Too many and too erratic


Deena Flinchum

The New York Times has been a great source of information regarding health care for many years. Recently it published two articles that I found particularly insightful — How Many Pills Are Too Many? by Austin Frakt on April 10 and The Cost of Not Taking Your Medicine by Jane Brody on April 17.

With ten years of research on Medicare Part D drug plans behind me, I found much to agree with.

So how many pills are too many? It depends. Older people are more likely to be taking too many drugs because they tend to have more chronic conditions and to be treated by more than one healthcare professional, none of which may be aware of all drugs prescribed to the patient.

Almost half of Medicare beneficiaries take five or more drugs. Nearly 20 percent take 10 or more. One of the most important aspects of the Medicare Annual Wellness Visit is that it presents primary care doctors with an opportunity to assess their patients’ drug lists, including non-prescription drugs and supplements, which can cause interactions as well as prescription drugs can.

Also drugs that were safe in higher doses years before can become less safe as people age because their bodies are less efficient at processing these drugs over time.

Drugs such as sleeping aids (Ambien) and benzodiazepines (diazepam) have been linked to adverse effects such as falls in older patients, possibly as a result of drug accumulation over time.

Unfortunately, both physicians and their patients can be fearful of changes, making adjustments that could prove beneficial less likely. One trial among older patients in which their drugs were carefully evaluated and monitored weekly resulted in a 35 percent drop in adverse drug reactions.

Another trial found that judiciously removing some drugs deemed unnecessary from a similar group caused no unfavorable effects. These results are good news but could prove more difficult to accomplish on an individual basis.

On the other hand, patients not taking their drugs or taking them incorrectly can also cause problems. Taking only part of a drug regimen, especially in antibiotics, can be worse than not taking any.

Some patients either stop taking a particularly expensive drug or take half a dose to save money. Any change in drugs should be cleared with a doctor first as the result could be unpredictable.

Sometimes a different, cheaper drug will work as well; or the expensive drug may be available through a patient assistance program if cost is the primary concern.

A few years ago, I worked with a man who had just returned to live in the area after he had been hospitalized elsewhere with what was described as dementia.

When I met with him and his son, he showed no signs of dementia. His son later informed me that his father’s apparent dementia had been brought on by erratic drug taking.

His wife, who had recently died, had monitored his drugs, giving him exactly what he needed at the correct time. After her death, he would forget to take his drugs for several days and then take several days all at once.

Once he was with his son and his drugs had been adjusted, he began taking his drugs correctly, and the dementia disappeared. I have to wonder if some of what is classified as dementia isn’t a reaction to the timing, number, or type of drugs that are being taken by a patient.

Being discharged from a hospital can present seniors with drug-related challenges. Often the drugs they take may have changed as a result of their hospitalization.

It is important that they or their caregivers reconcile their old drugs with the new ones and take only what are prescribed in the correct doses for the present time. Taking all of the pre- and post-hospitalization drugs could result in serious injury or death.

In the last couple of years, I have seen a huge increase in the number of people aging into Medicare. I have come to the conclusion that it is time for me to bring out some of my old columns outlining how Medicare works and how to sign up, update them, and run them again.

My editor has graciously agreed, so my next few columns may look familiar to my regular readers.

Deena Flinchum is a retired IT professional who has lived in the New River Valley since 2002. She serves on the board of the NRV Agency on Aging and as an RSVP volunteer. She also serves the Agency on Aging as an insurance counselor.