Your Medications – What You Should Know
Like most people, you have probably questioned the medications you are taking from time to time. Are they all needed? Should the dosage of one or a few be reduced? Are there better alternatives with fewer bothersome side effects? What about the long-term effects? Could some cause an adverse event** at some point, particularly as I get older?
But before we discuss the STOPP/START criteria, let’s first look at a few facts you should be aware of.
More than half of all prescription medicines are dispensed to seniors. To put that in perspective, this group accounts for 14% of the population. Perhaps that’s not so surprising given that older adults are likely to suffer from a greater number of chronic medical conditions. The fact remains that citizens over 65 are consuming a disproportionately large number of medications. (1)
One in six hospitalizations in older individuals is due to an adverse drug event (unwanted or unintended effect of a medication at a normal dose), a rate that is four times that of younger adults. What’s more, in those over 75 years of age, the rate increases to one in three. To make matters worse, one in five older adults is taking a potentially inappropriate medication, that is, a medication that may be causing more harm than good. (1)
And, a recent study indicates that physicians do not associate as many as 40% of adverse drug events with medication use.(2)
* STOPP: Screening Tool of Older Person's Prescriptions.
**In contrast to a drug side effect, an adverse drug event does not have a direct causal relationship to a particular drug. For example, a drug may cause sleepiness and grogginess which in turn may cause an individual to experience a fall.
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The Good News - Preventing Adverse Events
The good news is that most adverse drug events or reactions (ADEs for short) are potentially preventable. Medication or drug reviews play a significant role in preventing ADEs. In fact, a large study of 600 older adults showed that more than 70% of ADEs were preventable with medication reviews. (3)
Medication or Drug Reviews
So what exactly is a medication or drug review? Essentially, it is an analysis or close look at a person’s list of medications in efforts to optimize therapeutic outcomes and wellbeing. A medication review in the elderly will critically evaluate the role and necessity of each drug in a person’s therapeutic profile. The critical questionning included in the review is done within the context of the person’s medical conditions and drug therapies (see Key Factors & Questions).
Developing a false sense of security
A comprehensive medication review vs a drug interaction check at the pharmacy
Unfortunately, most individuals that obtain their medications from a community pharmacy develop a false sense of security about the medications they consume. This is understandable given that pharmacists are there to ensure that people get exactly what was prescribed by their physician. And, pharmacists will make sure that there are no significant drug-drug interactions within a person’s therapeutic profile. We expect that the right medication is delivered to the right person, but unfortunately that’s about all that happens when a drug is prescribed.
1. O'Mahony, D, et al. Age and Ageing 2015; 44: 213-218.
2. Hohl CM, et al. Can Med Assoc J 2015; 3(1): E103-110
3. Hamilton H, et al. Arch Intern Med 2011; 171(11): 1013-1019
This becomes of paramount importance in older individuals. They are particularly prone to ‘accumulate’ medications. In other words, there is a tendency to prescribe and add medications as opposed to stopping or ‘deprescribing’ medications. To a large degree this is understandable given that our health tends to decline with age. Sometimes a side effect is misinterpreted as a new medical condition. As a result, a new and 'inappropriate' drug is added to the regimen.