Pill bottles. Everywhere.

It’s a common sight for those taking care of their parents. But why do older patients have so many pills? It’s not a benign thing either—tens of thousands of elders are sickened or die from drug overdoses, side effects, and interactions every year.

So how did mom and dad accumulate all of these drugs, and how do they keep them straight?
Well the answer to the second question is easier so we’ll start with that – they don’t keep them straight. Coordinating schedules and doses of medications is complicated – that’s why nurses, pharmacists, paramedics and doctors have to go to school and become licensed before being allowed to schedule and dose them. But somehow, we all think that elderly patients with poor eyesight and possible dementia are able to read small labels on bottles, understand the instructions, and integrate their 1 pill 3 times daily into their schedule that includes 2 pills 4 times daily, and 1 pill at noon every other day…

Now, to the first question: How did they accumulate so many drugs? That is more complicated. Here is the breakdown up front, and I’ll get into details after:

1) Doctors are obligated to prescribe them when they diagnose certain conditions

2) There is no system that allows doctors to check what other doctors are prescribing, so all of their drugs add up

3) Elders are often reluctant to throw anything away

4) Patients add on vitamins, supplements, and herbal preparations that they see on TV or are told are “ good for them”

It is important that you understand these reasons so you can assess and manage what can be a very dangerous situation, so here are the details.

1) Doctors are obligated to prescribe them
No, this is not the result of the evil pharmaceutical cabal forcing doctors to churn out prescriptions to increase their profit. Doctors are obligated to behave according to professional guidelines that have been determined by panels of experts to be the most beneficial to their patients. This is also true of pilots, police, chefs, barbers, and any other profession that can have an effect on an individual’s health. In the case of doctors, we are ethically and professionally obligated to follow guidelines prescribed by medical associations. For example, if I diagnose high blood pressure in my patients, I follow recommendations of the JNC (Joint National Committee on Prevention and Treatment of High Blood Pressure) which is a group of nationally recognized experts who make recommendations based on large studies. I am not legally required as a doctor to follow these guidelines, but if I don’t follow them I get angry emails from insurance companies, hospital supervisors, pharmacists, and sometimes patients or relatives all demanding to know why I am not following the latest guidelines. Every specialist has guidelines to follow and thus they write prescriptions for medications that treat the diseases they diagnose – often without knowing the total number of medications written by other specialists. The result is that your mom may have twenty medications prescribed by her cardiologist, her pulmonologist, her podiatrist, her dentist, her dermatologist, and her psychiatrist – none of whom have spoken to each other.

2) There is no system that allows doctors to check what other doctors are prescribing, so all of their drugs add up
All of our cellphones, and Alexas, and cars, and TVs know where we are, where we are going, what we like, what we buy, and what we need. But, because Americans are so sensitive about government regulation there is no national system that allows doctors to see what medications and treatments were provided for a patient. In fact, electronic medical records systems are designed by private corporations which have a vested interest in not communicating with other systems, because they want to force their clients to stay with their product. Furthermore, even if a doctor gets permission from a patient to contact another doctor and get records, that doctors office will usually send paper records that can’t be entered easily into an electronic system (which is a problem if that patient record is 50 or 100 pages long). Most other modern countries have national systems that are secure and efficient. America does not.

3) Elders are often reluctant to throw anything away
This doesn’t require much explanation. Many elders are reluctant to throw anything away. They may have grown up in poverty, or may be afraid that they may not be able to afford a replacement. They have their reasons and you are unlikely to be able to change that. Medications are expensive and important, so it stands to reason that they won’t throw them away – even if they are expired, or discontinued, or incorrect, or replaced.

4) Patients add on vitamins, supplements, and herbal preparations that they see on TV or are told are “ good for them”
Medications are big business. While most people point fingers at “Big Pharma” as the prime movers in the business, they don’t recognize that the makers of vitamins, supplements, “natural remedies”, teas, and homeopathic remedies, are also big business. These alternative therapies manufacturers spend billions of dollars on advertising in magazines, mailers, tv commercials, sponsorships, and promotions. They pay radio and tv announcers millions to mention their products on the air, and they give away products to cashiers and customers who promote their products. The elderly are easy targets and much of this marketing is aimed at them. Make no mistake—“Natural” does not mean good or harmless (cyanide and arsenic are 100% natural). In fact, “Natural” doesn’t mean anything, since there are no laws that regulate what it means, so anyone can put it on their products’ label. Supplements are chemicals just like prescription drugs. The difference is that you don’t know what those chemicals are, what they do in the body, or how they interact with the prescription drugs.

OK so now you have the big picture. What do you do about it? Our recommendation is that you ask your parent’s doctor (or NP or PA) for an appointment to review all of your parents’ medications (let them know in advance so they can book the appropriate amount of time (it may take a while). When the appointment approaches, put ALL of the medications/vitamins/supplements you can find in the house (in every drawer, cabinet, table) in a bag, and bring them ALL to the appointment. The goal is to leave the office with only the correct medications in one bag, and all of the others in a discard bag (which you can bring to a pharmacy to dispose of safely).

When you get home, devise a system to organize the medications so that they can be safely and correctly taken (for example a day-of-the-week pill box). We will write more about medication organization in future articles.

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