Answers provided by Carol Baird, M.D., board certified in internal medicine and has an extensive background in caring for older adults.
|
|
| Carol Baird, M.D. |
Q: What is polypharmacy?
Polypharmacy is a word used for taking more medications than clinically indicated. Those medications can be prescription medicines or over-the-counter medicines. There’s no specific number that means too many medications but once you get to about seven or eight, your chances of interactions increase exponentially.
Q: What are some problems associated with that?
Things that I see in my practice are people who have increased risks of falls, an increased risk of dizziness, and increase in memory problems. The more medications you take the more likely you are to not be able to take them correctly. One study indicates that 75 percent of people of all ages can’t take a seven-day prescription without missing a dose. So if you see people in their 70’s taking eight or nine medications, the chances of them not missing doses are pretty small.
Q: What is the most important thing you can do to help with medication management?
Don’t be shy about asking questions of your doctor. In the end, it’s going to be your body that experiences the effects of the medicines, so if you have questions about the dose or how to take it, you should ask the doctor or pharmacist before you start taking a new medication.
Q: What are examples of over-the-counter medications that can interact with prescription drugs?
Over-the-counter medications can include vitamins, herbal supplements, pain relievers and cold remedies. It can also include alcohol, tobacco and caffeine. The number of chemicals we put in our bodies on a daily basis is pretty great. There’s a myth that if you’re taking an over-the-counter or natural health product that means it’s safe and it doesn’t interact with anything. That’s just not true. Natural or over-the-counter does not equal safe.
Q: Why would an older person be at risk?
There are a couple of reasons. Older persons may have more than one chronic medical condition that they’re dealing with; examples would be diabetes, heart failure, arthritis – and the result is different doctors can prescribe medications. A prescription cascade can occur where a side effect of one medication is viewed as a new medical condition and another medication is added. A side effect of the second medication is treated with a third, etc. Without one person coordinating the prescriptions, you can end up with medications that interact with each other. Another thing is older adults often need lower doses because they don’t clear the drugs as easily from their system and so they need more careful monitoring in terms of therapeutic effects, adverse effects and toxic reactions.
Q: What are some medication management methods?
I tell my patients if they find themselves with seven or more medications on their list, including over-the-counter products, they should ask either their pharmacist or their doctor for a comprehensive drug review. It helps to ask one doctor to be a gatekeeper for all your medications. Also, they should have all their medications filled at one pharmacy as the pharmacist will check for adverse interactions.
There are also tools that help you take medications on time – some people use medication boxes, calendars, have other people help remind them – all of those things are helpful in getting the right dose at the right time. Also, you need to make sure that you can read the bottle – sometimes the print is too small to be able to read. Ask for large-print instructions and large-print bottles. Some pharmacies will even put different colored lids on the bottles.
Q: Can medication management help with increasing prescription costs?
This problem is becoming worse and worse. When a patient is given a new medication, they should ask their physician “What is this going to cost me?” Sometimes there are generic or less costly alternatives.
|
