May 2007
Don't assume your doctor knows what you're taking. Or what it's doing to you!
In an era when, according to one study, the average American TV viewer is exposed to more than 30 hours of commercials for prescription drugs each year - and who-knows-howmany hours of ads for over-thecounter medications, vitamins and herbal supplements - it's no wonder we're seeing situations like the following:
The 69-year-old man had Parkinson's disease and several other chronic conditions, and was being seen by a primary-care physician along with two specialists. His doctors prescribed various medications. None of the doctors, however, fully grasped the veritable medicine cabinet the man was taking. His medical regimen consisted of 15 prescription drugs, two over-the-counter medications and 12 vitamin and supplements.
One would think that taking so many different medications would cure almost anything. Instead the man complained of dry mouth and a lack of energy, irregular heart beat, shortness of breath, chest pain, insomnia, daytime sleepiness and stiff, curling toes.
Not until a specially trained geriatric pharmacist analyzed the man's medication regimen did a picture emerge of why he was experiencing so many unpleasant symptoms independent from his chronic medical conditions. The pharmacist's analysis found multiple interactions among the medications he was taking. Some were duplicates, which meant he was getting too high a dosage.
This is a true story about a resident of our state. We know about him because he signed up to have his medications reviewed through the Medication Therapy Management program, which is offered through the University of Nevada, Reno Sanford Center for Aging and funded by the Nevada Division for Aging Services, and the Marion G. Thompson Trust.
During 2005-06, this statewide program provided free medication reviews to 75 people age 60 and older. To participate, a person also had to be taking five or more medications.
Results from the research program were disturbing.
- Nearly 4 out of every 10 reviews found that the person was using a drug that was harming his or her health; the potential for harmful side effects existed in 8 out of 10 cases.
- Nearly 6 in 10 participants were found to be at risk for a harmful interaction between two prescription drugs.
- One in four people had been prescribed a drug from the Beer's List, a group of medications identified by a national expert panel as potentially harmful in older adults.
Who's to blame for situations like these? Often it's the patient. Many, particularly the oldest of the old, are from a generation that has complete faith in medical providers, so they don't question their physicians' knowledge or expertise. They also assume that every doctor they're seeing is aware of everything they're taking.
That's impossible unless you, as a patient, give them the information. Make a list and bring it with you to your next appointment with your primary- care physician. Or simply fill a plastic bag with all of your prescription drugs, over-the-counter medications, vitamins or supplements. Primary-care physicians should be asking for this information, of course, particularly with elders who have complicated and chronic medical conditions and are being treated by specialists. Physicians need to emphasize to patients how important it is to what you're taking. That knowledge can not only significantly reduce the risk of deadly interactions but curb bothersome side effects. It should go without saying that this kind of communication is vital between patient and physician. But there's a third party in most healthcare situations: the pharmacist. A certified geriatric pharmacist, like the one employed in the Medication Therapy Management program, has the training to recognize if a medication is inappropriate for seniors and can spot ingredient duplications between various drugs and supplements.
Ideally, your primary-care physician would be working in tandem with a certified geriatric pharmacist. Ask your physician if that's the case. The answer, unfortunately, will almost certainly be “no.” That's because only a handful of certified geriatric pharmacists exist in Nevada. It's the same situation throughout the country, which is puzzling because about 50 percent of prescriptions are for seniors. You'd think that 50 percent of pharmacists would be trained to service that population. Not even close.
Until that changes, health-care consumers and their caregivers need to be proactive. Have a medication review done once a year, especially if you are taking several prescription drugs and over-the-counter medication. The Sanford Center for Aging will continue to offer free medication reviews as funding for the program allows. For more information on participating or to receive an application packet, contact the project's coordinator, Teresa Sacks, at 775-784-1612.
(Larry Weiss is director of University of Nevada, Reno Sanford Center for Aging and an adjunct associate professor of medicine. was a delegate to the 2005 White House Conference on Aging, serves on the National Council on Aging Leadership Council, and is a past president of the Nevada Public Health Foundation Board.)