By Heather Bennett Schickedanz, MD
Inspired to do some spring cleaning this April? Don’t forget to take stock of your medicine cabinet while cleaning out your garage or attic. Reviewing your medications with your care team to make sure they are still appropriate is vitally important, especially if you take five or more medications.
“Polypharmacy” – the use of multiple medications that creates an increased risk for side effects and complications – is common in older adults; roughly 44 percent of men and 57 percent of women over age 65 take five or more medications per week. Additionally, 12 percent of both older men and women take 10 or more medications per week.
Older adults who have multiple chronic diseases, see multiple specialists, fill their prescriptions at different pharmacies or combine prescription medications with over-the-counter and alternative remedies have a greater risk of polypharmacy.
Taking multiple medications does more than simply clutter your medicine cabinet. It can lead to a decreased quality of life and an increased risk of harmful side effects. In fact, inappropriate medication use ranks fifth among “preventable” health threats to older adults and causes more than a quarter of their hospital stays. The more medications you take, the higher the risk.
Common risks of polypharmacy include:
• Adverse drug reactions
• Inappropriate dosing due to age-related tolerance levels for drugs
• Drug-drug, drug-disease and drug-herbal interactions
• Confusion about proper dosage for each drug
• Excessive medical costs
There is also a problem known as the “prescribing cascade,” when an adverse drug reaction is misinterpreted as a new disorder and an additional drug is prescribed. This puts older adults at risk for new adverse effects as well as adding yet another medication to the mix. Instead, the initial drug could have been changed or discontinued to prevent the cascading effect.
For many conditions, the use of multiple medications may be appropriate. For example, in chronic diseases such as diabetes and coronary artery disease, multiple drug regimens have been shown to improve health outcomes. For an older adult with chronic diseases that frequently cluster together, such as diabetes, hypertension, high cholesterol and heart disease, using five or more prescription medications may be considered the optimal standard of care.
How do you know your medications are appropriate? Here is a list of suggestions that may help you avoid the risks of polypharmacy:
• Bring all of your pill bottles, including over-the-counter, herbals and supplements, to your appointments. Review the indication, dosage and possible side effects of each medication with your health provider.
• When you have a new health problem, ask if it could be an adverse drug effect.
• Inquire about non-medication options to treat a medical problem. For example, acid reflux and stress urinary incontinence may be managed with lifestyle changes, thus avoiding additional medications.
• If you have been treated with a medication for an extended period of time with good results, ask if appropriate to lower the dose and/or discontinue the medication.
I encourage you to feel empowered to take these steps. From a doctor’s perspective, it is extremely important to know what pills are inside my patients’ medicine cabinets and to review their appropriateness. Deciding when to stop medications is as important as when to start them.
Together, we can make sure that your medication regimen is clean and tidy this spring – and beyond!
Dr. Heather Bennett Schickedanz is a board-certified geriatrician with the highly regarded UCLA Geriatrics Program in Santa Monica and Westwood. For more information, call 310.319.4371 or visit www.uclahealth.org.