grow older, they can develop a litany of health problems and see
multiple specialists who prescribe various drugs to treat common
conditions such as osteoporosis, high blood pressure, diabetes, heart
disease, arthritis and memory loss.
If you're 65 or older and taking more than four medications, resolve
to talk to your doctor about doing a New Year's triage to make sure too
many pills aren't making you sick, advises Milta Little, associate
professor of geriatrics at Saint Louis University. "Drugs may not play well with
each other, and problems can snowball for older adults who take five or
more medicines," Little said.
‘People aged 65 or older and who are taking more than four medications, must talk to their doctor to ensure that too many pills arenít making them sick.’
"As a geriatrician who
quarterbacks the health care of my patients, I think six medicines
usually is too many, and studies have shown mortality is higher among
patients who are taking 10 medicines. I love to analyze medicines my
patients are taking because reducing the number of drugs often makes
them feel so much better. Many times, less is more."
is unique with different health goals and challenges that change as a
person ages, which is why one-size-fits-all guidelines don't work,
Little adds. She advocates an annual medicine check-up, where patients
ask doctors to assess the drugs they are taking, being mindful that
vitamins, supplements and over-the-counter medicines count, too.
and other nonprescription medications, which are often less rigorously
regulated than prescription medications, are a major cause of dangerous
drug-drug interaction in elderly patients," Little said. "I don't
recommend a multi-vitamin or gingko for brain health for everyone. The
supplements are for specific people, and I prescribe them like anything
else, only for those who need them."
Here are questions Little asks as she analyzes the medicines her patients take:How old is my patient?
Guidelines on what constitutes good health loosen with age. For
instance, a good blood pressure for a younger adult - 120/60 - is much
lower than a healthy blood pressure for an older adult - 160/90. And a
person who has a blood pressure with a top (systolic) number that's too
low - 130 - could fall or become dizzy, which creates additional health
risks. "My prescriptions for patients who are 65 are different than
those for patients who are 80," Little said. "For patients who are 100, I
probably wouldn't prescribe any medicine at all. If they've lived to be
100, it's probably nothing doctors did."How long has the patient taken the medicine?
Prescriptions are not forever, and should be reviewed periodically to
make sure they're still necessary. "It may have been appropriate for you
10 years ago, but may not be today," she says. "Under your doctor's
guidance, don't be afraid to try going off your medicine." For instance,
there is no evidence that shows a 76-year-old patient who has high
cholesterol but hasn't had a heart attack or stroke within the last year
would benefit from taking a statin, although he might have been
prescribed the statin 16 years ago, when it likely could help.Is the dosage right?
As people grow older their bodies change. A smaller dose of medication
might yield the same response as a younger adult. Often times, a
half-dose of a psychotropic medication works better in older patients
than a full dose, as does a smaller dose of medicine for osteoporosis.
"Start low and go slow," Little says. "You can always give more but you
can't take it out of the body once it's given."What are the drug's side effects?
A medicine might address one problem, but create another. For instance,
antidepressants can cause frequent urination, which can lead to
incontinence. Statins and blood thinners worsen frailty, which makes
patient vulnerable to more medical problems. An anti-diuretic for blood
pressure can worsen symptoms of gout, which is a form of arthritis.How well do medicines play with each other?
Drugs given for one illness could make another condition worse.
Medicine given for acid reflux can reduce the effectiveness of blood
thinners because of the way the medicines are broken down in the liver.
older adults believe taking a pill will make them healthier, which is
not always the case, particularly when they're taking many pills for
different health issues. Too many medicines can make older adults feel
fatigued, and undermine the quality of their lives," said Little, who is
the author of an editorial on overmedication in the elderly that appeared in a 2016 issue of JAMDA.
have a lot of evidence that non-medical treatments, such as exercise,
yoga and massages, work better in improving a person's health. But
Established in 1836, Saint Louis University School
of Medicine has the distinction of awarding the first medical degree
west of the Mississippi River. The school educates physicians and
biomedical scientists, conducts medical research, and provides health
care on a local, national and international level. Research at the
school seeks new cures and treatments in five key areas: infectious
disease, liver disease, cancer, heart/lung disease, and aging and brain