Managing medication

If you’re helping to care for someone with health and healthcare issues, chances are that person is taking at least a couple of prescription medications, if not several. Have you ever wondered if they’re on the right medications? Or have you worried about side-effects and interactions but stayed quiet because you feel like the medical professionals must know best? Don’t be shy. These are reasonable questions to be asking.

What you need to know

Medications can help, but studies have shown repeatedly that lots of older adults end up suffering from problems related specifically to too much medication. It’s good to step back and get an overview of everything they’re taking for two key reasons: As we get older, we metabolise drugs differently, and secondly, the combined effects of different types of medications can sometimes be counter-productive or even harmful. This does not only apply to prescriptions, it’s also true for over-the-counter (OTC) medications and dietary supplements, which people often use without letting their doctors know.

Research shows that the average older adult takes four or more prescription drugs each day, and a whopping 39% of older people take five or more prescriptions each day (known as ‘polypharmacy’). While each one was created to treat or manage a specific medical problem, each also comes with its own risks and side effects. The more medications a person takes, the higher the chances are for experiencing adverse reactions, negative side effects and even life-threatening conditions. Overall, polypharmacy in the elderly is a major contributor to disability, frailty, falls, long-term care placement and a decreased quality of life.

Treating only one chronic medical condition may require several prescriptions, but for older adults who often have several ailments, their medication regimens can be very complex. It can get to the point where the patient doesn’t know all the drugs they’re taking, why they’re needed, or how to take them properly. Medication errors are more likely with complex regimens and can be dangerous as well. What is worse is that physicians may not be aware of all the medications their patients are taking either.

Common adverse effects of multiple medications

If a loved one takes multiple prescriptions, OTC medications and/or supplements each day, it’s important to keep an eye out for troubling side effects such as:

• Tiredness, sleepiness or decreased alertness

• Constipation, diarrhoea or incontinence

• Loss of appetite

• Confusion (either continuous or episodic)

• Falls and other mobility problems (caused by balance issues)

• Depression or general lack of interest

• Weakness

• Tremors

• Hallucinations (such as seeing or hearing things)

• Anxiety or excitability

• Dizziness

• Changes in sexual behaviour

• Skin rashes.

How to reduce the danger of problems with medication

Responsible medication management is the best way to prevent adverse health outcomes related to drug use. Your loved one and their entire care team must work together toward this goal. It is a good idea to:

• Make a complete medication list (see page 6 of this article), including supplements. The list should include each drug’s name, strength (in milligrams or international units), recommended dosage, instructions (such as frequency and timing), and any cautions stated on the bottle or package.

• Read medication inserts and instructions carefully. The insert will provide information about the medicine, how to take it, possible interactions with certain medical conditions, other drugs, and foods, and tips for avoiding adverse effects while taking it.

• Use one pharmacy to fill prescriptions. This will help the pharmacist gather complete information about all the medications a patient is taking and ‘red flag’ possible side effects and adverse drug interactions. You can consider making your loved one’s pharmacist a larger part of their care team.

• Schedule regular medication reviews. Depending on how frequently your loved one’s regimen changes, it is wise to attend a check-up or medication review with their doctor or pharmacist at least once a year. Traditionally, this involves bringing in all their medication or a full medication list. It may be wise to schedule a longer appointment to ensure there is enough time to address any concerns. Squeezing everything into a generic 15-minute appointment slot is often a challenge.

Get to know ‘deprescribing’

If you’ve ever experienced concerns over your loved one’s medication, or if you (or your older adult) are taking more than five medications, familiarise yourself with ‘deprescribing’. It’s a process that can improve or resolve all those problems that older adults have with their medications and it’s essential to optimising the health of an older adult.

In literal terms, deprescribing is just as it sounds: it’s the opposite of prescribing. Instead of adding a medication to someone’s care plan, healthcare providers remove or reduce the dosage of one or more medications. Deprescribing means reducing or stopping medications that may not be beneficial or may be causing harm. The goal of deprescribing is to maintain or improve quality of life.

You might think this would be the default in healthcare, but unfortunately, it isn’t. For many reasons – the influence of drug companies, the shortage of time during GP visits, etc. – it tends to be much easier for doctors to prescribe medication than it is for them to take a close look at the types of medication your loved one is taking and reduce dosage or eliminate those that are unnecessary.

The most important thing to do is to ask your doctors to review medications with you regularly, and ask for help with deprescribing.

Which medications are the most important to consider deprescribing in older adults?

Some of the medications that are especially important to assess for deprescribing are:

• Medications associated with falls

• Medications associated with diminished brain function and cognitive impairment

• Non-steroidal anti-inflammatory drugs (NSAIDs)

• Medications that lower blood sugar (for people with diabetes)

• Proton-pump inhibitors (PPIs)

• Medications used in Alzheimer’s and other dementias to manage difficult behaviours

• Opioids and other medications prescribed for pain.

Ways to start a conversation with your doctor about deprescribing can include:

• Why am I taking this medication?

• What are the potential benefits and potential harmful effects?

• Can it affect my memory?

• Can it cause me to fall?

• Can I stop one of my pills? Do I need to reduce the medication slowly?

• Who do I follow-up with and when?

Deprescribing isn’t something that you can do for yourself or a family member. You should always work with a health professional before stopping or reducing any prescription medications. However, you can certainly get a head-start on the process by doing a little research and preparation before discussing medications with your health providers.