AARP Hearing Center
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Kyle Hilton
Key takeaways
- Taking five or more medications can raise the risk of side effects, drug interactions and medication-related hospitalizations in older adults.
- “Deprescribing” efforts help patients and clinicians review medications regularly to determine whether each drug is still necessary.
- Medication reviews should include prescriptions, over-the-counter drugs, vitamins and supplements. Some medicines may need to be tapered off rather than stopped abruptly.
Index
Medications can be a lifeline for people facing illness or chronic health conditions. A pill a day can often mean reduced pain, better quality of life or even a longer life. But medications can also cause serious harm if they are taken incorrectly, trigger an allergic reaction or interact with other prescriptions or supplements.
According to the Centers for Disease Control and Prevention, adverse drug events lead to 1.5 million emergency visits every year. And the U.S. Food and Drug Administration’s Office of Surveillance and Epidemiology (OSE), which monitors and evaluates drug safety profiles, reviews more than 2 million reports of adverse events and medication errors annually. Older adults are especially vulnerable to medication risks, in part because they are more likely to take multiple prescriptions.
KFF, a nonprofit focused on health and policy research and polling, released a survey showing that 6 in 10 people age 65 and older reported taking four or more prescription medications — and this number may not include over-the-counter (OTC) vitamins, minerals and supplements. Medication risks often increase when people take multiple prescription medications alongside over-the-counter drugs, like common pain relievers and allergy meds.
While home-based medication errors and side effects are a common concern, don’t assume you or your loved one is not at risk when in a long-term care facility.
“When we are adding another layer, which is the layer of nonprescribed medications such as supplements, on the already existing prescribed medications, we are creating this complexity of drug-supplement interaction, drug-drug interaction, side effects, allergic reactions and over-medicating errors,” says Dr. Parul M. Goyal, associate professor of medicine, and medical director of Population Health at Vanderbilt University Medical Center in Nashville, Tennessee.
However, there are some steps you can take to protect yourself and your loved ones from medication-related risks.
Why medication safety matters more after age 50
Medications are a leading cause of harm for patients, and older people may face more side effects than their younger counterparts, says Dr. David W. Bates, a professor of medicine at Harvard Medical School and director of the Center for Patient Safety Research and Practice at Boston’s Brigham and Women’s Hospital, who also serves as the editor of the Journal of Patient Safety. “As you age, you typically need fewer medications and often lower dosages of medications,” he adds.
Additionally, our ability to process medications changes with age.
“As we get older, our ability to clear, or metabolize, the medications decreases and our ability to accumulate medications increases, primarily because the medications are stored in our body for a longer time and usually in the fat cells,” Goyal says. “And most of the medications are metabolized either through the liver or through the kidneys. As we are getting older, both those functions slow down, and hence our ability to clear those medications is not as fast.”
Kidney and liver damage from medication can be relatively subtle, with few noticeable outward symptoms. That’s why it’s important to get regular blood tests when you are on medications to see how the medication is working for you and whether you are having any undetected side effects, Goyal says.
Medication side effects to watch out for
As for more obvious side effects, “lightheadedness and dizziness are some of the ones we worry about the most,” Bates says. However, some medications can cause memory issues. Sleep disruption, tiredness and difficulty driving are also possible side effects of many drugs.
There are specific categories of medications that can be concerning, notably anticholinergic drugs, used to treat everything from Parkinson’s disease to insomnia, to allergies, to incontinence. These can make you dizzy when you stand up and substantially increase the risk of falling, Bates says. More than 600 medications have anticholinergic properties. Other medications, including some used to treat depression, chronic pain and psychiatric conditions, may also have anticholinergic effects.
The important thing is to observe how you feel after taking a medication, including an OTC drug, especially when it is new to you. “If you observe a pattern, like every time after you’re taking a medication, say two hours later, you feel lightheaded, that’s also something to make note of and to tell your physician about,” Bates says.
General side effects versus emergency side effect
Most common side effects of medications can be dealt with by talking to your doctor about reducing or switching your medication. However, some side effects require emergency treatment.
For example, common side effects of angiotensin-receptor blockers and angiotensin converting enzyme inhibitors — used to treat high blood pressure — can include nausea, more frequent urination or tiredness, Goyal says. But tongue, lip or facial swelling “or feeling like you can’t breathe after taking the medication,” warrants immediate medication attention, she adds.
