I propose a challenge: place all your medication bottles (including those prescribed by your provider), over-the counter drugs and herbal supplements on a table. After you’re able to examine the amount of space occupied by your medications, read the name and dosage of each one and try to remember the reason why you’re taking it. Do you find yourself overwhelmed by the space occupied on the table? Are you confused as to why you’re taking any of these medications?
If you completed that exercise, I hope it wasn’t too overwhelming; let’s take a step back. Have you ever heard of polypharmacy? Polypharmacy is defined simply as the use of multiple medications by a patient. Although the precise number varies, more than 5-10 medications being taken by one patient (including prescriptions/over-the-counter drugs/herbal supplements) qualifies for polypharmacy.
The term is important because many individuals, especially those over 65, are at increased risk for harm from 1) interactions between multiple medications 2) increased risk for falls and fractures and 3) increased risk for metabolic disturbances that could lead to severe confusion or lethargy. These risks are directly tied to age and kidney function. The kidneys are the body’s filters of blood. Our kidneys manage electrolytes, nutrients and fluids. As we age, kidney function naturally declines. That decline can happen more rapidly for some based upon family history, high blood pressure, and diabetes or a number of rheumatological disorders.
One way to prevent the ill effects of polypharmacy is to stay well-informed about the medications you’re taking. Keep an updated list of the names of each medication with the dosage and how often you take it in your purse or wallet. Make a note of the reason as to why you and your doctor decided to start that medication. If you really want your doctor to hug you, keep the dates of when you started and/or made changes to these medications. Make a copy of the list to keep with your spouse in case of an emergency. Last but not least, always bring that list with you to doctor’s appointments so that together we can update any new changes.
The process described above is known as medication reconciliation (also called a ‘med rec’). A med rec is an ongoing and crucial component of a healthy doctor-patient relationship. We change medications nearly every visit, and it’s imperative that we document and stay updated on these changes. It’s crucial in emergency situations to know what kinds of medications a patient is taking. For example, knowing that a patient regularly takes a blood thinner can impact when and how a surgery is performed.
Studies have shown that drug-related accidents among older adults are more likely to occur and more likely to be preventable than in younger adults. One common issue contributing to drug-related accidents is when new medications are prescribed for side effects of already prescribed medications, especially in older adults. A med rec is the best way to prevent this from happening to you.
We can make our communities healthier by reducing unnecessary medications and/or reducing their dosage or frequency of which they’re taken. We can also work together on preventing drug-related accidents, overdoses and medication interactions by regularly reviewing and discussing a well-kept and updated medication list with your primary care providers.
Dr. Mitchell Keel is a Second-Year Internal Medicine Resident Physician at White River Medical Center. He is from Indianapolis, Indiana and graduated from Meharry Medical College. His hobbies include spending time with friends/family, basketball and traveling.