My sister-in-law has a good friend, Carol, who is 75 years old and takes 15 prescription medicines, not counting her multivitamin or blood glucose test strips. Concerned that Carol could be taking too many medications, she asked me to help. Carol agreed to send me her current list of allergies, medical conditions and medicines. Over the past several months, Carol had complained that she “felt too tired” to do the things she’d always used to have fun doing, and was in the hospital twice this winter for lung problems. She kept telling her friends, “It’s no fun getting old!”
But what if her fatigue is not from getting older but instead from taking too much medicine?
Over 1/3 of older adults take 5 or more prescription medicines. If you count non-prescription medicines like vitamins and supplements, the number taking 5 or more medicines doubles, to 67% percent. Part of the reason older Americans take so many medicines is that as we get older, we collect more chronic ailments, and the most common treatment doctors use for most medical conditions is a medication.
Taking too much medication actually has a name: polypharmacy.
What is polypharmacy? “Poly” means “much” or “many”, so polypharmacy literally means “many medicines”. Polypharmacy is not defined based on a specific number of medicines you take but whether you are taking more medications than medically necessary.
Polypharmacy is dangerous because the more medicines we take, the more they can interact with each other and cause harmful side effects, ranging from fatigue to confusion to an increased risk of falls.
Who is at risk for polypharmacy?
Older adults like Carol who live in their own home are more likely to be at risk of either taking multiple medicines for the same thing, or new medicines to treat side effects of their current medicines. Polypharmacy is even more likely if, like Carol, they see specialists or have been recently hospitalized.
How does polypharmacy happen?
When people visit a physician, they expect something to happen, and they are not often disappointed. Between 50-75% of emergency department (ED) and clinic visits result in the doctor prescribing a new medicine for you. Doctors feel pressure to provide some kind of tangible “care”, and medications are by far the most common form of medical treatment in the United States.
One preventable problem is that sometimes new prescriptions aren’t treating a new condition. Instead, they are prescribed to address a side effect of one of the medicines you are already taking! There’s a name for this: The Prescribing Cascade.
There are several factors that create conditions for polypharmacy and the Prescribing Cascade to happen. One risk factor is your doctor not having complete information on the medicines you are already taking or have already tried.
Another risk factor is seeing multiple doctors, including specialists who are seeing you for one specific issue, who don’t see the entire picture or are not aware of what your other doctors have already done.
Being admitted to the hospital for a new or worsening condition is another risk factor, which can add medications that may not be necessary once the condition stabilizes, but which are often continued after being discharged back home.
One of the most preventable yet dangerous causes of polypharmacy and the Prescribing Cascade is taking two medicines for the same thing at the same time. This can happen whenever a new medicine is prescribed, because doctors don’t have much time to talk to you these days, and there can be confusion or misunderstanding about whether your doctor ADDED this new medicine to the others you already are taking, or REPLACED one of your medicines, and if so, which one.
Using a mail-order pharmacy can also contribute to polypharmacy and the Prescribing Cascade. It can take a week or more until your new prescription arrives in the mail, which by that time you may not remember what the doctor told you about why you were taking that medicine and whether it was in addition or to substitute for another one. Using than one pharmacy also hampers the ability of a pharmacist to recognize unnecessary or dangerous combinations of medicines, because you don’t get all of your prescriptions in one place.
Why does polypharmacy tend to continue?
Reluctance to change can play a part. Physicians can be reluctant to change another doctor’s orders, especially if a medication is from a specialist.
Our medical care system is fragmented, with vital information often missing from the doctors taking care of you. New and important information about you from specialists isn’t always shared with your other doctors in a timely manner, creating gaps in knowledge of what has already happened to you.
Some patients become anxious about stopping a medicine that they were told by a doctor that they would be on “for life”, and may feel that the clinician suggesting they reduce or stop it as “giving up on them”.
Do certain medicines cause more trouble than others?
Unfortunately, yes. There are medicines that cause more problems in older adults, setting them up for getting prescribed even more medicines to “treat” those side effects, creating the Prescribing Cascade.
As we age, we gradually lose some resilience when it comes to tolerating different medicines. Adults over 65 years old are more likely to get dizziness, fatigue and confusion from their medicines than younger people.
Here Are 6 Ways to Protect Yourself from Polypharmacy and the Prescribing Cascade:
- Watch out when starting or changing medications.
After starting a new medication or after a dose adjustment, report any problems to your doctor right away. It’s better to decrease or change that medicine than end up on an additional one that’s treating its side effects!
- Keep a complete list of ALL your medications and supplements.
Include all the non-prescription medicines and supplements you currently take, and any allergies or adverse experiences you have had with any specific medicine in the past.
- Take your medication list to EVERY medical visit.
Whenever and wherever you receive medical care, give your medication list to your regular doctor, the Emergency Department, any specialist, even your dentist and chiropractor.
- Keep your medication list updated.
After any hospital stay or appointment with a specialist, update your medication list with any new or discontinued medicines. Ask for a summary of the hospital stay or specialist appointment that includes with any new plans or medicines, and use that to update your current list.
- Clarify any new medicine as either an addition OR a replacement.
Whenever you receive a new prescription medicine, make sure you understand whether it is in ADDITION to what you already are taking or REPLACES one of your current medicines, along with which medicine to stop.
- Ask your pharmacist.
If you have questions about whether medicines belong together or not, your pharmacist is a great resource.
