I recently assisted in moderating a local research study of individuals who took six or more prescription medications a day.
Some participants spoke of needing to take pills with food, while others needed to take their medication on an empty stomach. Some were required to split their pills, and some needed to modify their dosage daily depending on their health condition.
Still others spoke of changing pill shape, size and even form as their pharmacy changed generic providers.
To an observer like me, the process of scheduling and taking all these medications was complicated and involved, even though almost all study participants had adjusted to their regimen.
One person said they take 44 pills per day. Another carried in his wallet a long list of all the medications he was required to take daily, just so he could remember all of them and what they’re for.
Like it or not, we are a society of pill takers.
It’s estimated that in 2019, 4.25 billion retail prescriptions will be filled throughout the United States. Prescription medications are used by 75 percent of those age 50 to 64, increasing to 91 percent of those age 80 and older.
The average number of prescriptions filled annually also increases with age, from 13 for those age 50 to 64 to 22 for those age 80 and older.
Dr. Rita Redberg, editor in chief of JAMA Internal Medicine, describes the situation this way: “In general, patients like the idea of taking a pill a lot better than nondrug measures, such as improved eating habits or exercise.”
Other factors are at play.
Some studies have found that doctors are concerned about their own liability should something go wrong if they stop a medication in expectation of a patient making lifestyle changes, or they worry that if they do so they will fail to meet recently established physician benchmarks—especially those for managing pain.
Additionally, many physicians are reluctant to makes changes to their colleagues’ prescriptions, assuming that if they were prescribed there must be a good reason for it.
I was unaware, but learned from the sponsor of the study, that physicians do have the right to place a stop order for a prescription that is on an auto-refill program. Most don’t, and even if they do, sometimes the stop order falls through the cracks, even with electronic health records and healthcaresystem pharmacies.
For many seniors, problems arise when they’re discharged from the hospital with new medications layered on the previous ones and are trying to sort out the complexities of the new regimen.
In an effort to help, some physicians and hospital systems periodically conduct a medication “reconciliation” during an office visit or before hospital discharge.
If you haven’t had one, request one from your physician.
During these reconciliations, doctors review a list of everything a patient is taking: prescription medications, over-the-counter items and herbal and nutritional products. The patient is asked which of these they take regularly as they may not be taking all that are prescribed.
The doctor also asks about patches, creams, eye drops, inhalers, sample medications, shots, vitamins and supplements. Notes are taken of the discrepancies between the patient health records and what the patient states. The idea is to get a complete picture of every nonfood product entering the patient’s body.
The physician then asks about allergies, as well as who is helping to administer the medications. They ask when the patient began taking the medication, how many times in the past two weeks they have forgotten a dose of the medication and whether they take vitals to monitor their condition.
The physician also asks about side effects. If any are reported, they ask what action the patient took. Lastly, they ask if the patient is taking any other medications that have not been prescribed but have been helpful to them.
The patient is then provided with a new set of medications going forward.
It is important for all of us to take responsibility for our health and be diligent, especially as it pertains to our use of prescription medications.
If you need help, the FDA has a resource, Medicines and You: A Guide for Older Adults, at https:// www.fda.gov/Drugs/ResourcesForYou/ ucm163959.htm.