Is your pillbox overflowing? Or have you noticed that your elderly mother or father is taking more and more meds? Older Americans are being prescribed an increasing number of prescription drugs, and that heavy load can be a real problem.
That’s the conclusion of a new report from the Lown Institute, a nonpartisan healthcare think tank. As of 2014 (the latest government data available), 42% of adults 65 and older have taken five or more prescription drugs in the past 30 days, up from less than 14% two decades earlier; one out of five 45- to 64-year-old are popping five or more pills. Those numbers go up when you add in supplements.
There’s no firm number for how many drugs are too many, but the more you take, the greater the chance of side effects and harmful interactions, which can cause drowsiness, nausea, delirium, falls, serious bleeding, or even premature death.
An estimated one out of five older Americans had a bad reaction to a drug last year, the Lown report notes, and more than 280,000 were hospitalized as a result. Older adults with five or more prescriptions were almost twice as likely to seek treatment for a bad reaction than those taking just one or two meds.
“We’re not saying that taking medications is automatically bad,” says Shannon Brownlee, senior vice president of the Lown Institute. “For some patients, taking five or more medications is actually completely appropriate if those medications are being managed well, if they’re at the right dose, for the right patient.”
But, she adds, millions of older Americans are experiencing medication overload, when multiple medications are causing more harm than good. If you think this might be the case for an elderly relative or even yourself, here’s what you can do.
Ask lots of questions
When your doctor gives you a new prescription, ask questions before you fill it: What is the drug is supposed to do, how long should I take it, how will I know it’s working, and how it will interact with my other prescriptions, over-the-counter drugs, and supplements? For more potential questions, check out this list from the Food and Drug Administration.
And you should keep a list of all your drugs and supplements. In this fragmented health care system, there’s no guarantee that anyone else will do it. Make a note of when the drug was prescribed or started, and for what.
Keep a close eye on certain drugs
According to the Lown Institute report, certain types of drugs have a greater potential to cause harm. Blood thinners, diabetes medications, and opioids contribute to 60% of emergency room visits for adverse drug events in older adults.
Other drugs that can pose risks: sedatives, anti-anxiety and anti-depressant drugs, blood pressure medications, antipsychotics, and certain over-the-counter products, including bladder medications and antihistamines. If you’re taking drugs in these categories, you should be particularly careful to ask a clinician about why that drug is needed, what side effects you should look out for, and how you should be monitored.
Be careful during care transitions
You often are prescribed a new drug when you go into the hospital, and that’s totally appropriate, says James Rudolph, professor of medicine and health policy and practice at Brown University’s Warren Alpert Medical School.
But what is beneficial in an acute setting isn’t necessarily so once you leave the hospital, he says. Same with prescriptions added during rehabilitation—they may not be appropriate once you’re home. At each transition, speak with a health care professional about what drugs need to be continued in the next setting and which can be eliminated.
Schedule a prescription checkup
Regular prescription checkups are not a typical part of U.S. health care, though the Lown Institute report recommends that they become so. But you can review your prescriptions at a Medicare annual wellness visit or routine office visit.
Come prepared with all your prescriptions, as well as any other over-the-counter drugs or supplements you’re taking. Put it at the top of your priority list for the visit (and be aware you may need a follow-up visit to have a full discussion).
“If it’s the fourth thing you want to talk about, you may not get to it,” says Michael Steinman, professor of medicine in the division of geriatrics at the University of California, San Francisco.
Certain people taking multiple drugs can qualify for a Medication Therapy Management program under Medicare Part D, though those reviews are not designed to reduce unnecessary medications, the Lown report notes.
Your community pharmacy may also be able to offer a review, says Steinman, though you may pay out of pocket for it.
The key is to exchange accurate information with your health-care provider, says Rudolph. That means being honest about what medications you’re actually taking. (Research shows that adherence goes down as the number of prescriptions goes up.)
Discuss any side effects you’re experiencing. Ask questions, including whether you still need the medication and what your goals of care are, advises Nicole Brandt, executive director of the Peter Lamy Center on Drug Therapy and Aging and a professor at the University of Maryland School of Pharmacy.
Then you can prioritize the most important medications and discuss whether any are no longer necessary or are doing more harm than good. In some cases the solution may be lowering a dose rather than cutting a prescription altogether.
Don’t try to do this yourself
It’s a bad idea to just stop taking your medications, even if you’re feeling overburdened, says Brandt. Some drugs have adverse drug withdrawal effects and need to be tapered, so don’t stop taking anything without working with a clinician.