Dealing with Over Medicating

Facts about Medications and the Elderly

• Older Americans comprise about 13% of the population but they consume over 30% of all prescription drugs.
• It is estimated that 30% of the older population taking medications have had an adverse drug reaction.
• Up to 20% of hospital admissions for the elderly are due to adverse drug reactions.
• It is estimated that over half of the deaths attributed to adverse drug reaction are for people age 60 and above.

The Journal of the American Medical Association reports that if adverse drug reactions were classified as a disease it would rank as the fifth leading cause of death in the United States.

A major problem with medical treatment for the elderly is the large number of prescription medications the average older person is taking. On average a person over age 75 has five prescription drug medications and is using at least two over-the-counter medications as well is taking herbal supplements.

Due to impaired ability to "clear" medications from the body, recommended dosages of prescription drugs are often too much for older people. This can result in over-dosage and drug reaction and in some cases even death. The medical community is aware of this problem, but finding the right dosage is often a problem because drug reactions are often masked by symptoms of the many chronic medical problems most elderly endure. In addition, older people often don't recognize, or they fail to report drug reactions.

Another huge problem is that the primary care provider may not be aware of the prescriptions being taken and some of these drugs may be causing interaction with each other.

Finally, many elderly either over-dose or under-dose or fail to take medications as prescribed.

The most common problem with medications is that the doctor or the pharmacist may not be aware that a patient is taking several drugs prescribed by other doctors. Many older patients continue prescriptions with a number of doctors and specialists and no one doctor, not even the primary care physician, often knows the number or extent of medications being taken. Add onto this the fact that the elderly are most likely consuming a variety of over-the-counter medications as well as herbal supplements and it is not surprising to see the large number of adverse drug reactions and hospitalizations and deaths due to drug reactions among the elderly.

Elderly people also often fail to adhere to proper dosage and frequency of dosage with their medications. Some will take more pills than prescribed because they think more is better and will cure the condition faster. Others have a noncompliant attitude towards medical treatment in general and often refuse to take any drugs prescribed for them. Many are confused or have memory problems and aren't even aware they have taken pills or need to take pills. Oversight and administration of medications by a responsible person is an extremely important duty for caregivers of the elderly.

Medication Interactions

Here is a list of herbal supplements that may interact or interfere with prescription drugs.

• Ginkgo Biloba
• St. John's Wort
• Saw Palmetto
• Ginseng
• Yohimbine
• Senna Or Cascara

There are also several prescription drugs that should be avoided with the elderly. The elderly person or a responsible family member should always consult with the doctor and ask that doctor if he or she is sure that the medication is safe for an older person. It is not inappropriate to challenge a physician. If prescription drugs are bought through a trusted pharmacist, the pharmacist may also be willing to consult on the safety of the medications for an older person.

Doctors and pharmacists are generally careful about overdosing or using harmful mixtures of drugs; but other than dosages based on body weight, most prescription drugs do not have recommended dosages for older people. Often the doctor must experiment to find the right dosage and the problem is that many older people or their families fail to recognize drug reactions or they fail to report them. Without the proper feedback, under-dosage or over-dosage might occur and effective treatment of the condition is not possible. And of course, over-dosage may cause more severe problems than the condition being treated.

Multiple Medications

In order to control the problem with an older person taking multiple prescriptions from many doctors, the older person or a responsible family member should bring all medications being taken by the patient to a doctor's appointment. This includes all herbal supplements and over-the-counter medications as well. It is useful to go over with the doctor what each medication is for. If there is no reason to take that medication or if it may be causing interaction the doctor should indicate that and should withdraw the prescription. Generally, the more the medications the more the potential problems. A concerted effort should be made to prescribe the fewest medications possible to control a medical problem.

One way to combat the problem with an older person not complying with taking pills at the proper time or not taking enough or taking too many is to use the popular "pill calendar box". Most people have adopted this idea but for those who haven't this is an extremely effective way to administer medications.

Many aging seniors also order their medications through the mail and some may even obtain prescriptions on the Internet. Internet prescriptions might be a common practice for very popular medications such as phetermine or Viagra

It is recommended that all medications be ordered through one pharmacist particularly a pharmacist that has a certification in geriatric pharmacy. By controlling all medications through one database, the pharmacist can alert the older person or his or her family about a possible drug interaction or adverse drug reaction. This central database approach should become much easier for those older people enrolled under the Medicare part D drug program. Presumably the company offering the drug benefit will have a database for its insureds.