October 10, 2022 – When It’s Time Jenny Erickson EbenThe elderly mother moved into a nursing home in 2018, and the whole family agreed that the best place was near Eriksson Eben. It was warm weather as she lived in Texas, and Erickson Eben lived only a mile from the facility. She also had time to help take care of her mother. While she was taking on these duties happily and willingly, she did not realize what a big job she was involved in.
Ebben got physical help from the caretaker at the facility, but was not authorized to administer medication—Erickson-Ebben’s mother took 20. Even for an intelligent middle-aged woman like Erickson-Ebben, administering medication was a complicated task.
“I didn’t know how confusing the task would be,” admits Erickson Eben. “There was a nursing home nurse who stopped by once a day to check on my mother, but other than that the job fell on me, and it was stressful.”
Ericsson Eben developed a system to keep everything straight. She made regular trips to the pharmacy to get the medicines, and then, once a week, carefully counted the medicines and put them into her mother’s pill boxes, separated by morning, afternoon, and evening doses. “It was scary at first, because I didn’t know what the birth control pill was doing, but after a month, I learned all of them and knew what I was doing,” she says. “But I was always worried about what would happen if she missed a pill or if she took the wrong pill at the wrong time.”
Like many elderly people, Eriksson Eben’s mother had a host of illnesses and ailments, and managing prescriptions to keep them under control is a monumental task. Recently, the American Medical Association took steps to help solve this problem, issuing a new policy called “Reducing polypharmacy as an important contributor to disease in the elderly.”
The doctor who advocated for the new policy is in Louisville, Kentucky Tom James III, MD. He has been concerned for some time about the complex picture of patients – especially the elderly – who take multiple medications.
“There is an inverse relationship between the number of prescriptions a patient takes and their longevity,” he explains. “Of course, patients who are sicker take more drugs, but while all drugs are tested for their side effects, they are not tested together.”
As a result, James says, each patient taking multiple medications becomes their own individual testing site. Complicating matters further, he says, is the fact that medical school doctors are trained in adding drugs, but not subtracting them.
Another complicating problem is the fact that, like Ericsson’s mother Eben, many elderly patients have several doctors treating them simultaneously. Modern medicine today means that all too often, doctors don’t really have opportunities to discuss their common patients in person.
“We used to chat in the doctor’s lounge, often comparing notes on the patient,” James says. “Now we often put the information in electronic charts, but don’t talk face to face.”
What is sometimes missed, James says, is an opportunity for multiple doctors to be on the same page about a patient’s medications. “Drug profiles often don’t capture all drug interactions, because the tools we use are not discriminatory,” James says.
This extends to over-the-counter medications and supplements as well, which can sometimes interact with prescription medications. In general, many elderly patients are at risk of complications from overuse of medications.
Erikson Eben found it necessary that she and her family research what her mother was taking and why. “You have to advocate for the patient,” she says. “Unfortunately, if there is a reaction to a drug, you need to look into that as well.”
In the case of Ericsson Eben’s mother and her 20 medications, if one of them caused a rash, it was hard to tell which one. She points out, “You can’t take them from just one drug.” “Talk to doctors about your concerns, and don’t let them turn patients down just because they’re old.”
Create a safety net
The new AMA policy aims to create a network of care providers to educate patients about the important effects of all medications, as well as many nutritional supplements. Pharmacists, physicians, and other caregivers are encouraged to teach patients to bring updated lists of all medications/dietary supplements to each point of care.
The idea, James says, is “to get patients to think about becoming a victim of too many drugs.” Ask questions when you need answers.
Many doctors have limited time with patients these days, so advocacy is crucial. “If an adult child or home health nurse is in the picture, they should review the medication list at least twice a year with the patient’s primary care physician,” James says. “Often, if a doctor didn’t write a prescription on the list, he wouldn’t tamper with it. So hopefully the pharmacist will figure out the potential interaction.”
The Ericsson Eben family specifically chose to work with a single hospital system, in the hope that there would be good coordination between physicians. But this did not happen. “Doctors did not always communicate well with each other,” says Erikson Eben. “We found that each specialist was focusing only on his specialty.”
This is part of the current sponsorship gap, which James hopes to begin to resolve with the new AMA policy. Ultimately, he says, the current system relies a lot on the “I hope this works” approach. “We need to go beyond resolution and add an educational approach as well.”
The new AMA policy is a good first step on the path to improving health care for seniors, and James hopes to keep moving the needle. “There is universal agreement that there is a problem,” he says. “There is no global agreement yet on this approach.”