First. The irony. Could it be that it's now our parents who have a drug problem?
Maybe this crosses your mind as you plunk mom's meds into her little pill daily pill boxes each week. (And maybe the stress of caregiving makes you want to take a couple of those little pills yourself. Remember: this would be very wrong.)
Seriously, though, it's not your imagination. The average older American now takes four or five prescription drugs and at least two-over-the-counter medications, notes Bill Hogan, a journalist and co-author, with geriatric pharmacist Armon B. Neel, Jr., of the Ask The Pharmacist column for the AARP Bulletin; in nursing homes, he notes, it's not unusual for patients to be taking as many as 20 or more medications.
Of course, many meds are helping people live longer, better lives. But many are not, and the side effects and interactions can often be worse than the conditions they're supposed to be curing. Some drugs are prescribed "off label." And lots of drugs shouldn't even be taken by older people.
All this over-and-mis-medicating has a cost, for the patients, but also in healthcare dollars.
Hogan and Neel, a geriatric pharmacist have just published a new book "Are Your Prescriptions Killing You?" and it's an eye opener, both for caregivers, and for babyboomers approaching older age. The authors trace the rise of polypharmacy and what they call "prescription cascade" that is actually harming older people. (Here's the first chapter.)
Neel, a fifth-generation pharmacist, found some shocking trends in his work monitoring prescriptions at nursing homes in his native Georgia. Lots of ineffective meds were still being prescribed for patients, and some meds had side effects like dizziness and unsteadiness that resulted in falls. He also found a number of patients suffering from side effects were misdiagnosed with dementia or Alzheimer's.
It's all in the math, as the authors point out:
A person taking 10 medications, for example, has 44 possible drug interactions that need to be analyzed. A person taking 15 medications has 104 such possible interactions.
In a phone interview, Hogan cited one troubling example.
"Older women who have persistent urinary tract infections, where it's not treated correctly, the dose of antibiotics are not correct, they can get a potassium deficiency that causes a fog and confusion that can be mistaken for Alzheimer's," he said. "Who would think of that? How many people get that kind of expert workup before they are put on these drugs?"
There are lots of reasons for this. One surprising fact the authors point out is that the Food and Drug Administration doesn't test drugs on older patients. (This, despite the fact that people 65 and older account for more than a third of all reported drug reactions.) Secondly is our cultural belief--spurred on by billions in big pharma advertising and "educational websites" that pills can cure everything.
Hogan advises caregivers to get pro-active in managing medications. Now is a good time to take a look at your parents' prescriptions, since the time to change their Medicare Part D plan will soon be upon us.
A geriatric pharmacist can look at your parents' medications, and discuss their health with you. Here's a list of resources to get you started.
Take a look at the Beers Criteria, a list of medications that are inappropriate medically for older adults. If you really want to go crazy, you can even download an app for your Iphone with the criteria.
If you see a big change in lifestyle or behavior, ask first whether the drugs might be the cause, rather than aging or dementia, says Hogan: "It was shocking to me to see how many false diagnoses of Alzheimer's were due to mis-medication."
All this is important for babyboomers as well: it's worth the price of the book for information in the chapters on proton pump Inhibitors like Prilosec and Nexium, and osteoporosis drugs. But that's fodder for another post.
Here's a link to AARP's web series Inside E-Street, with another report on Neel and Hogan's work.
What do you think about medications and seniors? What's your biggest complaint about managing your parents' meds? Join the conversation at the Facebook page, follow us on Twitter, and now, check in on Pinterest. (I'm just figuring it out, but my reverse mentor tells me all the old ladies are on it.)