Medicare open enrollment begins this week, and most seniors will be checking to see if their medications are covered by their plans. However, health professionals warn there is a more important reason to audit medications.
Many older adults are consuming a potentially dangerous cocktail of prescription drugs. The problem is not a new one, but two recent studies highlighted the consequences of what is called polypharmacy. That generally means the simultaneous use of five or more drugs by one person. However, supplements can be part of the mix.
The University of Southern California (USC) research, published last month in the Journal of the American Medical Association (JAMA), found that over 22% of older Americans are combining medications that may produce harm, even death. Another report from the University of Buffalo (UB) revealed that one-third of cognitively impaired older adults are taking medications that can harm them.
The USC analysis pointed to antidepressants, statins, and blood thinners as the drugs posing the greatest risk of major interaction.
Fractionated Healthcare System
The problem begins with multiple doctors writing prescriptions without knowing what other medications and supplements a patient may be taking.
“It’s (polypharmacy) created because of a fractionated healthcare system,” Dr. Edgar Creagan, of the Mayo Clinic, tells SavingAdvice. “It is not a system, but a patchwork of trying to provide care under very difficult circumstances. The fundamental issue has been the devaluation of the primary care physician. Once upon a time there was one physician that cared for a group of patients, and he was the one who oversaw these medications. Today many patients don’t know who that provider is. And there are multiple individuals writing prescriptions for patients with very little coherence or coordination among providers.”
Overspecialization
Eric Collett, founder of A Mind For All Seasons, a brain health and dementia consultancy, told SavingAdvice that he has seen the same discoordination.
“With overspecialization, a provider often treats one organ system narrowly without thinking about everything else,” says Collett. “Doctors don’t want to step on each other’s toes. So-and-so prescribed this, they’ll manage it, I’ll deal over here. It’s too siloed.”
That failure to communicate can lead to tragedy.
“At the same time, there is a concern about the risk of someone falling,” adds Creagan. “I think we all know that the mortality from a broken hip is enormous at one year after the injury and many of these falls occur because of a combination of medications.”
Cognitive Impairment
The problem can be magnified when a patient is cognitively impaired, as the UB research found.
“The body is a system of systems,” says Collett. “There is too little recognition that a gut problem, a losing battle between constipation and diarrhea with all sorts of medications thrown at it, relates heavily to a mental health problem like clinical depression, which has other drugs thrown at it.
“Then someone with advanced cognitive impairment responds to all of that behaviorally, and more drugs come on board. It becomes a dirty snowball that gets worse and worse.”
Creagan sees that dirty snowball building to an avalanche.
“Right now, someone is diagnosed with Alzheimer’s dementia about every 65 seconds,” he states. “And obviously our communities are not designed to deal with this tsunami of suffering and misery, and many of the medications used for the management of Alzheimer’s disease can magnify the problem. So, we have a bewildering portfolio of medications that compound the issues. Many of the FDA medications, which are approved, can worsen the cognitive decline of patients.”
Health Record Spaghetti
You might think that all the forms you fill out and the medical tests you may have taken over your lifetime would help. They do, according to Collett, if they are well maintained. However, often they are not.
“Health records add to the problem,” he says. “You have all these different record systems, and you have to request records from other physicians. If something was identified 20 years ago and the person changed to a provider who uses a different system, that information may never transfer, even though it could shortcut a provider to the right answer.”
Patients Must Take Responsibility
All the medical professionals SavingAdvice talked to emphasized the need for patients to take responsibility for their medication and supplement intake.
“Many clinicians coming up through the ranks are focusing on artificial intelligence and also scans, rather than physically examining the patients,” says Creagan. “So patients need to understand that a careful history by a concerned clinician can generate a working diagnosis of the patient’s concerns by history of the ailment.”
How to Talk to Your Doctor
Ellen Lubensky, attorney and founder of The Mental Health Choice Project, explains how to approach taking charge of your medication interactions.
“Patients and caregivers should feel empowered to request a ‘medication cleanup’—a careful review of each medication’s purpose, risks, and continued need,” she maintains. “Asking questions or requesting transparency is not disobeying a doctor. Patients should be able to decline treatment without pressure or intimidation. A doctor’s unwillingness to respect a patient’s ‘no’ is a red flag. If a doctor dismisses a request for a medication review or refuses to discuss concerns, I would encourage patients to seek a second opinion.”
Bring A Friend Or Relative
“If you are comfortable, bring someone with you to the examination,” recommends Creagan. “These are stressful experiences. We may forget something.”
He speaks from personal experience. Several years ago, he passed out and had a car accident. The search for the cause, which he says included “taking every test imaginable”, was fruitless. It wasn’t until his wife, accompanying him to an examination, cited symptoms she observed that a diagnosis of sleep apnea was made.
Dr. Mamata Majmundar, founder of Caregiving is Healthcare, counsels relatives helping family members take control of their medications.
How To Talk To Your Doctor
“Here’s what I tell families,” she notes. “You have the right to ask questions and to get your education to make good choices. It’s your loved one you’re supporting or if it’s for yourself, if it feels awkward, it helps to say, ‘I saw research on medication errors and older adults. Can we review the medication list?’”
Lubensky agrees.
“Older adults facing socioeconomic barriers may find it especially difficult to ask questions, express concerns, or obtain coordinated care,” she maintains. “Their concerns deserve to be heard, and they should feel supported in declining treatment they do not want. I advocate for older adults to involve a trusted family member, friend, or advocate in their care, if they wish, to help ask questions, clarify information, and ensure that their preferences are respected.”
What To Bring To The Examination
Some sources advise taking a list of medications to doctor appointments. However, Creagan has another idea.
“Don’t take a list – take those pill bottles with you,” he advises. “Know who prescribed the medication. Why was it prescribed? Who’s going to refill that for you? And, what medication should you not take with the medications in that bottle.”
In addition to pill bottles, Majmundar suggests a few other items.
“Bring every medication, including over-the-counter medications, drug supplements if you’re using CBD or THC or even vaping,” she recommends. “Bring that information and have it all written down and ask a doctor or pharmacist for medication review to make sure each one is still needed. I recommend actually scheduling an appointment specifically for this so that you can have enough time to talk about it.”
What To Bring To The Pharmacy
You should implement the same medication and supplement review with a pharmacist as you do with your doctor, say the medical experts SavingAdvice interviewed. That is especially true if you are changing pharmacies.
“So, bring that medication with you,” says Creagan. “Bring that bottle with you, which has a number on it, so that a pharmacist in a different pharmacy will know exactly what you’re taking.”
Knowing what medications and/or supplements you are taking and why you are taking them is key to good health, according to the experts.
“When you change one part of a system, by definition you change the whole system,” notes Collett. “You can’t do something that affects the gut without affecting the brain. A concerted effort to understand root causes, rather than being so quick to medicate, would get us further.”
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