For more information on adverse drug reactions, visit the FDA’s Finding and Learning About Side Effects site. MedlinePlus, a service of the National Library of Medicine/National Institutes of Health , offers a searchable database of prescription drugs and OTC medicines, including side effects and special precautions.
How to avoid being harmed by medications and supplements
There are steps that patients and caregivers can take to reduce the risk of being harmed by prescription medications and OTC drugs. Goyal and Bates recommend the following:
- Always double-check to make sure that you are measuring doses correctly and following the label directions exactly, including proper storage of medication.
- Ask your doctor or pharmacist about the proper timing of medications.
- Never share prescription medication with other people in your household.
- When possible, use one pharmacy and develop a relationship with your pharmacist so they are aware of your health conditions and any potential adverse interactions.
- Most importantly, create a list of your medications, including vitamins and supplements, with their dosages and medication timing. Bring this list to the doctor so that you can have an informed conversation about what you are taking. (Also, keep this list handy at home and when traveling in case of emergency.)
By bringing your medication list to your doctor’s appointment, you may be able to go through the “deprescribing” process, where doctors take you off medications that may no longer be needed, or shift you to a newer and better medication.
“Oftentimes, my patients will carry a [medication list], but it will not have their doses, it will not have how many times they take it, or the list is not updated,” Goyal says. Having an up-to-date and accurate list is very important, she says. “Especially in this day and age, when adults are traveling more — when you’re out of town, you get sick or if there’s an emergency — the provider, [who] is treating should know what medications you’re on.”
This up-to-date medication list is vitally important when you are being discharged from the hospital and bringing new medications home with you. The Journal on Quality and Patient Safety notes that an estimated 46 percent of medication errors occur during the patient’s admission to or discharge from a clinical unit and/or hospital. To combat this, at discharge the medical staff will reconcile the patient’s home medicine list with the hospital medication list to help ensure that no potential interactions or duplications are introduced.
Schedule a medication review
If you do not have time to discuss your full medication list at your annual visit, you can also schedule a medication review appointment, which may be covered by Medicare under certain conditions. Some private health insurance plans may cover a medication review or medication management service, depending on the provider and state. Patients should contact their insurance plan to confirm eligibility.
Signs you need a medication review
- You are taking five or more medications and supplements — a situation often referred to as polypharmacy.
- You see multiple medical specialists, which can lead to multiple prescriptions.
- You experience new symptoms, including falls, fatigue, confusion, dizziness or light-headedness, after taking a prescription medication or a new over-the-counter drug, particularly if you notice a pattern after taking the medication at a specific time every day.
- Note: The amount of time it takes for medications to take effect varies; some may take weeks. Ask your doctor when you may start noticing side effects.
Patients should also bring prepared questions for their doctor to help streamline deprescribing efforts during a medication review, Goyal says.
Questions to ask your doctor about deprescribing current medications
- Why am I taking this medication? What is its purpose?
- Can I discontinue this medication? If I do, what should I expect?
- If discontinuing isn’t possible, how long should I take it?
- How do I dispose of unused medications?
For a printable list of these questions, please click here.
Discuss new prescriptions thoroughly
When your doctor suggests a new medication, it’s useful to ask them what the indication for the medication is, if there are particular side effects that you should be watching out for and if there are any specific concerns for you as an individual, given your medical issues. “For example, if somebody is a little unsteady on their feet, any medication that might make you more likely to fall is a particularly big concern,” Bates says.
It’s also important to ask how you should take your medicine — for example, whether it should be taken with food or not, and how hard and fast that rule is. “I’ve found that some of my patients get more worried about that than they really need to be,” Bates says. Sometimes the potential consequences of not taking a medicine as directed are very serious. “Other times, it might be that [the medicine] just would not absorb as well as if you did not take it with food.”
Questions to ask your doctor about new medications
- What would be a general side effect from this medication, and what would be considered an emergency side effect?
- How long do side effects last, and what should I do if you experience one? Which side effects will go away with time?
- Does this medication interact with the rest of the medications I’m taking, including supplements, or any food that I may eat?
- What should I do if I skip a dose or if I accidentally miss a dose?
For a printable list of these questions, please click here.
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