Dear Doctors: I'm a 74-year-old woman in good health. During any medical visit, if I have any issues, I'm prescribed an additional medication. I don't feel like the list of medications is reviewed, it just gets added to. What advice can you offer to narrow down all the medications?
Dear Reader: You are voicing concern about something known as polypharmacy. This is when a person is prescribed multiple medications at the same time. The current threshold for polypharmacy is five or more medications. But of particular concern is what has happened to you, which is the gradual accumulation of additional medications over time.
As people age, they can begin to develop a variety of health conditions. This leads to visits with different doctors and specialists, multiple diagnoses and multiple medications to manage them. Unfortunately, polypharmacy can put patients at serious risk. This ranges from drug interactions that may make a person feel unwell, to those that are dangerous and can cause physical harm.
It is estimated that nearly 40% of adults over the age of 65 take more than five prescription medications. Also of concern are over-the-counter products such as antacids or pain relievers, herbal and homeopathic remedies, and nutritional supplements. All of this has led to growing awareness of polypharmacy by medical care providers and efforts to flag when multiple prescriptions pose a risk. This includes drugs that are no longer needed, those with duplicate effects and those with possible adverse interactions.
Computerized patient records within health institutions have been an important step forward in managing polypharmacy. This gives medical professionals easy access to the full scope of a patient's care. However, medical care often occurs in separate systems, so transparency can be limited. That leaves it up to patients to take an active role in managing, and sometimes questioning, their medications.
It is recommended that each person create and maintain a complete list of every medication that they take. Group them into prescription medications, OTC medications and herbal and nutritional supplements. Note the name, frequency and dosage of each. Also write down the prescribing doctor, the date the medication was first prescribed and why. Add any new medications and cross off those that you discontinue. The next step is a professional assessment. For that, consider an important ally who is often overlooked: your pharmacist. They can review the list and note any duplications or potential interactions. Based on the "when and why" information, a pharmacist can also identify drugs or drug combinations that would benefit from review by a physician.
Some patients find it helpful to bring along their actual medications. Seeing everything together can reveal issues that a list alone may obscure. And yes, if you prefer, this can also be done with the help of your healthcare provider. Going forward, bring your updated list of medications with you to every medical visit, including the dentist. By making it a feature of each appointment, your medications will be actively evaluated and not simply added to.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
