Friday, May 13, 2011

Medicating the Elderly

It has been said that the elderly are too often over medicated and too easily get their meds mixed up.  How does that happen?  I’m beginning to learn - first hand.  At 68 I hardly consider myself elderly, but, after a brief encounter with a wee little heart problem a few years ago, I find myself on a regimen of six medications, some taken once a day and some twice.  
For convenience, I count them out and put them in one of those little plastic boxes with seven compartments, one for each day of the week.  Now and then a pill ends up in the wrong compartment.  The little buggers have a mind of their own it seems.  I never forget to take the morning dose, but if the evening gets complicated by this or that, I sometimes overlook the nighttime pills.  Moreover, my insurance requires that I get my meds from a mail order pharmacy that sends a three month supplies of each.   To make sure I don’t run out, they renew the supply several weeks before the three months is up. The net result is a growing cache of meds.
It’s not a big problem.  My primary care physician keeps everything coordinated and simple.  My memory is just fine.  I’m not on anything narcotic.  An occasional missed dose is not fatal, and my growing supply of pills is more a storage problem than anything else.  But it brings to mind the last few years of my mother’s life.  A variety of doctors treating a variety of illnesses and conditions had tanked her up with an uncontrollable number of prescriptions.  This slight, frail woman was on doses of narcotic pain meds that would have knocked out a large man.  Her accumulation of three month supplies and old prescriptions added up to a huge number of pills lying around.  It was not possible for her to keep all that straight, and I have no doubt that it contributed as much to her death as did the conditions they were intended to address.
I suspect that mom was not an isolated case, but common and symptomatic of a problem that needs to be addressed by the larger community.  I’m not sure what that would involve, but a part of it has to be a way to teach elderly patients how to understand and manage their own medications.  I believe that physicians and pharmacies are too ready to patronize the elderly as incompetent consumers, and too many elderly find it very easy, even convenient, to let that happen.  Old does not mean stupid or incompetent, nor does it mean that one cannot learn new habits and be held accountable for them.  

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