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Senior Health: Medications and the elderly: Beware of polypharmacy

Older populations generally experience more disease and complex medical conditions, which is why seniors are often consumers of a large number of medications meant to treat their ailments. However, it is important to understand how the simultaneous use of multiple drugs to treat one or more conditions can impact functioning.

As we age, the changes that take place in our bodies also have a significant impact on how medications react, are absorbed and eliminated. Since most medications are eliminated by the liver and kidneys, a naturally aging kidney or liver can result in decreased elimination of medications. Changes in the body over time, like loss of skeletal tissue and increased fat, can cause some fat-soluble medications to stay longer in the body.

Polypharmacy, or the use of multiple medications, further compounds medication problems that can occur in the elderly. Polypharmacy in itself has shown to increase the risk of hip fractures from falls, decreased adherence to medications, and increased adverse events. Sometimes, the use of multiple medications can lead to a “prescription cascade” where a medication is prescribed to offset the side effects of another. Studies have found that two groups of medications — sedatives (sleep medications) and medications with anticholinergic activity — are especially implicated in cognitive decline and mobility issues. Anticholinergics act on a particular receptor in the body and can cause multiple unintended side effects. Other medications, such as depression medications, cold remedies, and allergy medications, tend to have anticholinergic activity and their effects can add up. This can result in more falls, confusion, urinary retention and cognitive impairment.

So clinicians, the elderly and their caregivers face a dilemma. Older adults tend to experience more complex medical problems and illnesses that often require the use of multiple medications for disease prevention and treatment. The difficulty is finding a balance that meets the medical, emotional and financial needs of the patient. For example, clinical guidelines for an older female patient with chronic obstructive pulmonary disease, type II diabetes, osteoporosis, hypertension, and osteoarthritis suggest prescribing 12 medications for this individual at a cost of about $406 a month. However, how well a patient tolerates multiple medications is different from person to person and medication cost in this day and age is definitely a defining issue. In most cases, clinicians can prescribe a less costly generic drug or substitute medication that will be just as effective.

Herbal medication intake has also more than tripled in the geriatric population over the past four decades. Prescription medications tend to be perceived as more chemically potent, while herbals are thought to be safer. However, this is not always the case as herbal medications are not strictly regulated. It is important to understand that the interactions between herbal medications, dietary supplements and prescription medications can be severe. It is always advisable to write down all the medications you take, including herbal, non-prescription and prescription medications, and give that list to your doctor. 

In summary, I recommend the following:

• Discuss your care goals with your doctor.

• Review your medication list.

• If you are on a large number of medications, ask if there is a way to safely reduce the number of medications you are on. 

• Ask questions about the long-term medications and possible interactions with other prescription and over-the-counter medications you may be taking.

• Understand why you take a medication and how it is supposed to help you.

• Discuss if doses can be reduced.

• Bring all the medications you are taking to your appointment.

Surprisingly, a recent study revealed that more than 30 percent of Medicare beneficiaries had not discussed their medications with their doctors in the past 12 months. Having a discussion about your medications, their need and how that plays into your goals of care, might be a good step in reducing some of the problems that we all face with polypharmacy.

Dr. Devarajan Manu is board-certified in geriatric medicine and sees patients at Bassett Medical Center in Cooperstown. To learn more about the providers and services within Bassett Healthcare Network, visit or call (800) 227-7388.

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