Health
In today’s world of people living longer with a number of chronic illnesses, medications, both prescription and non-prescription, are an increasingly large part of medical care. More and more individuals, especially older individuals, take pills on a daily basis for conditions such as hypertension (high blood pressure), diabetes, heart diseases such as congestive heart failure and angina, respiratory diseases, and arthritis (the most common chronic disease), just to mention a few.
The correct medication, in the correct dosage, for the proper indication, can improve quality of life, limit disease symptoms and progression, and reduce or significantly postpone death. Conversely, the wrong medication and/or the incorrect dosage of a drug can lead to serious problems, including death.
What should you, as a consumer of medications, do or know in this world of so many new and expensive medications? The guiding principal, I believe, is to be an educated consumer. Know as much as you can about any chronic (long-term) illnesses you have. Know the symptoms, the treatments (medication and especially non-medication), and the prognosis (expected outcome over time).
You can obtain this education through reading (books, magazines, and websites), attending talks or seminars, joining support or self-help groups (available in most cities for: Parkinson’s Disease, breast cancer, colon cancer, Alzheimer’s Disease, heart disease and many other types of diseases), and speaking with your physician.
Is Medication Always Necessary?
Before you begin taking a medication, I believe it’s very helpful to first explore any non-medication approaches to therapy. Occasionally, such an approach can eliminate the need for medication altogether. More commonly, it can reduce the dose or reduce the number of medications you need.
Regular exercise has been proven to be very helpful in treating or preventing a number of diseases. For battling obesity, correct diet and exercise are far better and safer than any medications currently available. In the treatment of hypertension, a very common problem, regular exercise can often make it possible for you to control your blood pressure with just one, instead of two or three medications, thereby lowering your chances for adverse (bad) drug reactions or interactions, and significantly reducing your medication costs.
Learn As Much As You Can About Your Medications
If your physician prescribes a medication for you, be sure, before you leave the office, or hang up the telephone, that you clearly understand the name of the drug, both generic and brand names. Be sure you understand why you are being given that particular medication, the dosage you are expected to take, the time(s) of day to take the medication, and how long the physician thinks you will need to continue taking this drug.
Understand the side effects
Finally, be sure to ask about any common side effects that might occur, whether they are mild or potentially serious, and whether they persist or usually disappear after taking the medication for a brief period of time.
Make sure your doctor knows what you are taking
Most importantly, be absolutely certain that your physician knows about all the medications you are taking. This will help to avoid predictable medication-medication interactions, which can lead to serious problems. Indeed, the best thing to do is actually bring all of your medications, prescription and non-prescription, with you to each and every office visit with your physician. This will not only enable your doctor to check exactly what you’re taking, it is also a perfect way to discuss your questions and concerns about these drugs. If you can’t bring the medications themselves, bring an up-to-date list of your current medications and dosages. Be especially sure to alert your doctor to any new medications (including “natural” remedies such as herbs or vitamins) you have started to take, and any that you may have recently stopped taking.
Tell Your Doctor About Side Effects
It is very important to discuss with your physician any unpleasant symptoms you are having that may or may not be caused by your medications. Don’t assume that you simply have to live with unpleasant side effects in order to treat your illness.
For example, there are many medications for hypertension that are safe and effective for treatment. You don’t have to tolerate ongoing nausea, diarrhea, dizziness, or decreased sexual drive in order to control blood pressure. You ought to be able to find a medication, or a combination of medications, that both controls your blood pressure and allows you to be free of unwanted side effects.
Cost of medications
The same applies to cost of medications, which can be very high. As you know, the traditional Medicare Program does not pay for drugs, and it is not unusual for older individuals to pay hundreds of dollars or more each month for medications. Discuss cost with your doctor, especially if you do not have a prescription drug benefit and pay for medications yourself. Often she/he can prescribe a generic drug that works just as well, is just as safe, and does not have any more adverse effects than the brand drug for the same condition.
Why Are Medications Potentially More Dangerous For Older People?
Besides the fact that older people take more medications than younger people, which leads to greater likelihood of drug-drug adverse interactions, there are physical and cognitive (mental) changes that occur with aging, along with changes in how our bodies handle medications. As we age, medications are absorbed differently, transported differently in the blood, and metabolized (broken down) differently by the liver and kidneys.
For these reasons, lower dosages are often indicated for older individuals. Usually, the best advice when beginning a medication is to “start low and go slow” — begin at a low dose and increase it, as necessary, slowly.
Some specific advice about four medications
If you are taking any of the following commonly prescribed medications, it is important to anticipate potential effects of adding, taking away, or changing the dose of another drug. Those medications are Coumadin (sodium warfarin), Lanoxin (digoxin), Dilantin (diphenylhydantoin), and Theo-Dur (theophylline).
For example, suppose you are taking Coumadin, a “blood thinner” used to treat a number of conditions, and you are then prescribed a sulfa-containing drug such as Bactrim for 10 days, perhaps for a urinary tract infection. There is a possibility that the addition of Bactrim will increase the level of Coumadin in your blood, thereby increasing the likelihood of a spontaneous bleed in your body. Be sure you understand these possibilities if there are changes in your medication regimen and you are taking any of these four medications. Your doctor will be able to explain them to you.
Do Older People Take Too Many Medications?
Taking multiple medications, or “polypharmacy,” was once thought to be a problem in the elderly. While this can be the case if they are not properly prescribed, today it is felt that there really is no such thing as taking too many drugs. The key principle to remember is that every medication you take should have a clear reason or justification for its usage and should be prescribed at the proper dosage. Some individuals need eight or more medications daily, some need two or three, and some don’t require any prescription drugs. Again, the issue isn’t the number of medications, but rather their justification and correct dosages.
No One Is Too Old To Be Treated
Equally important, but often not addressed, is the problem of not being given medication because “you’re too old”. To my knowledge, there is no classification of medications that cannot be given to an individual, of any age, if clearly indicated. No physician should tell you that you’re too old to take medication. Within classes of medications, there are some individual drugs that should not be used in older people for a variety of reasons, but there are always others that can be safely used. So under-usage, or not using indicated medications, can be just as harmful as over-usage, or taking too many drugs.
Proper Medication Usage Is Very Serious Business
Proper usage of medications is a very serious business indeed.
In the hospital
Over 100,000 deaths occur each year in U.S. hospitals because of adverse reactions and medication errors made by hospital staff. Hence, if you are hospitalized, for whatever reason, be an educated and informed patient there also. Always ask what medications you’re being given and why they’re being prescribed. Always ask if you are receiving the correct dose. If you are too incapacitated to ask, make sure a family member or friend is present to be your advocate to obtain this information. People with kidney or liver problems should pay special attention to medication dosages.
On your own
Medication reactions or interactions are responsible for falls, hip fractures, head trauma, and automobile accidents, just to name a few serious problems. In some people, medications cause urinary incontinence (inability to hold your urine before getting to the bathroom), loss of sexual interest, depression, insomnia, decreased appetite, chronic dizziness — again, just to name a few common adverse effects.
Clearly, medications are a double-edged sword. They are often tremendously helpful in treating both acute and chronic diseases. They can prevent major problems and can even be life-saving. The proper medication in the correct dosage is a crucial part of good medical care today. This will become increasingly true as new and better drugs are discovered and developed. On the other hand, as illustrated above, the potential and sometimes serious problems associated with medication use are real and common.
So always keep in mind, the best person to monitor your medication usage is you. Be aware. Know your medications and dosages. Read. Ask questions. Become an expert about any illness you may have and any medications you may be taking.
