Does it seem like you, your loved one, or your patient is on too many medications? Further, just how many is “too many”?
The medical term for this is “polypharmacy”, and an increasing number of older adults worldwide are experiencing it. One common definition in the medical literature is the regular use of 5 or more medications. Or, we may just say, “more medications than are truly needed”… whatever that number may be for a particular person.
Studies in the US have consistently shown that the number of adults taking a large number of medications has increased since 1999 (from 8% to 15% of people 20 years and older). These numbers increase as we study older populations (up to 39% of adults 65 years and older). This number climbs markedly if we examine people living in long term care (up to 91% of such people!)
We must be careful with these statistics, because many of us actually need the medications we take… whether that is 2, 5, or 10. The point of this discussion is to raise awareness, and help to better inform you and encourage you to ask the right questions.
Why does Polypharmacy occur?
Older adults have simply been through enough of life to have multiple chronic conditions. They also have had, and recovered from, many illnesses and injuries. Combine this with our fragmented healthcare system, our constantly changing healthcare system, effective advertising, and internet sensationalism… and we may look up one day to find we all have a basket of pill bottles to manage!
Medical research has uncovered some things that make polypharmacy more likely:
- Being “older” (older than 62, according to some research)
- Having multiple subspecialists
- Having no primary care physician
- Residing in a long term care facility
- Having cognitive impairment or a developmental disability
- Having a mental health condition or diagnosis
- Being “frail”
- Having multiple medical conditions (such as heart disease, diabetes, high blood pressure, chronic lung or kidney disease, etc.)
Why does “Polypharmacy” matter?
Being on extra medications can put us at risk of certain undesirable consequences:
- Decreased mobility
- Decreased lifespan
- Decreased QOL (quality of life)
- Increased number of visits to the doctor, ER, or hospital
- Increased risk of medication side effects and interactions
- Increased fall risk (injury), disability and/or frailty
- Increased need for long term care placement (which further increased risk of polypharmacy)
- Poor compliance with medication regimen, and confusion as too which medications are highest priority
- Increased cost (both out of pocket and cost to insurance, Medicare and Medicaid)
What do to about it?
Do not simply stop any of your medications without discussing with your physician or primary care provider… there are several things that you and your physician can do to evaluate which, if any, medications are best removed from your regimen. Also, note that many medications may require tapering, or some testing / monitoring when making any changes!
Here are some suggestions steps to take if you think you may be on “too many” medications:
- Make a list of medications that is accurate, complete and up to date.
- Separate it into medications that you take “regularly”, and those that you take “as needed”
- For the “as needed” medications, write down how often you typically “need” them.
- Try to write down your recollection of what you take each medication for, and when you started it (our metabolism, and our “needs” for each medication may change over time)
- Write down any side effects you think you may be having, from any of them. Think about what has been happening in your life lately.
- Are you more “foggy”, sleepy, dizzy, unsteady?
- Do you have more frequent changes in bowel function or urination?
- Are you more depressed, more anxious, less able to sleep?
- Has your weight or appetite changed?
- Are you having new/different pain, difficulty breathing, visual changes?
- How is your energy level? Are you taking longer to do normal tasks?
- Make another list of ALL of your doctors and health care professionals.
- Include Primary Care Provider(s), walk in clinics and urgent cares that you use periodically
- Include all specialists, even if you don’t think it is particularly relevant at this time.
- Pick ONE Primary Care Provider that you can discuss this with… and revisit with. It is important that you and your PCP take adequate time to have this discussion, and plan for f/u sessions as needed.
- Make sure that your PCP, or their office, are aware that this is what you would like to accomplish during this visit.
- This conversation may necessitate more discussion with one or more of your specialists, as you work through your list of priorities.
After meeting with your PCP, the two of you may decide that “deprescribing” is necessary. Be sure to express your priorities during this process: Is relief of side effects more important than reducing your lab markers? Is a good night of sleep more important than treating your “end-of-the-day” ankle swelling?
Most importantly, take an interest in your medication list, and be empowered to be informed, involved, and satisfied that you are on the medications that are appropriate for YOU.