Experts warn about the dangers of polypharmacy
By Deborah Jeanne Sergeant
The older patients become, the more likely they need prescription medication. According to the AARP, people 45 and older on average take four prescriptions daily. While needed medications improve length and quality of life, taking too many unnecessary prescriptions can have the opposite effect.
Physician Joanne Wu, board-certified integrative and holistic medicine and rehabilitation doctor, specializes in wellness and sees clients in Buffalo and other areas in Upstate.
She believes that one reason that some older adults take unnecessary medications is that their care providers lack to time to comb through their patients’ medical records and discuss their health goals.
Many also don’t re-evaluate how well medication is working.
“We’re striving for better cholesterol, diabetes and blood pressure numbers, which prevent mortality in the long run, but if you’re taking three to four drugs and the numbers are not well-controlled, at some point, the primary care team may need to sit down and review it,” Wu said.
The patient’s physicians may not realize all the medication taken. At this age and stage, many patients see numerous specialists who may not always communicate with each other. Despite the prevalence of electronic medical records, the systems don’t usually transfer data between them. By law, they also require signed paperwork from patients to transfer data.
Older patients also seldom self-advocate.
“A lot of older adults don’t have the medical literacy to understand that a drug may cause harm,” Wu said. “It takes a strong primary care team and support for that older adult so they can understand they have a choice in the matter as to whether they take that drug or not.
“If people take time to talk about those goals with the family and patient, we’d probably cut down on polypharmacy.”
Wu added that some older adults taking over-the-counter drugs, herbs and supplements don’t realize the potential for negative drug interactions.
Older adults who travel or spend winters South use different providers and pharmacies, making it more difficult to keep track of what they’re taking. For elderly adults, taking multiple medication may become difficult — and more dangerous — because of cognitive impairment.
Physician Priyanka Patnaik serves as medical director with UBMD Family Medicine at UBMD Outpatient Center at Conventus. She is also an assistant professor in the department of family medicine in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.
She said that younger patients may well tolerate medication that a middle-aged or older person may not. As the body ages, it’s less capable of efficiently processing and metabolizing medication.
“The body itself is changing physiologically,” she explained. “The type of side effects they didn’t see when they were younger become evident. Their body fat distribution is different. They may eat less. As a result, they may need their dose adjusted because otherwise, they can experience side effects such as an unstable gait or feeling confused.”
Some patients may take medication to counteract a side effect of another medication; however, if the side effect is that bothersome, Patnaik said that patients need to ask about alternatives that could help mitigate the original problem.
Patnaik advises patients to bring every prescription bottle, over-the-counter medication and supplement to every visit with every provider, even if the medication wasn’t prescribed by that provider.
“That is one of the most important suggestions that patients should follow,” Patnaik said. “A lot of times, patients are going to multiple physicians and they don’t advise their primary care provider about what they’re taking from other providers.”
She encourages patients to regularly assess their medication with their providers, since one’s health and body change constantly.
“It’s always a good thing to ask questions about side effects and be aware of what possibly can happen,” Patnaik said.