“Is your medication making you sick?”
by Family Councils Ontario
Guest Blog Submission by Dr. Rhonda Collins
It is entirely too often that I see older adults taking too many medications or medications that are unnecessary or potentially harmful. This is called polypharmacy and it can lead to many problems.
According to the Canadian Institute for Health Information, 67% of Canadians over the age of 65 take 5 or more medications, 24% take more than 10 medications and almost 10% take 15 or more medications daily. This can lead to side effects and interactions between medications that can cause illness. Up to 25% of emergency department visits in older adults are due to a side effect from a medication.
There are several reasons why medications pose a greater risk as we age.
Chronic illness, body weight, fat and muscle content and our liver and kidneys can affect the way our bodies handle medication. Sometimes, doses need to be lowered so the medication does not become toxic. The older we are, the more likely we are to experience side effects; and the more medications we take, the greater the likelihood of interactions between the meds, which can also cause unpleasant effects. An article published in the Archives of Internal Medicine identified that the average medication label lists more than 70 potential side effects. Imagine what that means if you’re taking 5 or more medications? There are many potentially serious consequences of polypharmacy, including memory loss, confusion, difficulty swallowing and falls.
You might ask why a person can end up on too many medications and there are several reasons for this as well. Physicians often follow guidelines for certain diseases like heart disease, high cholesterol, high blood pressure and diabetes. These guidelines suggest target numbers for blood pressure, sugar, cholesterol, etc. The problem is the guidelines are based on large studies, but most of those studies included younger, healthier individuals. Because of some of the things that change in our bodies as we age, those guidelines don’t always apply to older adults. Another reason is more than one physician caring for the same patient – as in when you see a specialist or get admitted to hospital. Often new medications are added, and the family physician doesn’t want to reduce or discontinue medications started by another physician. There are also patient factors like being nervous about stopping a medication that they’ve been taking for a long time.
So, what can you do? Talk to your doctor about your medications. Important questions to ask when a medication is prescribed are:
- Do I really need this medication?
- What are the most common and most dangerous side effects?
- How long will I need to take it?
- Will it interact with other medications?
- Are there alternatives (like diet, exercise, behavioural therapy)?
Important questions to ask when you’ve been taking a medication for a long time:
- Do I still need this medication?
- Is it still providing any benefit?
- Is it safe for me to stop taking this medication?
- Is there a risk of my symptoms returning if I stop?
- How should I stop? (some medications need to be gradually reduced to prevent symptoms)
Not all medications are bad, and some are necessary, but many become unnecessary or even harmful as we get older. If you are taking medications, it is important to discuss them with your doctor. If you are the Power of Attorney for a loved one who is no longer able to make decisions about his or her health care, it is a discussion you should have with your loved one’s physician. Reducing or stopping medications can reduce or eliminate symptoms that you may or may not be aware of and improve your overall health.
Dr. Rhonda Collins is the Chief Medical Officer at Revera. She is a Family Physician with advanced certification in Care of the Elderly and an Assistant Clinical Professor at McMaster University. She has initiated several quality improvement projects in deprescribing and is passionate about improving the lives of older Canadians. If you’d like further information, Dr.Collins can recommend the websites Deprescribing.org and the Canadian Deprescribing Network for excellent patient resources.