Statistics from 2012 showed that a majority of Canadian adults in their sixties took more than 5 medications daily and 40% of those over 85 took ten or more! Not only is this a huge potential risk for seniors but also resulting problems from polypharmacy represent an economic toll on our health care system and an emotional toll on families and caregivers. This month, Elder Voice looks at one aspect of medications and our Elders.
96 year old Helena is a warm, engaging and fully alert woman–the kind everyone wants for a grandmother, and everyone would welcome as the family matriarch. Following a medical incident, for which she was admitted to hospital, we were hired by her U.S. based family to help her find housing before a rushed discharge. After arranging for her move and helping her settle in, she told us about a new medication she had been prescribed due to having to use the washroom so often at night. We reviewed her medications again and found one side effect of her antidepressant can be increased urination. Investigating further, she told us that both the antidepressant and a sleeping pill she was on been started during her hospital stay. The staff had given her the anti depressant without her knowing what it is, presumably due to her upset about her condition (despite the fact that grief was a totally appropriate reaction to the change in her condition and it’s impact on her life). Both had simply been continued after discharge. We immediately asked for a medication review by the physician.
Helena was in some ways, fortunate. The sleeping pill had not made her groggy or lead to a fall at night. It did not dull her cognitive ability. When the anti depressant was stopped, she did not have to use the washroom so often. She was fortunate that we reviewed her medications with her and listened as she told us about changes in her body and new symptoms she was having.
It is easy to forget what powerful affects a little pill has on all of our body systems, Things to remember include:
- We may react to medications differently when we are older than when we were younger because our body process them differently
- Side effects can come on gradually, or begin due to interactions that were not foreseen.
- Side effects can be seemingly unrelated to each other and obscure.
- Side effects can affect many areas of our lives: lifestyle, cognition, or physical ability. For instance, some medications can affect taste, so people don’t eat as much, may become malnourished or weak, and then fall. People are not generally educated as to the potential side effects, and if they are living on their own are not monitored by anyone.
If someone is admitted to a care facility from a hospital, the care facility generally continues to dispense medications as prescribed for at least several months. They do not ask what was being taken at home before the hospital admission. Although care facilities often have medication reviews with physicians on a regular basis they do not invite family input, nor do they let families know that their loved one is being reviewed or what the result is.
It is important to realize that EVERY medication has some side effects, and sometimes we need to balance the risk with the potential benefits. Seniors and family members need to understand their medications. Pharmacists should sit down with their customers when they bring in a new prescription, and review it with them, looking at possible side effects and drug interactions.
Below are a few tips for you:
- Always ask about potential side effects and drug interactions with the dispensing pharmacist.
- Review your medications regularly with your doctor and your pharmacist.
- Be aware of general risks with medications such as increased risk for falls, confusion, grogginess, or other impaired cognition.
- When a medication has been prescribed to treat mood or behaviour, you should always ensure that non pharmacological interventions have been explored first.
- Prescribing physicians and health care professionals who are advocating a medication should consider the impact of someone’s’ family, social, living, psychological circumstances might be having on symptoms they are seeing.
- Be aware of long term effects of some medications, such as addiction and impact on the functioning of organs.
- Before trying to fix a new problem with a new medication, always ask if it could be related to a current medication or medication interaction.
- Care facilities should be required to inform families whenever a medication is changed, stopped, or started.
- Family members of someone in care should always ask if your loved one needs a medication, and why. This includes standard medications such as for constipation.
- A pharmacist can be a crucial ally in obtaining the best care possible for anyone of any age. Involve them in your ongoing health care.