It’s no secret that Americans use a lot of medications. Chances are that your parent’s nightstand, TV table, bathroom cabinet, and kitchen are all occupied by bottles of pills. You’re probably thinking, “All these pills can’t be good…” and you would be correct, it isn’t good. Too many medications, which physicians call “Polypharmacy” (poly=many, pharmacy=medications) creates a whole bunch of potential medical problems that add too, rather than cure, patient’s medical issues. First, the more medications one consumes, the more those medications can interact with each other and cause terrible side effects. Second, it is difficult to manage the scheduling of multiple medications, so they are often taken incorrectly. Third, they are expensive. Fourth, many medications become unnecessary with age. In my experience, reduction of the total number of medications a patient is taking alleviates many of their symptoms. In some cases, patients became considerably more healthy and comfortable. We would like that outcome for all of our patients and relatives, so we will work together toward that goal.
So why is Polypharmacy so common among elderly patients? The answer to that question—indeed, the answer to many medical questions—is, “it’s complicated”. So, in the interest of explaining the reasons for poly pharmacy thoroughly, I have broken them down in a list below. My intent is to have you understand the reasons and the scope of the problem, so you can help address it. The goal ultimately is to reduce the number of medications your parents are taking, with only essential ones remaining.
Cause #1 — Too many Specialists, Not Enough Primary Care
Each medical specialist has a goal of optimizing their particular organ system, and recommends medications according to national guidelines. Often these guidelines are intended for otherwise healthy middle-aged people, and don’t take into account the changes brought on by age, or the medications prescribed by other doctors. Furthermore, many specialists are unaware of the other medications being taken by the patient, and therefore cannot address the interactions with medications they are prescribing.
Primary Care doctors are supposed to be the central repository of medical information for patients, and the coordinator for all of the specialists, so this one doctor knows everything that all of the specialists have seen, done, and prescribed. Unfortunately, the United States has a shortage of primary care physicians, so many patients simply don’t have one.
Cause #2 — No National Medical Computer System
Because of strong opposition to a nationalized healthcare system, the United States does not have a uniform standard for electronic medical records (EMR). As a result, every hospital and doctor’s office uses their own EMR system provided by a private company. These companies are not required to link up with other companies/ EMR systems (and they have an incentive not to do so, thus keeping their clients captive to their systems). As a result, electronic medical records from one hospital or doctor are not readily available to otters hospitals or doctors. One of the many damaging results is that doctors cannot see the medications prescribed by other doctors.
Cause #3 — Inadequate Geriatrics Training
Geriatric patients are not the same as young and middle aged patients. All doctors learn that children are not just little adults. Yet, somehow we are never taught that geriatric patients are not just old adults. As a result, many medical specialists and Emergency Doctors prescribe medications that are inappropriate or improperly dosed for elderly patients. It is not the specialists’ fault that they don’t know what they don’t know. It is the responsibility of medical schools, medical residencies, and state medical boards to require geriatrics training for all doctors who are going to treat elderly patients.
Cause #4 — Confusion Among Patients
It would difficult for most of us to manage the schedule of just three medications: one medication twice a day, another three times a day, and another four times a day. Imagine coordinating ten medications? Imagine doing that if you are depressed, or have early dementia? Confusion around scheduling of medications leads to many medication errors.
Elder patients often get confused about when to stop medications. Physicians will sometimes change medications if a prior one is ineffective or recommendations change – but patients often don’t understand that they must stop the previous medication. As a result, it is not unusual for patients to be taking multiple medications that they were supposed to have discontinued years before.
What should you do about it? Schedule an appointment with your parent’s primary care doctor or geriatrician specifically to go over medications. Then, in preparation for the appointment, put every pill in the house into a bag and bring it to the doctor appointment. Be sure to include all of the vitamins, supplements, herbs, and over-the-counter medications in that bag. Your goal is to leave the doctors office with a little bag containing 4 or 5 medications that your parent should continue taking, and a big bag of medications that should be discontinued. The big bag should be brought to the pharmacy for proper disposal (we don’t recommend flushing medications down the toilet anymore).