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The Perils of Polypharmacy

Come again?  Polypharmacy?  We’ve got polygamists, polymaths, polyrhythms and polygraphs.  Now there are polypharmacies?  Or is it polypharmacists?  What?

Polypharmacy is far more familiar than you might think, and no, it’s not about great hoards of white-coated druggists threatening to redefine civilization.  It’s a form of battle, a grim one that takes the lives of 100,000 older adults each year.

It goes something like this.  Your elderly (but perfectly independent and competent) mother is taking several prescription medications daily – in fact, a total of five, though she is a bit vague about the actual number when you ask.  She also takes the usual over-the-counter stuff, some antacids, a few Tylenols, a sinus remedy.  She drinks coffee every morning – brews it herself, from those nifty little single-serving cups – and enjoys a glass or two of Pinot Noir with dinner.

She likes her privacy, and enjoys bargain-hunting, so she fills her regular prescriptions online, or at least at different pharmacies around town.  She finds she saves quite a bit doing this, and it’s fun.  And she has three separate doctors.  Mom has strong opinions about medical care and carefully chose each specialist.  Each one prescribes medications for her and they don’t talk to one another.  In fact, they may not even know about one another.

Now, every medication causes side effects, even as it effectively treats the disorder or condition for which it was prescribed.  So here you have five separately prescribed medications, plus all sorts of OTC remedies and drugs, and each one is doing its best to fulfill its assigned mission.  Think of the confusion!  In fact, experts describe it as a form of warfare, with the various drugs vying for internal supremacy and, in the process, damaging otherwise healthy organs and systems. The resulting side effects are far too often serious and potentially life-threatening.

Along with taking more than one prescription medication every day – and the average older American adult is taking five or more daily – polypharmacy includes:

  • Regularly missing or mistaking the proper dosing of one or more prescription medications, even if they are all otherwise correct and compatible.
  • Having the right medications but taking, at the same time, OTC drugs or drinking alcohol or coffee or eating grapefruit or similar foods that might cause bad side effects or other complications.

Family members, close friends and other caregivers are in a perfect position to spot polypharmacy.  Many signs of trouble are not just part of ordinary aging.  Some of the symptoms that should prompt concern include a parent or loved one showing signs of:

  • Incontinence, constipation or diarrhea
  • Tiredness, diminished alertness or sleepiness
  • Loss of appetite
  • Confusion, either episodic or continuous
  • Depression or general lack of interest
  • Tremors
  • Weakness
  • Anxiety or excitability
  • Hallucinations (hearing or seeing things)
  • Dizziness
  • Skin rashes
  • Decreased or changed sexual behavior

What can you do?  First of all, there are ways to reduce the effects of polypharmacy.  

  • Make sure every single doctor treating your parent or other loved one is aware of each and every medication, supplement, and OTC remedy that patient takes.  Collect all the bottles and organize and list each drug.  Include the dosage, the dosing recommendations and any warnings or cautions stated on the bottle or packaging.
  • Read all the package inserts or label descriptions of each drug taken.  Read the small print, too.  There will be warnings about conflicts with other drugs and details about specific conditions that make the risks worse.  
  • Keep track, in writing, of any side effects you may observe.
  • Consider taking all the medication bottles and packages to one of the pharmacies currently used and requesting a database analysis of each drug and the whole combination.  This will help identify conflicts and side effects.
  • Make sure all doctors and medical offices treating the patient in question have a copy of the list of drugs along with your notes about possible side effects you’ve observed.
  • Do your best to consolidate things.  Try to have one doctor in charge of all the prescriptions.  Have one pharmacy as the source for all medications, Rx and OTC.  Let one pharmacist there serve as your professional counsel for the drug regimen (a service available at no extra cost).

What else can you do?  It helps if complicated dosing schedules are carefully organized, and remember that most of us need assistance with this.  Just offer, don’t wait to be asked.  Those plastic trays with multiple little bins are really handy and they keep the medications separated, preventing drug interactions from starting even before the pills or tablets are taken.  A medicine log is also important for noting the date and time each drug is taken.  This may seem fussy in the beginning, but once the system is installed, it’s easy to keep it in place.  

It is widely believed that polypharmacy is the single biggest threat to sustaining the quality of life and health among our aging loved ones.   Medical professionals are always looking for ways to improve outcomes and co-ordinate patient services, but family members and caregivers are the first – and best – line of defense in this strange and thoroughly 21st Century conflict.  Not that guarding the home front is new.  But against our own prescriptions? Who’d have thought it?


 

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