Polypharmacy’s impact

BINNY GOLDMAN AND MARILYN KRYGIER

Close to 200 people, mainly seniors, heard from three speakers at the Jewish Seniors Alliance fall forum, Live to 120 – Thriving, on Nov. 3 at the Peretz Centre for Secular Jewish Culture.

Forum chair Michael Jacobsen highlighted the ways in which the medical system supports and sometimes fails seniors, and then introduced the forum’s speakers.

Dr. Margaret McGregor, director of community geriatrics with the University of British Columbia department of family practice, spoke about the issue of the overmedication of frail seniors and what can ensue from overtreatment. McGregor said she would urge doctors to ”do less” when dealing with frail seniors, and she shared less-known facts about the use of prescription medications. Despite the upward trend in life expectancy, for example, seniors can be compromised by the overuse of medication, inappropriate mixing of medications and debilitating side effects from those drugs and their interactions. Many pharmaceutical studies do not even include frail seniors as subjects, and what may work well for younger people may not be appropriate for those who are older and frail.

Modern medicine cannot stop the aging process. Cells stop regenerating when telomeres (aging markers on chromosomes) become shorter, but keeping active and a healthy diet can help.

So, what can seniors and their family members do? Don’t be afraid to question health providers, McGregor said. Be sure that the treatment or medication that is being prescribed will have some benefit and will allow you to have quality years at home. Challenge researchers, when possible, and ask them why frail seniors are not being included in their studies. As well, challenge the use of high-tech, in-hospital treatment in favor of home support and continuity of care. What frail seniors need is “low-tech,” integrated care.

Dr. James McCormack, UBC professor of pharmaceutical sciences, made an innovative presentation, using humor combined with music and audience interaction in his attempts to dispel common “medical myths.” He urged audience members to become doubters, to question doctors about medication, and advised that we should advocate for minimal disruptive drug treatments. He said that many new pharmaceuticals have become available in the past 10 years, but some of these new drugs have not proven to be any more effective than the old ones, and there have been numerous recalls. Aside from responsible pharmaceutical use, McCormack advocates a healthy Mediterranean diet, exercise and no smoking.

“Ask questions,” he said, “and don’t believe everything you read or hear on the news regarding new cures.” Be a skeptic, not a cynic, he advised.

Johanna Trimble was the third speaker of the day. A World Health Organization patient-safety champion who focuses on prescribing practices for geriatrics, the topic of her talk was Is Your Mom on Drugs? She explored whether or not there is an epidemic of dementias (including Alzheimer’s), or whether some of these diagnoses could be related to overmedication. She illustrated her point with a personal story involving her mother-in-law. Misdiagnosis, leading to incorrect medication, can produce dire consequences, she said. Doctors must look at the whole patient and involve family members, as they are the ones who best know the patient and who can best advocate for loved ones. When frail seniors have a setback that lands them in the hospital, they may receive additional medication on top of the drugs that they already take for chronic problems. Unfortunately, as a result of this polypharmacy (the use of multiple medications), a patient may develop delirium, which can result in dementia-type symptoms. Luckily, these symptoms are treatable. If the health provider or family members are not astute, the senior may be diagnosed with dementia and then there will be other medications prescribed, and so it goes, she warned.

All three speakers recommended that people be responsible, informed health-care consumers for themselves and for their loved ones, advocating for frail seniors to be sure that medical procedures, hospital stays and prescriptions are helping, not hindering or causing further harm.

Videos of the presentations are available at jsalliance.org.

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