“Suddenly people started buying the generic at the chain, while getting their brand-name drug through a mail-order service. With no central reporting system, there is no way for your doctor(s) to know everything you are taking— unless you tell him,” says Mike Cohen, R.Ph., director of the Institute for Safe Medication Practices (ISMP) in Pennsylvania.
At Erickson communities, a major aid is the Centricity electronic medical records system. (See “Electronic Medical Records” at www.EricksonTribune.com). Even so, the doctors at these communities don’t assume all the medicines they see listed in the system for a patient are correct.
Over-the-counter meds
“Many of our residents see outside specialists. That is why during every visit I print that person’s medication list and ask if anything has changed since I saw them last,” says Roland Lascari, M.D., Erickson Health physician at Cedar Crest, an Erickson community in New Jersey.
If there is no computerized list, follow this advice: “I have people I’m seeing for the first time put all their medicines in a bag and bring them in so I can review them,” says Marcelis.
Lascari, Marcelis, and other Erickson Health physicians make sure to include OTC (over-thecounter) medications and natural supplements (see the June 2005 “Natural Supplements” story online at www.TheEricksonTribune. com) in their discussions with patients.
“There is one nighttime pain reliever blacklisted for use in people over age 65. For various reasons the component that helps you sleep, diphenhydramine, causes delirium, agitation, and other problems in older adults. Even if the drug itself wasn’t dangerous, Marcelis says he would still be leery of having someone older use it. “Anything that makes an older person drowsy, be it OTC or prescription, can be dangerous. Think of the risk of falls and fractures if they wake in the middle of the night to go to the restroom, dizzy and disoriented in the dark,” he says.
“I know at 62 I have more pains when I get up in the morning and it is easy to take something like ibuprofen or naproxen (e.g., Motrin or Aleve). But these drugs are both excreted by the kidneys and neither your kidneys nor liver work as effectively as you get older,” says Cohen. That makes it dangerous to take such medications for long periods, to treat chronic problems like arthritis.
Beyond medication
That is why the motto for Erickson Health physicians is “Review, Identify, and Educate,” having the kind of conversations both Marcelis and Lascari emphasize. It is a practice they urge older adults to engage in with their physicians, to reduce the risks of multiple medications.
People age 80 and older need to be especially careful. “Studies on drug side effects aren’t done in this age group. If someone is age 87, maybe it isn’t as critical to use a statin drug to lower their LDL (bad) cholesterol from 120 to much lower, as has been recommended in new guidelines, if the drug creates other problems,” says Lascari.
Exercise generally considered gentle like tai chi, can be a safer—and more long-term—soother for arthritic joints than drugs. “In Erickson communities we have Fitness Centers, all-season pools, nature walks…all sorts of options to help people develop and maintain a less drug-dependent lifestyle,” Lascari says.
“If someone has lost 60 pounds, I re-evaluate their medicines. Maybe I can eliminate their high blood pressure drug,” says Marcelis.
Is the activity and lifestyle change harder than popping a pill? Yes. But unless you really want the side effects and costs of five different medications (the average for most older adults), it is time to look at how to eliminate some of them.