Danger of Polypharmacy in the Elderly by Anita Kamiel, R.N., M.P.S.

Definition

Polypharmacy is a term used for taking five or more drugs concurrently and this trend is on the rise. While this is a cause for alarm in the young, in the elderly, who usually take a panoply of medications prescribed to them by their stable of specialists along with their internist or geriatrician, the effects can be extremely serious. With so many doctors and healthcare professionals managing the patient, it is easy to both rack up the number of drugs at play as well as fall into the “prescribing cascade” where drugs are prescribed to counteract the side effects of another prescribed drug.

Risks in the Elderly

As with most things, the problem of drug interaction is more acute in the elderly than their younger counterparts. If dizziness is a side effect, as it is with beta blockers, and a fall occurs, the results can be catastrophic as compared to someone younger. In fact, higher medication use in the elderly has been cited as responsible for some falls and doctors have been advised to avoid medications that have been linked to falling.

Older patients seem to use their own discretion when taking their medications. They don’t easily cede their independence and it extends to this area of their lives as well. The senior patient may also be loath to tell the doctor about a complementary therapy or remedy having experienced a closed-minded or judgmental reaction it in the past.

Rising Trend...

According to a Harvard study, polypharmacy has seen a 70% increase over the last 12 years. A longitudinal study in JAMA Internal Medicine found that more than 33% are taking five or more medications, 66% are taking dietary supplements and 40% are taking over the counter drugs.

In 2006, 8% of seniors were at serious risk for drug interaction, but that number rose to over 15% in 2011. Adverse drug interactions include combining aspirin with the blood thinner Plavix. Taken together there is an increased risk of abdominal bleeding. Taking fish oil for heart health combined with the blood thinner Coumadin can also cause bleeding.

Most elderly patients don’t bother to tell their doctors about the non-prescription drugs or supplements they are taking for the simple reason that their doctor often neglects to either ask them about it or inform them that there could be risks of drug interaction. If the elderly will be choosing which medication they want to take (or can afford – a whole other topic), it is important to educate them about the purpose of each and the possible interactions, so they, their families and doctors can make informed decisions.

Communication & Follow-up Is Key

A serious problem is that medications are very often prescribed by specialists who don’t necessarily communicate with each other. A clinical pharmacist specializing in geriatric care can help. They are often the repository for all the prescriptions for the patient and can be a central clearinghouse. They can perform a drug reconciliation to make sure the patient is not combining substances with negative interactive effects. Consult Beer’s List put out by the American Pharmacists Association for drugs not to use in older adults. There is a handy list of “Tips on Polypharmacy Management” available through the ClevelandClinic.org.

Another problem is once we start medications, we almost never stop them. Money is poured into efficacy tests for a course of drug treatment, but we almost never study how and when treatment is to end. A study out of the Veteran’s Affairs Hospital showed that 44% of elderly patients were actually given at least one unnecessary medication upon discharge.

In the meantime, go along with your senior loved one to the next checkup or doctor visit and bring every prescription and non-prescription over the counter remedy or supplement with you so you can do a comprehensive review. It will be a good time to re-visit the necessity of the medications as well as a time to tweak dosages.

If elderly patients are confused about what to take or are in the beginning stages of dementia, it’s easy to mismanage the arsenal of medications they are prescribed or recommended to take. A caregiver or family member must step in to avert what can sometimes become a life threatening disaster.

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Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.

Consider a Geriatrician to Manage the Whole Patient

As we age, the health challenges we face become more complex. If you or an aging loved one is beginning to become overwhelmed, it may be time to consider a new approach. Chronic conditions, as well as the list of medications can quickly pile on, thereby necessitating a more holistic view of the geriatric patient.

A geriatric medical doctor can help an elderly patient when:

  • The physical and mental health management of senior adults becomes too complex for a regular internist.
  • You find that you are trying to coordinate too many specialists.
  • The list of medications becomes complicated and confusing.

GeriatricianA geriatrician is a board-certified family medicine or internal medicine physician with an additional 1-2 years of fellowship training in geriatric medicine. A geriatric care physician offers a unified framework to issues such as adult-onset diseases, incontinence, dementia, depression and changes in mobility. Their focus is on enhancing quality of life and helping older adults remain independent for as long as possible.

Geriatricians use a “whole-body” approach in patient care as their paradigm. During a first visit, you can expect an extremely comprehensive geriatric assessment with a number of components. These include a thorough physical examination after a full recording of the patient’s medical history including a pain assessment. The workup will also include cognitive testing, osteoporosis and arthritic evaluation, a nutritional assessment as well as vision, hearing and dental screening. Additionally, inputs from a geriatric social worker and the family are often important components of the evaluation.

