Mrs. T, age 79, suffers from diabetes and hypertension, among other conditions. Like about one in three older Americans, she takes more than five medications on a regular basis--in her case, nine.
On a recent phone call with Nurse Alicia Schwartz, Mrs. T mentioned taking a medication that her nurse knew was no longer among those prescribed for her. "I wasn't feeling well, and this helped me before," Mrs. T. said. Alicia explained that the doctor had replaced the discontinued medicine with another prescription that addresses a similar condition, and the two together can cause dizziness and a severe drop in blood pressure.
"That must be why I was dizzy last week," Mrs. T confessed.
Over the next several weeks, Alicia, who has been coordinating care for Mrs. T for several years, was able to "negotiate" with her over the phone to get rid of old medications, advising her to put them in a bag and dispose of them. "It's like many things in nursing," says Alicia. "They have to build up that confidence in you, that you're telling them the right thing."
Medications play an increasingly big role in the daily lives of older Americans and those with chronic conditions. Some 15% of Americans regularly take five or more medications (known as polypharmacy), according to a recent article in JAMA, the Journal of the American Medical Association. This is up from about 8.2% a decade earlier. For Americans age 65+, the figure for polypharmacy was even higher--39% (up from 24% a decade earlier).
"Medication can be a big chore," says Alicia, a care coordinator at VNSNY CHOICE Health Plans. "When you're elderly, that's an added obstacle in your life. We have some patients who are taking ten or fifteen medications, which is hard for them to keep track of."
Patients taking so many medications often fail to take them as prescribed, which puts their health and well-being at risk. Some just don't take their prescribed medication (or even fill the prescription), while others hold onto and dip into discontinued or expired medications, which can also be risky. The National Consumers League reports that nearly three out of four Americans do not always take their medication as directed. Each year in the U.S., this poor adherence is linked to more than one-third of medicine-related hospitalizations, nearly 125,000 deaths, and $290 billion in avoidable healthcare costs.
To help people better manage their medications, particularly those with many to manage, clinicians at VNSNY CHOICE have compiled a to-do list and five questions to ask your pharmacist or primary care physician (PCP) on a regular basis, at least annually.
To Do
•Compile a complete list of your medications, including name, condition and dosage. This can be done with your pharmacist, and/or your PCP in combination with specialists. Take this list with you to all PCP and specialty care appointments. To help you compile the list, you may want to take your medicines with you to the pharmacy or PCP. This way, all doctors know what you are already taking when they evaluate a new prescription.
•Get all your prescriptions filled at a single pharmacy, if possible. That way, a pharmacist can check your existing medicines when you add or change a prescription.
•Dispose of any discontinued or expired medications, according to FDA suggested guidelines.
•Let your doctor know if a medication disagrees with you--rather than just not taking it. The doctor can often recommend a similar medication that you may tolerate better.
•To keep from running out of medications that have to be specially authorized for insurance, reach out to your doctor to reauthorize when you still have one refill left. If you do run out, speak to your doctor about getting samples, so you can continue treatment as you wait for reauthorization or refills.
To Ask
1. What is this medication for, and how am I supposed to take it?
Over time, you can forget why you are taking a certain medication. Let your pharmacist refresh your memory, as well as remind you how to take the medicine. Some medicines should be taken on an empty stomach, and others a full stomach. Timing can be important, too. For some antibiotics, "every six hours" means just that--including waking at night to observe the schedule. It is not the same as "four times a day" within waking hours.
2. Can these medicines interact with other things, including food?
Some medications can interact with others, which is why it's important to make sure your pharmacist knows all the medications you are taking and to ask the pharmacist this question when adding a new medication. Medications can also interact with foods we eat. Some blood pressure medicines cannot be taken with the salt-alternative Mrs. Dash. Vitamins and juices can also affect medicines. Lipitor, for example, cannot be taken with grapefruit juice.
3. Can I crush these pills, as I have trouble swallowing?
While there are medications that can be crushed, others cannot. Extended-release medicines, for example, are designed to be absorbed over time. They should not be crushed, or they will release too quickly and can have severe effects on the system. If you have trouble swallowing, talk to your doctor about an alternative prescription, perhaps a liquid.
4. Do these natural medications or vitamins have side effects or can interact with the medications ordered by my doctor?
You might think that natural medications, also called Complementary and Alternative Medicine (CAM), are free of interactions and side effects because they are "natural." This is not the case. Ask your doctor or pharmacist if the natural medicines, supplements or vitamins you take are safe in combination with your prescription medicine and whether there are side effects. (Nearly half of those who take CAM, according to a national study, do not discuss it with their conventional medical providers.) Ginkgo biloba, for instance, may lower blood sugar and blood pressure, and may place an individual at risk for bleeding. It must, therefore, be stopped before planned surgery.
5. Can I stop this medication on my own?
If you are having uncomfortable side effects, speak to your doctor immediately. Even if you are feeling better, you should never stop a medication without consulting with your physician. It's important to adhere to the prescribed course of antibiotics, for example, to ensure that all the bacteria has been killed and won't return (and become drug-resistant). And if side effects like nausea or sleeplessness are keeping you from taking the prescribed treatment, talk to your doctor about alternatives that may be easier for you to tolerate.
After all, medicines can only help when you take them.
Do you have any tips for managing medicines, for yourself or someone you care for? Let us know.