Anyone who’s ever watched television has probably heard this: Ask your doctor if taking this medication is right for you.
The University at Buffalo wants older adults to start asking their doctors if stopping certain medications is right for them.
UB’s Center for Successful Aging has launched a new deprescribing effort to warn older adults about the dangers of taking too many medications and teach them to talk with their doctor about how to safely cut back.
“We want to encourage patients and their family members to speak up to advocate for stopping medications,” said Dr. Ranjit Singh, director of the Primary Care Research Institute at the UB Jacobs School of Medicine and Biomedical Sciences. “So when you go to the doctor, don’t go in asking for new medications. Start out by asking, ‘Are there any medications I don’t need anymore?’”
Nearly 40% of Americans 65 and older take five or more medications, according to a Harvard University study published in 2015. Taking so many medications at once — often called polypharmacy — can cause cascading side effects, dangerous drug interactions and even unnecessary death.
For the last several years UB has shared the story of Alice Brennan. The 88-year-old Lockport woman was being given 26 prescription drugs, including a muscle relaxant considered dangerous for older adults, before dying of health care-associated infections in 2009.
UB typically presents Brennan’s story to medical students to warn them about the dangers of overprescribing older adults, but this fall it began directly presenting the story to older adults so they can advocate for themselves.
“So the effort is to not only work with health care providers, but also to empower patients to really take control of their health and to really feel comfortable questioning physicians about medications,” said Alice Brennan’s daughter, Mary Brennan-Taylor, who leads the presentations. “‘Is this really necessary? What if I don’t take this particular medication? Are there other options for me rather than a medication?”’
The four presentations were offered at senior centers throughout Western New York via the Erie County Department of Senior Services’ University Express program.
Those involved in the effort, dubbed the Elder Voices Network, hope it’s just the beginning of their outreach. They’ve also created educational videos, narrated by a cartoon character of Alice Brennan, and hope to place them in doctor’s offices and share them with other deprescribing groups across the country.
The presentations and videos recommend asking your doctor about stopping certain medications you may no longer need, as well as asking about alternatives to medication like physical therapy.
If you are prescribed something new, they recommend checking out the American Geriatrics Society’s Beers Criteria, a list of medications deemed unsafe for older adults.
Above all, they recommend older adults be “on guard and take charge.”
That may be easier said than done. Those involved in the program acknowledge that patients, especially older ones, don’t always feel comfortable questioning their doctor.
Wayne Sorrentino, a retired U.S. Navy commander who attended the program’s presentation last week at the Cheektowaga Senior Center, said questioning your doctor or nurse is not something he was raised to do.
“This is a medical professional, you’re paying him to take care of you,” he said. “If you start questioning everything he does for you, why the heck are you there?”
Sorrentino, 69, has had concerns about some of the medications he’s been prescribed, such as the painkiller Codeine.
“So many times I’ve had prescriptions filled, read the side effects and said, ‘I don’t want this stuff,’ and take it back to the hospital when they have the recycling,” he said.
Singh, one of the core members of the effort, said he understands Sorrentino and other older adults’ hesitation, but that most physicians are receptive to questions.
“The culture in medicine is changing and physicians and other prescribers are much more willing to have a more active dialogue with their patients,” he said. “The paternalistic approach of the past has more or less gone away. I think providers appreciate the patient viewing themselves as equal partners in their care, rather than just taking orders from their doctor.”
Brennan-Taylor noted medications are big business. U.S. pharmaceutical sales are approaching $500 billion. She feels that with many physicians financially incentivized to prescribe, it may ultimately be up to patients to shift the tide to less meds.
“It has become such a lucrative industry that I think patients really need to be able to step up and say, ‘Hey, wait a minute. Polypharmacy is not going to be on my watch,’” she said.
