Oct. 10, 2022 – When the time came Ginny Erickson-Ebben‘s elderly mother wanted to move to a retirement home in 2018, the whole family agreed that the best place was near Erickson-Ebben. The weather was warm where she lived in Texas, and Erickson-Ebben lived within a mile of the facility. She also had the time to help with her mother’s care. While she happily and willingly assumed these duties, she didn’t realize what a big job she was signing up for.
Ebben had physical help from a caretaker at the facility, but she was not authorized to administer medication — Erickson-Ebben’s mother took 20. Even for an intelligent, middle-aged woman like Erickson-Ebben, medication administration was a complicated task.
“I didn’t realize how overwhelming the job would be,” admits Erickson-Ebben. “There was a nurse at the nursing home who came by once a day to check on my mother, but otherwise the work fell on me and it was stressful.”
Erickson-Ebben developed a system to keep everything straight. She drove regularly to the pharmacy to get the medicines and then once a week carefully counted the medicines and put them in her mother’s pill boxes, separated into morning, afternoon and evening doses. “It was scary at first because I didn’t know which pill did what, but after a month I had learned them all and knew what I was doing,” she says. “But I’ve always worried about what would happen if she missed a pill or took the wrong pill at the wrong time.”
Like many seniors, Erickson-Ebben’s mother had a multitude of ailments and illnesses, and managing the prescriptions to keep them all in check is a huge undertaking. Recently, the American Medical Association has taken steps to help with this problem, issuing a new guideline entitled “Reducing Polypharmacy as a Significant Factor in Elderly Morbidity.”
The doctor who championed the new policy is based in Louisville, KY Tom James III, M.D. The complicated picture that patients – especially the elderly – take multiple medications has bothered him for some time.
“There is an inverse relationship between the number of prescriptions a patient takes and their longevity,” he explains. “Of course, sicker patients take more drugs, but although all drugs are tested for their side effects, they are not tested in combination.”
As a result, James says, each patient taking multiple medications becomes their own individual testing site. To make matters worse, he says, doctors in medical school are trained to add drugs, but not remove them.
Another problem is the fact that many older patients, like Erickson-Ebben’s mother, are treated by several doctors at the same time. Today’s modern medicine means that doctors often don’t really have the opportunity to personally discuss their mutual patients.
“We used to talk in the doctor’s office and often exchanged notes about a patient,” says James. “Today we often enter information into electronic cards, but we don’t talk face to face.”
What is sometimes lost, says James, is a chance for multiple doctors to be on the same page about a patient’s medication. “Medication profiles often don’t capture all drug interactions,” says James, “because the tools we use are non-discriminatory.”
This carries over to over-the-counter medications and supplements, which can sometimes interact with prescription medications. Overall, many older patients are at risk from the complications of overmedication.
Erickson-Ebben felt it was important that she and her family research the medications her mother was taking and why. “You have to stand up for the patient,” she says. “Unfortunately, if there is a reaction to a drug, you also have to research it.”
In the case of Erickson-Ebben’s mother and her 20 medications, it was difficult to know if any one caused a rash. “You can’t just wean them off a drug,” she emphasizes. “Speak to doctors about your concerns and don’t let them turn patients away just because they’re older.”
Creating a safety net
The new AMA policy aims to create a network of caregivers to educate patients about the significant effects of all medications, as well as many dietary supplements. It encourages pharmacists, doctors and other caregivers to teach patients to bring lists of all updated medications/supplements to each care item.
The idea is to “get patients to think about becoming victims of too much medication,” says James. “Ask questions when you need answers.”
Many doctors these days have little time to spend with patients, so advocacy is vital. “If an adult child or home care worker is in the picture, they should discuss the medication list with the patient’s GP at least twice a year,” says James. “Too often, if a doctor hasn’t written a prescription on the list, he or she won’t mess with it. So we’re hoping that a pharmacist could spot the potential interaction.”
Erickson-Ebben’s family specifically chose to work with a hospital system in the hope that there would be good coordination between doctors. But that didn’t happen. “The doctors didn’t always communicate well with each other,” says Erickson-Ebben. “We found that each specialist only focused on his or her specialty.”
This is part of the current supply gap that James hopes to address with the new AMA policy. In the end, he says, the current system relies too much on the “I hope this works” approach. “We need to go beyond the resolution and also add an educational approach.”
The new AMA policy is a good first step towards improving healthcare for seniors, and James hopes to keep moving the needle. “There is general agreement that there is a problem,” he says. “There is still no general agreement on how to proceed.”