Overmedication a serious concern for the elderly
Doctors, families, pharmacists and others can help prevent dangerous prescription errors
Published 1:14 pm, Monday, January 6, 2014
Seniors can easily run out of room in their medicine cabinet. They are the largest consumer group of prescription and over-the-counter drugs in the U.S., with one in three older adults taking five or more prescriptions and about half using OTC medications, according to a study published in the Journal of the American Medical Association.
Not every drug a senior takes may be necessary, though.
"By simple virtue of aging and having multiple chronic conditions, older people are at risk for overmedication," said Dr. Holly Holmes, an associate professor in the Department of Internal Medicine at the University of Texas M.D. Anderson Cancer Center and a board-certified geriatrician.
Overmedication happens in many ways. It can involve taking a drug no longer needed; unknowingly using the same medication under two different names, thus doubling the dosage; or taking one drug to treat side effects of another instead of switching to an effective alternative for the original medication. Dr. Rock Ferrigno, chairman of Bridgeport Hospital's emergency department, said one of the biggest problems he sees among those with multiple medications is taking the wrong medication.
To avoid getting into these situations, Holmes recommends that seniors take responsibility for their overall care.
"They have to own their medication list and make sure it's correct every time they go to a doctor," she said, also stressing that the importance of regularly asking if specific drugs are still necessary and contacting the doctor they see most when another wants to add a medication to their regimen. "Patients will call me after seeing a cardiologist or neurologist and ask me what I think. By and large, I agree."
Ferrigno, meanwhile, said families can play a big part in preventing overmedication. If family members are present during discussion of a patient's treatment plan, he said, it increases the chance that the patient will follow the plan and not, for example, use the wrong medication or take a drug for longer than necessary. "Patients that have their families involved seem to do better," Ferrigno said.
Getting all prescriptions filled at one drugstore further reduces the risk of overmedication in seniors. "The pharmacy is the most underused resource they have," Holmes said. "A pharmacist has the education and training needed to look at their complete profile and see problems."
As part of the medication therapy management pharmacists provide, they check for potential complications and offer a consultation with every prescription filled. They also perform a free annual evaluation for seniors as part of their Medicare coverage. Walgreens spokesman Phil Caruso said patients can bring their medications to any of the chain's stores and discuss their prescriptions with a pharmacist, who can educate them about drug interactions, the best way to medications and other facts.
David Tran, pharmacist and pharmacy manager at a Houston Walgreens, said this is something his store regularly does with patients.
"We do a complete medication review," he said. "We talk about every single drug with the customer." During the evaluation, which can take from 30 minutes to two hours, depending on the number of medications, they discuss the reason for each drug and whether it has had the desired effect. The pharmacist also asks if there are any obstacles to taking the medication, such as timing or cost.
Providing complete information proves especially important for seniors, as the Journal of the American Medical Association study found that one in 25 older adults faces the risk of a major drug-drug interaction and that half of the potential interactions involve the use of nonprescription drugs.
Seniors also can bring along a family member or other caregiver who helps manage their medication. Tran said as long as the customer gives the OK, the person can take part in the confidential conversation. Once a complete medication list exists, experts recommend that seniors not only bring it to all appointments but also carry it with them to have on hand in case of an emergency.
Caruso said getting all prescriptions filled at the same store, or same chain of stores, also cuts the risks of overmedications or dangerous interactions, as the pharmacist will likely have the patient's entire prescription history and be able to highlight any potential problems.
Staff writer Amanda Cuda contributed to this report.