Multiple drugs and the elderly

Ashley Thomasson
Ashley Thomasson

This one of a series of columns about health issues written by staff members of ProMedica, Mercy Health Partners, Toledo Clinic, and the University of Toledo Medical Center, the former Medical College of Ohio.

In the United States, people over the age of 65 make up approximately 13 percent of the population but use about 30 percent of all prescriptions written.

At any given time, an elderly patient takes on average four or five prescription drugs and two over-the-counter (OTC) medications. The elderly use more drugs because they have more illnesses such as heart disease, high blood pressure, and diabetes. As the baby boomers age, the increase of elderly patients in hospitals, emergency departments, and physician’s offices are rising.

A common issue that the medical community sees is “polypharmacy,” which essentially means “many drugs.” Studies have shown that polypharmacy continues to increase and be a significant risk factor of mortality and morbidity, especially in the elderly. People at risk of polypharmacy include the elderly, people who live alone, people who use multiple pharmacies, and people who see multiple providers.

There are multiple reasons why polypharmacy occurs, including using multiple pharmacies, not keeping adequate medication records, not including OTC medications in the medication list, and failure to review medications with primary care providers. Some medications used to be by prescription only, such as Prilosec and Claritin, but now people can buy them without one. Even though these medications are sold over the counter, they still can have interactions with prescription medications. Herbal supplements also can have interference with prescription medications and the FDA does often not regulate herbs. Use caution when taking OTC medications and talk to your primary care provider when starting a new medication.

Sometimes polypharmacy is necessary to take care of complicated medical conditions but most of the time problems occur as a result of too many medications. Such complications include increase risk of side effects due to multiple drugs, decrease risk of compliance because of the number of pills that have to be taken, poor quality of life because of side effects that can occur, increase medical expense and unnecessary drug costs, and poor patient outcomes.

Patients often see specialty providers for complicated issues such as problems with their heart or lungs and obtain medications from that specialist. It is easy to forget to tell their primary care provider that a new prescription was written by the specialist. By doing a review of medication with the primary care provider, it is easy to examine medications that are deemed unnecessary or have an increase risk of side effects. A good way to review medications is to bring in every medication that is being taken at home, including prescriptions, OTC, herbals, and vitamins.

Here are some tips to reduce polypharmacy:

Write down all medications including over the counter drugs. Include the dose and how many times a day it is to be taken.

  • Use one pharmacy to fill medications.
  • Use the pharmacist and the educational services that they provide.
  • Review all medications with the primary care provider including medications that are prescribed from specialty providers and all over the counter medications.
  • Never take one drug to off set side effects from another drug.
  • Report all symptoms or side effects that might be occurring.
  • Use all medications exactly how the are prescribed.

If you feel you are taking too many medications, then talk to your primary care provider. They will work with you to come up with regimen that you both can agree on. Reducing the amount of medications that are taken on a daily basis can improve compliance with medication regimen, reduce side effects of medications, and overall improve the quality of life.

Ashley Thomasson is a registered nurse at Mercy St. Anne Hospital.