Taking Five or More Prescription Medicines
Taking five or more prescription medicines (called polypharmacy) is more common than most people realize. Research shows that it is very common among older adults. Usually, this is because the person has several chronic conditions. That’s why health care providers tend to add medicines. The problem? The chances of a poor outcome go up the more medicines you take. Palliative care doctors can make a difference.
By spending time communicating with you about your medicines and your quality of life, they can find out if you are taking some that are no longer essential. They will report back to your primary doctor. Together they may take away some medicines that are no longer necessary. This can eliminate side effects that may be affecting your quality of life.
But your primary doctor can also determine whether you’re on medicines that are no longer helping you. How should they do this?
Figuring out if you’re taking too many medicines
Your primary doctor should take the time to learn more about the medicines you are taking. They should carefully review your medical records and medicine list. And they should ask you some specific questions (e.g., do you still need your proton pump inhibitor). If they don’t ask, you should start that conversation. If you’re also seeing the palliative care team, the palliative care doctor will do this.
Your list of medicines
First, make sure that you and your doctor carefully examine the list of medicines you’re taking. How many are there in total? If the list shows more than five, know that this is associated with worse outcomes, especially in older people. Research tells us that older adults are at greater risk for experiencing bad drug reactions in general, and the risk goes up the more medicines you take.
Have you been taking a particular medicine for a long period of time, without a break? Do you still need to keep taking it? Maybe the benefit of the medicine has run its course and could be stopped.
Sometimes people may not think to ask, “How long have I been taking this medicine, and should I keep taking it?” But your doctor should ask this question! If they don’t, you should.
Necessary or unnecessary
Some people may not even know whether they still need a particular medicine. Another issue to consider is that you may be taking a medicine originally prescribed to counter the side effects of another medicine. Are you even still taking the original one? If not, you may no longer need to be taking it. Your doctor should check with the doctor who originally prescribed the medicine.
Common, overprescribed medicines
Certain medicines are “usual suspects” for being overprescribed. As a 2019 study in the Journal of Clinical Medicine Research found, the most common overprescribed drugs tend to be: pain medicines, medicines for acid reflux, hormone replacement medicines (e.g., levothyroxine), and antidepressants. However, this depends on your stage of life, especially if you’re an older adult. The list may change as you get older.
You should be especially careful about high-risk medicines. One category in particular, especially for older adults, is anticholinergics (e.g., amitriptyline). These are prescribed for a variety of conditions such as Parkinson’s disease and chronic obstructive pulmonary disease (COPD). But they are known for causing dizziness, fatigue, cognitive changes, and other symptoms that can impact a patient’s quality of life. And this category of medicines is associated with an increase in death as well as permanent cognitive damage in older adults.
Our medicines need to change as we get older. What might be right for a middle-aged person could be quite different from what’s appropriate for an elderly person. So, always review your list of medicines with your primary doctor and your palliative care team to make sure that the benefits of medication outweigh the risks.
GetPalliativeCare.Org is an online resource for patients and families that focuses solely on providing information on palliative care from the point of diagnosis. At GetPalliativeCare.org you can take a short quiz to see whether you or a loved one could benefit from palliative care. The site is provided by the Center to Advance Palliative Care.