or more prescription medications, according to data from the Centers for Disease Control and Prevention. And the older patients are, the more likely they are to take even more medications.
But taking multiple medications together, known to medical experts as polypharmacy, increases the risk of serious side effects and drug interactions, said Dr. Nina Blachman, associate professor of medicine and geriatrics at the Grossman School of Medicine from New York University.
Studies show that taking multiple medications is associated with faster memory decline in some patients with mild cognitive impairment, and a higher risk of falls in people with balance problems or weakened muscles. And some drug combinations can cause excessive bleeding, dangerously low hypoglycemia, or other serious complications that lead to hundreds of older adults being hospitalized every day.
While medications can be essential to improving our quality of life, it’s important to understand why people end up taking too many medications unnecessarily and when to seek help in narrowing down your prescription list.
How Prescriptions Can Stack Up
As people age, they develop more health problems such as diabetes, heart disease, arthritis and high blood pressure, and “end up taking more and more medications,” Blachman said. Many never stop medications they have been prescribed for years, even if they no longer need them or there are new formulations available that can treat different symptoms simultaneously.
Patients sometimes also see various medical providers, each of whom may prescribe medications without necessarily communicating with each other.
Sometimes healthcare professionals may prescribe medications to treat the side effects of another medication, in what doctors call a “prescription cascade.” For example, people who take certain over-the-counter pain relievers called nonsteroidal anti-inflammatory drugs may experience increased blood pressure, which doctors may misdiagnose as a new illness and prescribe calcium channel blockers as treatment. But in some people, these blood pressure medications can cause swelling in the ankle, which can then lead to the prescription of a diuretic to reduce fluid buildup in the body.
“So you end up chasing the side effects of one drug after another,” Blachman said.
Older patients may also be more likely to develop new or worse side effects with medications, because kidney and liver function may decline with age, making the body less able to filter certain medications, said scientist Barbara Farrell. at the Bruyère Research Institute in Ottawa. , Ontario. This can lead to patients being prescribed even more medications to treat these side effects.
Although polypharmacy is more common among older adults, young adults and even children, particularly those with complex chronic conditions like epilepsy, learning disabilities, or mental health problems, can also find themselves under many medications.
To complicate matters further, pharmacists and doctors don’t always know how or when to help patients stop taking their medications safely, Farrell said. But in recent years, she and other experts have called for more guidelines on reducing or stopping prescription drugs.
How to review your medications and cut back where you can
Ideally, doctors and pharmacists should do what’s called medication reconciliation every time you see them, said Kuldip Patel, assistant director of pharmacy at Duke University Hospital in North Carolina. To do this, his team reviews the list of medications people take when they are admitted or discharged from the hospital. But that doesn’t always happen in all medical settings, he said.
Experts suggest having a primary care physician or pharmacist perform a comprehensive medication review at least once a year. Many pharmacies offer such assessments as part of free medication therapy management programs. Make a list of your medications — including supplements and over-the-counter medications — or collect all of your pill bottles and take them with you to the appointment, Patel said.
But perhaps the best time to talk about using prescriptions is before you start taking a new medication. Ask your doctor questions like, “Am I experiencing a symptom that could be a side effect of a medication I’m taking?” or “Can I try to manage this symptom with lifestyle changes first?”
When you need medication, see if you can start with a lower dose, Farrell said. Remind the doctor about the medications you are taking and ask how the new medication will interact with them.
Finally, ask how long you will need to take a medication and make a plan with your doctor to stop taking it if necessary. You need to understand how your provider plans to help you taper off treatment, what withdrawal symptoms to watch for, and how to make sure the problem you were being treated for doesn’t return.
“These are questions that people should ask themselves even in their teens and 20s when they start taking some of these medications,” Farrell said. “Then we hope that one day we can prevent people from getting to the point where they’re taking 25 medications in total.”
Sheikh writes for The New York Times.
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