Mind Your Medications
Take two aspirin and call me in the morning.” That classic prescription is a relic of days gone by, good for a chuckle in today’s world of designer drugs.
Infections that once meant almost certain death can now be subdued with antibiotics. Conditions that once lead quickly to disability are often controlled or delayed for years. Older people have benefited greatly from the expanded array of medications.
In fact, seniors, who comprise 13 percent of the population, account for 40 percent of medications prescribed in this nation. A recent AARP survey found that the average senior uses six prescription drugs, plus over-the-counter products such as aspirin, vitamins and digestion aids. Many people use more. Should we worry? We should at least pay close attention to the possibility of risks as well as benefits. In 2005, according to the U.S. Centers for Disease Control report, at least 30,000 citizens died from reactions to prescription drugs and some two million were hospitalized.
Drug reactions have surpassed falls as the largest cause of accidental death among seniors. The increased use of psychotropic drugs by older people is a related concern, in part because these medications may increase the risk of falls. A recent health bulletin of Blue Cross/Blue Shield of Massachusetts advised against the use, by seniors, of four classes of the drugs, including the well-known Valium and Elavil. There are other choices that are safer and more effective, according to the bulletin.
Primary care physicians are the coordinator of patients’ medication regimens, but problems can slip through or come on rapidly. A patient may not be forthright about other medications that he is taking. He may not take “as directed” or may fail to report side effects. Some physicians may not be sensitive to the special needs of older people.
An emerging concern is that of product safety. Questions about the adequacy of drug trials and the FDA approval process have been raised. The low number of older people in clinical trials appears to be an issue. A 2004 report from the U.S. Food and Drug Administration states that in trials of new medications for six types of cancer, 36 percent of the subjects were over age 65. Yet elders comprised 60 percent of cancer patients. This omission could give a false picture of drug safety for elders.
“Caution in putting a new drug on the market is critical,” says pharmacist Karen Elsasser, “but I think the testing procedures have usually served us well. The benefits of modern pharmacology are impressive. We now treat for quality of life.” She gives the example of preventative medications such as those that reduce hypertension. The patient will avoid the risks of hypertension and will have a better life for more years.
Elsasser, a registered pharmacist at Concord Hospital and a clinical pharmacist on patient care units, reviews all new medication orders in conjunction with current orders and consults with physicians, nurses and patients. She expresses a special interest in older people, who often have the most complex medical situations.
“It is true that older people process medications more slowly,” she says. “Often a lesser amount should be used than what would be effective for a younger person. But too little of the medication also carries risks.” The most important issue by far, she adds, is open communication with your physician.
Unfortunately, that communication is sometimes missing. A recent Associated Press story made the point that patients often fail to disclose symptoms, side effects and medications they are already taking. One example given was a man who was given Vicodin to relieve pain from a wrist injury. He neglected to mention that he was taking Xanax for anxiety. He spent several days in a state of confusion before he recognized the problem, which could have been deadly, and called the doctor.
Elsasser lists a few ideas for getting the most benefit from your medication and avoiding problems.
“Get to know your medications,” she advises. “What are they, why were they prescribed, what do they look like … what color, what size and strength … and when should each be taken.” There are aides such as daily pillboxes or check-off calendars that can be helpful, especially for a person who takes several medications.
Remember that over-the-counter medications can interact with prescription drugs. Don’t forget to tell your doctor or your pharmacist if you are using supplements and over-the-counter medications. Products such as aspirin and ibuprofen should be regarded as “real” medications; even cough medicines could be problematic for some people.
“Don’t accept side effects,” Elsasser says. Some patients assume that side effects, such as sleepiness, jittery feelings or loss of appetite, are just part of the process of taking medication. But side effects give important information that should be taken seriously and shared with the pharmacist or physician.
Work with the same pharmacist, if at all possible. If this isn’t possible, then purchase your medications at the same pharmacy. Your record will be available to the pharmacist on duty at that time. “The patient, the physician and the pharmacist are a team,” says Elsasser. “The most important thing a patient can do is to keep the communication open.”
Should a medication problem arise when reaching the physician or the pharmacist is unlikely, she suggests making a call to the New Hampshire Poison Control Center, which has a 24-hour crisis phone line. The staff there is well trained and is able to deal with questions about medications. The toll free number is (800) 222-1222. NH