Over-prescribing is on the riseLesterman/ShutterstockTypically defined as taking five or more medications at the same time, over-prescribing or polypharmacy has become a big problem, particularly among older adults. "There are many factors contributing to the high rates of polypharmacy we're seeing, including patients living longer, more medicines coming on the market, and our fragmented health system, where care is often uncoordinated," says Caleb Alexander, MD, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. "Prescription medicines serve an invaluable role in the treatment of many diseases, but millions of Americans are on medicines they may no longer need." In fact a 2015 survey by Harvard researchers found that 39 percent of adults over 65 take five or more medications, which is a 70 percent increase over a 12-year period. "It's stunning how much more of this I'm seeing," says Gary L. LeRoy, MD, a family physician in Dayton, Ohio, and a member of the board of the American Academy of Family Physicians. "I think electronic health records are helping us realize more patients are falling into polypharmacy, because instead of handwritten charts we can now electronically follow people's prescriptions."
Don't forget vitamins and OTC medsR_Szatkowski/ShutterstockOver-prescribing is known as polypharmacy because it doesn't just involve prescriptions; over-the-counter drugs and supplements also contribute to the danger. "Back when I was a med student, Prilosec could only be prescribed by gastroenterologists; today you can buy it yourself. We now have many medications you can buy off the shelf that aren't exactly harmless," says Dr. LeRoy. "Even if it's natural or herbal, it may have an ingredient that could adversely interact with a prescription." In fact, the vast majority of older adults taking prescriptions are also using over-the-counter treatments, says Dr. Alexander, who co-authored a 2016 study on the subject in JAMA Internal Medicine. "In this paper we found that 15 percent of older adults were at risk for a major drug-to-drug interactions because of the combination of prescription medicines with over-the-counter medicines and dietary supplements," he says. The types of non-prescription pills found to lead to troubles included omega-3 fish oil, aspirin, potassium, and garlic. Discover which eight supplements women may not need.
Beware the Rx cascadeSherry-Yates-Young/ShutterstockSay you're taking a sleeping pill prescribed by your doctor; while on that, you have a procedure and the surgeon gives you a pain medication; then you notice a rash and decide to swallow Benadryl. "Now you're taking three things that suppress your ability to stay awake and breathe," says Dr. LeRoy. "That's a dangerous combination, and it's only one example of possible interactions." Other scary combos can cause reactions ranging from "confusion to life-threatening cardiac events and anything in between," says Dr. Alexander. Then there's the prescribing cascade, in which a bad reaction to one medication is viewed as a distinct medical issue that leads to another prescription, and so on. Call it "distraction complexity," says Dr. Alexander: There's too many meds for patients or their providers to keep track of.
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Getting older could mean fewer pillsSikhorn-Palanan/ShutterstockWhile some may think aging inevitably means more meds, Dr. LeRoy says that isn't always true. "Sometimes, things just get better," he explains. "I'll see patients who retire and stop worrying about work, and suddenly their hypertension improves and they sleep better, so I can reduce their blood pressure dosage or drop their sleeping pills. I recently had a patient say, 'I finally started eating right and lost 20 pounds!' His blood pressure looked amazing and some of his gastrointestinal problems improved, so we could back off those medicines." Hearing that their prescription regimens could be trimmed can motivate patients to live a healthier lifestyle, Dr. LeRoy adds. "It can help patients realize, 'If I'm good we could get rid of some of these pills.' And that reduction decreases the likelihood of drug-drug interactions." Take the first step by trying this diet to lower your blood pressure.
Watch for med mistakesDavid-Smart/ShutterstockSome patients have so many pill bottles prescribed by so many doctors, they lose sight of what's necessary. For example, Dr. LeRoy has seen patients daily swallowing medications that were prescribed to be taken "as needed." He's also seen patients prescribed a generic like omeprazole by a specialist who didn't realize the patient was already taking Prilosec. "Those are generic and brand name versions of the same medication," says Dr. LeRoy. "So the patient is doubling up and suffering side effects." Learn about 10 additional medication mistakes to avoid.
Let loved ones help outTHEERASAK-TAMMACHUEN/ShutterstockIn some cases, it's not the patient but their spouses or adult children who might be in the best position to catch signs of over-prescribing. "Start by noticing how many pill bottles are lying around the house," says Dr. LeRoy. "Then do a two-minute quiz: 'Mom, what is this medication for?' or 'Pops, when is the last time you took this?' If you're seeing 16 bottles sitting out, and the patient isn't sure how many they take or when, that's a big problem." Loved ones can also provide crucial help by coming to appointments, adds Dr. LeRoy, in order to take notes and hear first-hand what the medications are for and how they should be taken.
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Know when it's time to call for helpAndrei_R/Shutterstock"I think any patient who is concerned about whether or not they're on too many medicines should raise this issue with their physician," says Dr. Alexander, who also notes some specific circumstances that might prompt a patient to pick up the phone. Starting with being on five or more medications, or if you're experiencing what you believe are adverse effects from a pill or a combination of pills. "It's impossible to have too much communication between patients and providers about the treatments patients are taking," Dr. Alexander adds. Discover other signs and symptoms that should prompt a call to the doctor.
Call the right docKittipong33/ShutterstockThose myriad pill bottles may have different docs listed as contacts, but stick with your primary care provider for your first call. "Although our healthcare system is quite fragmented, primary care physicians should serve as quarterbacks for their patients and help coordinate all the care they're receiving," Dr. Alexander says. "Primary care physicians are very well suited to try to minimize avoidable polypharmacy by making their patients' prescription regimens as lean as possible." Dr. LeRoy, a primary care physician himself, agrees. "Everyone needs a family physician who knows them personally," he says. This relationship also helps the physician know which loved ones to involve in the patient's care. "I'll call the wife, the sister, or the brother—with my patient's permission—to discuss these prescriptions and make sure everyone is on the same page."
Talk with your doc to lighten your Rx loadPhovoir/ShutterstockIn order to sort through a confusing medication regimen, your doctor could schedule a "medication reconciliation" visit. "I've had patients bring in small carry on suitcases filled with pill bottles," says Dr. LeRoy. "We line them up, discuss why they're taking each one, and make sure there are no drug-to-drug interactions." During such reviews, physicians can look for opportunities to whittle down the regimen to the essentials. "I'm a firm believer that less is better," says Dr. LeRoy. This move is safe, suggests a 2016 Australian study, which concluded "deprescribing" among older adults had "no significant adverse effects on survival or other clinical outcomes."
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