Bursack: Older adults might benefit when doctors eliminate some drugs
Dear Carol: My mom lives with emphysema so she's been on oxygen for more than two years. Mom needs several medications to manage this awful disease, which I understand, but some of her other medications concern me. I’ve asked her current doctor to consider lowering doses or taking her off some of them, but he’s made it plain that her life expectancy is quite limited so he doesn’t want to “rock the boat” by making changes. Meanwhile, Mom is becoming foggier in her thinking, and her memory and balance are bad. Maybe this is just age and poor health, but I really wonder if she still needs some of these older prescriptions that haven’t been changed for years. Should I be pressing for someone to reconsider her medications or just ignore what I see as a problem? — RG.
Dear RG: You’re smart to consider this route to potentially better health for your mom. Her life expectancy may not be extended by changing or eliminating some medications, but the quality of life that she has for now could possibly be improved.
Another doctor may agree with her current primary physician, but you won't know unless you try so I'd suggest that you seek a second opinion. Scheduling her with a geriatrician would be ideal but there is a shortage of these doctors who are specifically trained to work with older adults. Because of this, you may need to seek the help of an internal medicine physician who, we can hope, will have had experience with older patients.
To be clear, my following comments about drugs are not meant to second-guess doctors who prescribe serial medications or people who take these drugs. Medications save lives and can improve the quality of life for countless people. However, what's known as polypharmacy can be an issue for older adults, and the responsibility to have the patient's need for certain medication adjustments sometimes falls on the patient or the patient's caregiver.
That being said, most doctors do regularly assess the need for each drug listed on their patients’ charts. This process may cause them to reconsider dosages of some medications or even eliminate drugs that were once helpful but no longer make sense. The term doctors use for eliminating drugs is to "deprescribe." This word is becoming mainstream because clinicians are increasingly recognizing the need to consider adjusting medications, particularly for their older patients.
In some cases, the health problem the drug was meant to treat is no longer a priority. Additionally, our bodies change with age. We may gain or lose weight, which can affect dosing. Our ability to metabolize drugs changes, as does our ability to tolerate side effects.
Your instinct that your mom's drug list should be reviewed is a good one. I genuinely hope there is room for adjustments that may lead toward her feeling better overall. Even if no changes are advised, you will have obtained another trained opinion so you can then be at peace with the result.
Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at www.mindingourelders.com. She can be reached at firstname.lastname@example.org.