Have you found yourself eyeing your parent’s medication list, wondering if you should worry? It’s a reasonable thought, especially if your parent is taking more than five prescription medications. The CDC estimates that 177,000 older adults visit the emergency room due to medication problems each year.
Learn more from Leslie Kernisan, MD, who shares her senior medication safety checklist with us.
Research has shown that “inappropriate prescribing” is common in older adults. Meaning that, when patient charts are carefully reviewed, experts often find that seniors are receiving medications that are ineffective, duplicate the effect of another medication, or otherwise lack a basis for being prescribed. Why does this happen?
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Well, doctors often see patients during short visits, which can make it hard to think carefully about prescriptions. The healthcare system, after all, wasn’t designed to provide ideal care to people living a long time with chronic illnesses. Doctors are also humans, not computers, so it can be a challenge for them to keep up with all the latest medical knowledge. Plus, they also just sometimes slip up, as we all do.
To reduce the chance of a senior being harmed by inappropriate medications, the answer is not to look for a super doctor. The answer is to regularly conduct a methodical medication review. Scheduling such regular medication review is becoming more common in well-run primary care clinics. But if your parent’s doctor’s office doesn’t yet offer this service, you can ask for it.
Better yet, whether a medication review is the clinic’s idea or your request, you can jump-start things by doing a little preparation in advance. It is sometimes necessary for you to think like a geriatrician in order help your doctor spot oversights, or medications that are no longer truly necessary.
Before going in for your medication review, here are five things you can do to lay the foundation for checking a medication list for safety:
1. List all medications your parent is taking, along with the intended purpose of each medication.
If you aren’t sure of why a medication is prescribed, make a note to ask the doctor. Pharmacists can usually help as well. You may also find that some medications are serving more than one purpose. For instance, for someone diagnosed with both atrial fibrillation and hypertension — a common combination — the cardiovascular medication diltiazem can be used to lower blood pressure, as well as to keep the heart from racing.
Clarifying the purpose of a medication will make it easier for your parent and the doctor to then figure out if the medication is still necessary.
2. Know the purpose of a prescribed medication and symptom and take note of when the symptom was last checked on.
This is especially important for medications prescribed for bothersome symptoms, such as depressed mood, incontinence or pain. If the symptom isn’t better, that is often a sign that the treatment plan needs to be reassessed, either by stopping the medication and trying something else or by changing the dose.
If the symptom is better, this might be a sign that it’s time to try tapering the medication. Or it might mean the current treatment is just right and should be continued. Which it is will depend on what condition is being treated. High blood pressure, for instance, usually requires indefinite treatment. But for other conditions, it might be quite appropriate to try reducing the medication to see if it’s still absolutely necessary.
What you don’t want is for a medication to remain at the same dose simply because things are on “auto-pilot.” Keeping a medication at the same dose should be an actively considered choice made by the patient and doctor together, rather than the consequence of inertia.
3. Know which medications are on the Beer’s list.
The easiest way to do this is to go to a page that lists all medications that are on the Beer’s list — like this one — and then use your browser’s search feature to check and see if any of your parent’s medications on the page. You can also ask a pharmacist to help you spot these drugs.
If you do find that your parent is taking a medication on the Beer’s list, this doesn’t mean the doctor has prescribed inappropriately. It does mean, however, that it’s extra important to review the benefits and burdens of this medication. It’s also extra important to ask about non-drug alternatives for treating whatever problem the Beer’s list medication is intended to treat.
For instance, it’s fairly common for seniors to be prescribed medication for overactive bladder, because urinary leaks are common among older adults. But most of these drugs are anticholinergics, which means they affect the brain along with the bladder. Anticholinergics are on the Beer’s list because they can cause confusion in older adults; they’ve also been linked with developing dementia. Fortunately for seniors, it’s often possible to improve bladder issues using non-drug techniques, such as bladder training, pelvic strengthening exercises, or timed toileting. This may not be right for every senior, but by spotting any Beer’s list medications, you can give your family an opportunity to consider potentially safer treatment options.
Along with anticholinergic drugs, the Beer’s list medications I see prescribed most often to seniors are sedatives and tranquilizers for sleep or anxiety, antipsychotics for dementia, and non-steroidal anti-inflammatory drugs (such as ibuprofen or naproxen, which are also available over-the-counter) for arthritis.
4. Check for signs of over-treatment, especially for diabetes and high blood pressure.
Did you know that it’s fairly common for seniors to be receiving higher doses of medication than is actually necessary? This can create safety issues, especially when it comes to diabetes and high blood pressure.
Over-treatment of hypertension, for example, can cause an older adult’s blood pressure to be low, especially with standing. (A drop in blood pressure with standing is sometimes called orthostatic hypotension.) This can cause dizziness or light-headedness. It can increase the risk of falls; a study found that seniors taking high blood pressure medication had a higher chance of bone-breaking falls.
Similarly, high doses of diabetes medication can cause a senior to experience episodes of hypoglycemia or low blood sugar. Studies have found that insulin, in particular, is linked to hospitalizations and emergency room visits.
To help your parent’s doctor spot over-treatment, you’ll want to familiarize yourself with what the “goal” is for your parent’s treatment. For blood pressure, this means finding out what range your parent’s blood pressure should be in. Based on the most recent expert guidelines, the recommended blood pressure target for adults aged 60 or older is less than 150/90. (The recommended goal used to be less than 140/80, but there’s now increasing concern about the risks of blood pressure treatment in seniors.) For diabetes, you’ll want to find out what is a good range for your parent’s random blood sugar, as well as the ideal range for his hemoglobin A1C. You can learn about expert recommendations for diabetes control in seniors here.
5. Check for drug interactions.
You may also be concerned about the possibility of drug interactions, especially if your parent is taking several prescription medications.
If that’s the case, you can try entering your parent’s medications in a free online drug interaction checker. (I have tried this one and it seems relatively easy to use.) If any concerning interactions crop up, make a note to ask the doctor. You can also print the webpage showing the interactions and bring it to the next doctor’s visit.
Risky drug interactions are certainly a serious issue in senior health care. That said, I find it’s much more common for seniors to be suffering from other forms of “inappropriate” drug prescribing, such as being given medications that are on the Beer’s list, or being aggressively treated for high blood pressure.
You may be asking why shouldn’t we expect doctors and pharmacists to make sure a senior’s medications are safe and appropriate, particularly with technology and modern conveniences?
The answer is that we are constantly working within healthcare to make things better and safer for seniors. But reviews of healthcare quality show that seniors often don’t get recommended care, and it will probably be a while before it’s safe to assume that a senior’s healthcare is optimal without double-checking on things.
The fact remains that seniors and families who actively participate in optimizing their health care often do better. By working with your doctor, you’ll not only help catch oversights, but you’ll also ensure that symptoms are properly addressed and that the medical care is better tailored to your parent as an individual.
Healthcare works best when it’s a partnership between patients, family caregivers and doctors. By learning to request and prepare for a senior’s medication review, you’ll be making sure an important aspect of senior healthcare is better handled.
What comments or questions do you have about this senior medication safety checklist? We’d like to hear them in the comments below.
Leslie Kernisan, MD, is a practicing geriatrician who believes that it shouldn't be so hard for older adults and families to get the right kind of help with health concerns. For more practical tips — and to get her free, quick guide to checking aging parents — visit her at BetterHealthWhileAging.net.