Geriatricians are adept at working closely with the multiple specialists who may be currently managing chronic illnesses of the elderly patient. Based on the patient’s health status, life expectancy and personal directives, geriatric physicians are selective when it comes to ordering certain tests or performing procedures weighing the costs and benefits of each, as they can be physically and mentally stressful for aging patients. Routine or preventative testing may be counterproductive or risky in certain circumstances. In addition, you will find that a geriatrician is extremely sensitive when listening to the concerns of the elderly patient and in helping them deal with end-of-life issues. They realize the importance of incorporating the unique psycho-social issues related to the elderly into their care plan. Geriatricians can also act as important resources for their particular needs.

As we age, our metabolism changes and medications are absorbed differently than when we are young. A geriatrician pharmacologically monitors all of the patient’s illnesses and evaluates the therapeutic efficacy and dosage of medications. Polypharmacy, which is managing multiple medications, can unintentionally, and needlessly, result in dangerous drug interactions. A geriatrician is uniquely qualified to recognize and avoid the problem of over-medication with an eye toward managing any over-the-counter or supplements that find their way into the mix.

Geriatric medicine is poised to grow as our population ages. Some 6,200 health care providers nationally are members of the American Geriatric Society, which includes physicians, psychiatrists, nurses, pharmacists, physician’s assistants and social workers, all focused on the prevention and treatment of the diseases and unique challenges that face older adults. Lifescript Doctor Review has an interactive portal to help you find a qualified doctor in your area with the expertise you and your family need as you transition into this new phase of life. We owe it to our elderly to make sure they are properly cared for.

For additional support, please call David York Home Healthcare Agency at (718) 376-7755. David York Agency is abreast of all the latest guidelines for seniors and can satisfy all your questions. We would be happy to give you more information and discuss your case with you. David York Agency provides healthcare professionals to the elderly and infirm, with the highest degree of personal service. To hear more from us, please like us on Facebook or follow us on Twitter, Google+ or LinkedIn. For any of your questions concerning elder care, contact us.

Doctors Are Ageists

A typical scenario: An 80 year old man walks into a doctor’s office and says, “My bones creak and I feel pain when I just walk.” The doctor responds, “Well, Abe, you are getting on in years.  Nothing works like it used to.  You can’t expect to feel like you did 30 years ago.”

Doctors are Ageists

Doctors have historically had an ageist approach to their elderly patients which often results in doctors ignoring their complaints of pain and symptomology.  As such, the elderly are left to needlessly suffer and the diagnosis of their ailments may be overlooked.  Because doctors expect the human body to breakdown as it ages, they often have a callous attitude toward the pain and complaints their older patients have.

As far back as the 1960’s, Pulitzer Prize winning gerontologist Dr. Robert N. Butler coined the term ageism to describe this syndrome and his landmark study found that “many of the symptoms previously attributed to aging were actually the result of diseases, some of them treatable.”  Dr. Butler established the very first Geriatric Department at Mount Sinai Hospital in New York where he tried to bring this issue to the fore.

It’s not just doctors who ignore older people.  Everyone from store clerk to pharmacist has been known to focus attention and questions on a younger companion rather than deal with the elderly customer or patient.  Nancy Perry Graham of AARP The Magazine calls this “the last remaining acceptable prejudice” and has found that some of the worst offenders are doctors, the very people we would have expected to be the most understanding. 

Both studies and anecdotal evidence show that doctors pay less attention to the complaints of their older patients than those of their younger patients.  Some studies show that in this age of ‘drive-through’ medicine, doctors spend even less time with their older than their younger patients.  This attitude leads to even less attention paid to actually diagnose a potential disease.

The expectation that age is perforce accompanied by pain and suffering has been so ingrained in the culture that the older person is now of the mindset to tolerate the pain rather than demand it be alleviated.  One reason for this might be cultural.  People of the older generation were taught to revere doctors and to follow them almost unquestioningly.  This could result in a lack of assertiveness regarding their real medical complaints.  Of course, patients with dementia are often not able to voice complaints effectively.

Prejudice against the elderly is the same as any other and one that everyone can fall prey to since we all age.  Some hospitals and medical schools are emphasizing the study of aging as a way to counteract ageism, something imperative as the baby boomers come of age.

To combat age related prejudice in the medical care of the elderly:

  1. Find yourself a doctor well versed in gerontology and geriatric medicine.
  2. Be sure that the doctor spends a reasonable amount of time both listening to and hearing you.
  3. The doctor should ask about your pain level each time you visit.
  4. If you are with a younger companion or relative, demand that the conversation is directed to you.  Make sure the doctor gives you the respect you deserve as the steward of your own good health.

Back to our original scenario, instead of dismissing poor Abe’s complaint of aches and pains, the doctor could have responded empathetically.  Abe could very well be suffering from something manageable like arthritis.  Alleviating his pain and treating him medically and holistically could greatly increase his quality of life as well as his continued contribution to society.

David York Home Healthcare Agency takes the needs and input from each and every client seriously.  Our home health aides are amongst the most compassionate and professional in the business.  We would be happy to discuss your case with you.  Please call us at (718) 376-7755 or visit our website at http://davidyorkhomehealthcare.com/.

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