Wielding the Double-Edged Sword of Medications

Many Americans, especially older Americans, take a lot of medications. Not just prescriptions but over-the-counter (OTC) drugs as well. A double-edged sword in some ways since medications can obviously help, but too many together can cause unwanted side effects.

Providers who practice home-based primary care (HBPC) can help address this issue, suggests Dr. Ina Li, MD, Clinical Director of Continuum of Care and Home Based Services and Clinical Director of Geriatrics for the Christiana Care Health System in Wilmington, Delaware

Older Americans on average fill between nine and 12 prescriptions a year. “That’s a lot for anyone,” said Li, who also serves as an expert faculty member for the Home Centered Care Institute (HCCI).

Li says older Americans account for the sales of as much as 35 percent of non-prescription drugs and 40 percent of all prescriptions. In a presentation she gives called “Medications and the Elderly,” Li says people between the ages of 60 and 80, whose reliance on prescriptions and OTC medications is increasing, are most at risk from drugs and dosages that no longer fit their changing bodies.

Dr. Ina Li

Dr. Ina Li

“As we get older,” Li said, “our bodies metabolize drugs differently. And not as well.” That means that older patients react differently to medications at age 80 than at age 60 or 70, when they may have first been prescribed. “In general,” she said, “our organs lose 1% of their function for every year over age 30. When you hear this, you think, ‘This is not great.’”

It’s not. “The two big ways for our bodies to get rid of medications is through the liver and kidneys,” Li said. “And these organs are less and less able to do this as we age.” Because the body can’t get rid of waste as well, older people tend to have more side effects and drug interactions.

Fortunately, because they are in patients’ homes, HBPC providers have a much better opportunity to become aware of medication problems in their patients. “You’re in their home and can see what’s happening with their medications in person,” Li said, “Providers, especially those seeing patients in an office setting, don’t have that ability.

The problem, though, isn’t just with prescriptions.

Li often warns both providers and patients that OTC drugs also carry great risk. Providers must monitor these as well, she said. A presentation Li uses cites statistics showing that common OTC drugs, such as sleep aids and bladder-control medications, can interfere with bodily functions. They can also cause uncomfortable side effects such as dry mouth and constipation as well as more serious ones, including delirium and depression.

Multiple medications prescribed by different specialists is another issue. With a laugh, Li said, “I had a patient who once told me that every body part had a specialist. Ear, arm, heart … every body part needs a checkup.”

Managing multiple medications from other providers and questioning the continued use of some isn’t simple. Patients may have prescriptions for ailments that are no longer current. For instance, a patient taking anti-seizure medication but hasn’t had a seizure in three years can ask if the prescription is still necessary. A provider can and should check with the specialist, Li advised, adding that she tries to empower her patients. “The patient can ask their neurologist. Sometimes, I’ll write the question down on a 3-by-5 card and give it to the patient to ask the specialist.”

On average, she said, every older patient is taking at least one unnecessary prescription, and it is “our responsibility as their home-care providers to de-prescribe this medication.”

Finally, according to Li, a provider should always consider whether a medication is necessary. “[Does a patient] really need this stuff?” Li said. “Every medication has to be justified.”