Medication reduction in the elderly

Legend By Legend, 5th Nov 2013 | Follow this author | RSS Feed
Posted in Wikinut>Health>Drugs & Medicines

The elderly generally take a large amount of medications. A good physcian should always be mindful of what medications he can reduce. This improves overall care for the elderly, reduces health costs and could reduce side effects as well.

The multi drug treatment (polypharmacy) of the elderly

Often, elderly patients, will present to their treating physcian or the emergency room with a long list of medications that they take on a daily basis. The list has been built over the years, with each new medical problem receiving attention in the form of a specific medication which is supposed to be administered for that specific problem. This long list of medications is sometimes termed "polypharmacy". There are several potential problems with these long lists and efforts should be made to curtail them whenever relevant or possible.

The cost of polypharmacy

If a patient consumes 20 different pills a day, this is probably costing him a great deal of money. For people without adequate finances and health insurance, this could mean that the person ends up not purchasing many of his medications due to lack of funds. Even if the person has medical insurance which foots the bill, that just means that the cost of medications is being footed by the rest of the people paying for insurance. An octogenarian who has a pension of 800$ a month and spends 300$ of it on medications is unfortunately not an uncommon scenario. If people don't get those medications which are truly necessary, they end up being sicker and thus increase public health costs in a roundabout way. Reducing medications for these people lets them focus on which medications are truly important and helps to reduce overall costs for them as well for society.

The problems of polypharmacy

Several problems arise around polypharmacy. Sometimes, new medications that are from the same class as older medications are added on top of the older medications without stopping the older ones. This means that the patient is actually being treated with excessive doses of similar medical compounds, generally at a greater expense than if a single medication were being used. Many medications have interactions with other medications. Most physicians are only aware of the most basic drug interactions and with polypharmacy, there are probably more interactions than even the most proficient pharmacologist could monitor. These interactions can mean more drug related adverse events as well as reduced efficacy of certain drugs.

Stopping medications requires guts

The problem with stopping medications which might be needless or problematic is that it requires guts. When a medication is stopped, the physician stopping it would generally like to see what happens to the patient after the medication is stopped. If a hypertensive medication is stopped, for example, it would be nice to know what happens to the blood pressure afterwards. For this reason, medication modifications are often best modified in an in-hospital setting where closer monitoring is possible and and side effects of medication cessation can be identified. The hospitalist, conversely is often more concerned with immediate problems presented by the patient than with fiddling with his medications. Nonetheless, all caregivers should be mindful of these issues and chronic therapy should reviewed and analyzed periodically.

Tags

Drug, Drugs, Elderly, Medication, Medications, Polypharmacy

Meet the author

author avatar Legend
I am a practicing physician. I have spent 5 years in Yeshiva studying religion. I published a card game on wikinut and I am in a process of getting divorced

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