“…the single greatest adverse drug event risk factor is the number of medications a patient takes.”

Lessons from speaking to elders about their medications.

Early in my career, I taught groups of seniors about common medications as part of a hospital-based community health program. I traveled around the Chicago area, speaking to groups at senior centers, apartment buildings, and places of worship about their health and medications.

As part of our program’s mandate to educate physicians and nurses as well, we interviewed many elders on film, asking them to tell us about their medications. I will always remember one lady, relating a friend’s problems with adverse drug effects. “He’s dead now,” she stated with finality. She made it clear that she blamed his demise on the drugs his doctor had prescribed.

My experience in the Chicago medication education program influenced my pharmacology lectures to nursing students. Students may remember me most for the many times I repeated this statement: “The first sign of an adverse drug reaction in an older person is often a change in mental function.” This is a central reality of drug effects on the elderly.

Paying attention to unexplained cognitive changes.

Yet even today, the default response of many prescribers to an elder experiencing the recent onset of cognitive changes is, “Well, at your age, it’s to be expected.” We would never respond that way to a young adult taking the same medication and presenting with the same cognitive changes.

Now, more than 30 years since my early, wonderful experiences with elders, medication-related problems have escalated:

  • There are many more drugs to prescribe.
  • People often begin long-term regimens (for example, with drugs like ibuprofen) much earlier in life, increasing their lifetime exposure to these chemicals.
  • More specialization has resulted in many more different people prescribing for one person.
  • Unaffordable medications are taken erratically, contributing to potential adverse effects.
  • Mail-order pharmacies eliminate the safety check provided by interactions between pharmacists and patients.
  • And our fragmented health care system ensures less coordination and oversight of medication regimens.

In this month’s AJN, Jaclyn Gabauer takes a critical look at drug therapy in older adults. Her article, “Mitigating the Dangers of Polypharmacy in Community-Dwelling Older Adults,” describes factors that contribute to polypharmacy; the many possible consequences of inappropriate drug regimens, including cognitive changes, functional decline, urinary incontinence, and malnutrition; and ways to reduce inappropriate prescribing to community-dwelling elders.

She also describes in detail several helpful tools that can assist nurses and prescribers in managing medications, and reminds us that discontinuing a medication is often more helpful than adding to a regimen.