In a recent column, I briefly discussed how medication side effects have become a frequent topic of discussion among older friends. This week we’ll discuss some of the reasons for what is called medication mismanagement and its impact on older adults.
I had the opportunity to have a conversation with a pharmacist specializing in geriatric pharmacy. She is Hedva Barenholtz Levy, author of “Maybe it’s Your Medications: How to Avoid Unnecessary Drug Therapy and Adverse Drug Reactions” (2023, Skyhorse Publishing). Levy, a senior care pharmacist, is the founder of a specialized consulting practice working with older adults in their homes.
The following information is based on her book and our conversation. Note: Older adults are defined as those aged 65 and older. To check out your knowledge about the subject, take the following true-false quiz.
1. About half of older adults take one prescription drug regularly while roughly 10% take five or more.
False. Roughly 90% (that’s almost all of the age 65+) take one prescription drug regularly and close to half take five or more.
2. Older adults are more vulnerable to drug interactions than younger adults.
True. With age, our bodies become more sensitive to medications. Levy notes four areas: how drugs are absorbed, their distribution, changes in our metabolism and elimination.
3. The suboptimal (below the best possible standard) use of drug therapy results in an estimated annual cost of over 500 billion dollars in the United States. That includes all ages.
True. Mismanagement is costly not only in dollars. It also is associated with over 270,000 deaths a year. According to an analysis conducted by the American Society of Pharmacovigilance, adverse drug events are now the third leading cause of death in the U.S.
4. Older adults often are excluded from clinical trials.
True. Unfortunately, they often are excluded or are underrepresented. One report found that almost 30% of research trials excluded older adults, an important part of research to detect adverse side effects.
5. Medication-related problems can be caused by overuse, underuse and inappropriate prescribing.
True. More specifically, the problem may be caused by an adverse reaction or interaction, doses that are too high or too low, improper selection of a drug, untreated or undertreated condition, not taking the medication and prescribing unnecessary medication.
6. All adults taking medication should have a medication review.
False. Not necessarily. The more an older adult has the following characteristics, the more likely the adult will have a medication problem. For example, taking five or more medications regularly, having more than one prescribing physician, use of more than one pharmacy. Add to that difficulty in remembering to take the meds, having a complex drug schedule and having recent changes in prescriptions.
Levy continues that we all have a responsibility to be our own advocate. Here are some questions she recommends in meeting with one’s physician.
- Why am I taking this medication?
- How do I know it is working?
- What are my treatment options?
- What are the expected benefits and harms of these options?
- Do I need all of their medications? And at the same dosage?
- What happens if I don’t treat the condition?
Then there are guidelines in selecting over-the-counter (OTC) drugs, which are not regulated by the Food and Drug Administration. They do count as drugs.
- Choose a single ingredient when possible. She writes, “if your only symptom is nasal congestion, no need to take ones that treat fever, pain and cough.”
- Ask your pharmacist which is most effective for your situation.
- Avoid doubling or tripling up on an ingredient in more than one of the OTC drugs.
We have the Internet, AI and advertisements.
- Be cautious in using AI.
- Have the most recent information.
- Determine the sponsor. That could be a nonprofit organization, the government or a private company. Most reliable websites end with gov, edu or gov. However, there are exceptions.
- Check if the author is qualified, whether there is a reviewer and the date of the review.
And finally, there is the impact of advertising. Since 1997, regulations have allowed pharmaceutical industries to advertise prescription drugs directly to consumers. Drug companies spend about $6 billion annually in advertising that contributes to polypharmacy and a “pill-popping culture,” according to Levy. New Zealand is the only other country where this is legal.
So dear readers, the game is not to outsmart our doctors. It’s just to be informed and to be an advocate for yourself. And as a reminder, stay well and be kind, always.
Helen Dennis is a nationally recognized leader on issues of aging and the new retirement with academic, corporate and nonprofit experience. Contact Helen with your questions and comments at Helendenn@gmail.com. Visit Helen at HelenMdennis.com and follow her on facebook.com/SuccessfulAgingCommunity.