Vague symptoms can be a hallmark of many problems as we get older. Complaints of headaches, fatigue, dizziness, confusion or depression could be clues and are often simply dismissed as “you’re getting old”. One of the first avenues to explore with older adults is to look at the medications being used and evaluate if potentially polypharmacy (too many medications) could be the culprit.
In 2010 the Center for Disease Control estimated that 37% of Americans age 60 or older take five or more medications and 76% take at least two. Given that 13% of the total U.S. population is over the age of 65 (2011 census) this estimate affects over 40 million people. Paying attention to polypharmacy is important for several reasons, both for patients and for doctors.
Polypharmacy can be harmful. The more medications you are on the more likely you are to have an adverse drug reaction (ADR), often caused by two drugs interacting with each other badly, or by overloading your own capacity to process medications. This leads to higher rates of emergency room visits and hospitalizations. If you are over the age of 65 your likelihood of an ADR doubles compared to a younger person.
Polypharmacy can be expensive. Medications themselves can be expensive with insurance plans not always covering full costs. Having multiple medications yields multiple out of pocket costs. ADRs are costly, both to patient and the medical system. This is particularly true when looking at institutional care such as skilled nursing facilities (nursing homes).
Over the Counter Medications
Over-the-counter (OTC) medications and food contribute to polypharmacy. Even simple pain relievers such as non-steroidal anti-inflammatories (NSAIDs) like ibuprofen interact with a number of common prescription medications. Alcohol increase risks with a wide variety of classes of drugs like pain relievers and psychiatric medications. Grapefruit juice can slow down the breakdown of many drugs and an abrupt change in consumption of dark leafy greens can affect clotting in patients on blood thinners. Even drinking your morning coffee can be an issue if you take thyroid medication (taking both together decreases absorbtion of thyroid by up to 50%).
How you can help. The most powerful tool you have is awareness. Keep a careful record of all of your prescription medications, supplements, and over the counter medications including who prescribed them and when you started taking them. Bring this record with you to every doctors visit, review it with all of your medical providers and make sure to leave a copy. Understand why you are on each medication and ask periodically if it’s still necessary, if you can lower the dose, or if there is a better drug option. Before starting a new medication talk to your doctor and pharmacist about it and how it fits with your existing medications. Note any changes after starting a new medication and report them to your prescribing physician.
Dr. Alethea Fleming, ND is a passionate advocate for naturopathic geriatric medicine. A 2007 Bastyr University graduate, she also earned a certificate in Gerontology from the University of Washington. Dr. Fleming is the owner and lead physician of the Vital Aging Clinic in Anacortes, Washington where she provides primary care to all adults as well as adjunctive geriatric care. Dr. Fleming is active in multiple community organizations as well as a member of WANP, AANP and OncANP. In her off hours, Dr. Fleming can be found hiking the beautiful trails of Fidalgo Island, spending time with her wonderful husband and son, or with her nose firmly in a good book.
