The average American older than 65 takes four prescription and over-the-counter medications, says Dr. Richard Rosher, associate professor and chief of the Geriatrics Division of the Southern Illinois University School of Medicine. To ensure those drugs work effectively and with as few side effects as possible, both the doctor and patient have important roles to play.
Differentiating between normal changes as a person ages and changes related to disease is the first challenge.
“Physiological changes that occur in aging affect every aspect of taking medication, from ingestion and absorption to distribution and excretion,” says Rosher.
For example, normal changes in liver function over time make liver enzymes less efficient, which affect the way drugs are metabolized.
Decreasing kidney function, even without the presence of disease, may reduce the body’s ability to eliminate a drug quickly and completely. In elderly persons, diseases such as hypertension, diabetes and heart disease accentuate these changes. And many patients Rosher sees require treatment for multiple problems.
“Treatment decisions are made to achieve clinical stability in all areas,” says Rosher. However, a physician not only has to understand how one system affects another, but also how various combinations of drugs will interact with each other.
“Once you are taking four or more medicines, you have a 100 percent chance of drug-to-drug interaction,” Rosher explains, “and that interaction may not be evident.”
The potential for treating a problem with a drug, then requiring another drug to address the side effects caused by the first drug, and so on, is what Rosher calls “the road to medical hell — that is, giving medications to counteract the effects of other medications.”
Like Rosher, Dr. Stephen Randag of the Springfield (Ill.) Clinic is familiar with the problems of polypharmacy. In addition to the problem of possible drug toxicity, there is the problem of expense.
“One of the biggest challenges in treating an elderly population is that drugs are truly getting expensive. Drug costs are disproportionate to inflation and the cost of living,” he says.
Doctors today have to know which drugs are most effective, as well as those that are most economical. Otherwise an insurance claim will be denied. This is also true in the case of alternative medicines and complementary therapies. Herbs, chiropractic care and acupuncture may be effective in a given situation, Randag says, but if they are not justifiable by the insurance company, their use may pose a hardship on an elderly patient with a fixed income.
To more accurately anticipate and measure drug effectiveness, doctors may order blood tests for organ toxicity in the kidney, liver or bone marrow. Such tests may be requested at the outset of treatment or scheduled early on in the treatment process to measure a drug’s action in the body. Other tests may be ordered to measure lung or thyroid function.
Patients themselves are taking greater responsibility in monitoring chronic conditions, says Rosher. Home blood-sugar tests and blood-pressure tests have become easier to use and easier to read.
In general, the patient has a crucial role to play in communicating with the doctor.
“It’s a partnership,” says Rosher. “We do not have mental telepathy. Tell us what you want.”
Be prepared to identify any new developments and changes.
“Alteration in function is the most sensitive indicator of new disease or a new problem,” says Rosher. “It doesn’t tell what the problem is, just that something is wrong
In addition, help your doctor help you by employing basic preventive measures such as receiving proper immunizations for influenza and pneumonia, says Rosher. Get a tetanus shot every 10 years. Schedule mammograms, have your stools checked for blood, have a bone-density study and regular eye examinations, and review the results of all of these health procedures with your doctor as well.
With the successful use of reliable drugs and a healthy lifestyle, the golden years just may last even longer.
Bring questions, pills
Prepare some basic information for each office visit and you’ll be helping your doctor help you.
• Be ready to clearly tell the doctor what’s the matter. An average appointment is 15 minutes. Write down why you made the appointment to help you remember the details.
• Come prepared with your expectations. What do you want to accomplish at this visit? Do you want answers for a list of questions? Do you want your drug prescription renewed? Write down your expectations if you think you’ll forget once you’re in the waiting room.
• Bring your medicines with you. If you have a daily or weekly tray you use to organize your drugs, bring it along, too.