While the chore of swallowing high numbers of pills can itself negatively impact quality of life, studies also show that more meds can lead to more medical problems.Illustration by The Globe and Mail/Getty Images
Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
Recently, as I was wrapping up an appointment with a lovely 79-year-old patient, she quietly asked, “By the way, do I really need to be on two water pills still?”
She had asked this question a few months earlier, but we deferred the discussion because of more pressing issues. This time, after reviewing her chart, I concluded that, no, she didn’t need to be on two different water pills; a single diuretic would do. We agreed to follow up in a few weeks to make sure stopping the pill didn’t lead to problems – and she left my exam room looking forward to swallowing one less tablet.
As a family physician, one of my favourite things to do is deprescribe medications. This is especially true when I’m working with older adults, who according to recent data take a lot of meds. A report from the Canadian Institute for Health Information found that in 2021, one in four Canadians over the age of 65 were prescribed 10 or more different drug classes. (In my older adult clinic, our current record holder is – approximately – taking 22 different drugs; given his complex health status, I’m reviewing these medications with our pharmacy team every three months.)
I’m a family doctor who practises in rural Canada. Here are five things I’ve learned
While the chore of swallowing high numbers of pills can itself negatively impact quality of life, studies also show that more meds can lead to more medical problems. Taking more than five medications increases the risk of falls, cognitive impairment, adverse drug interactions and hospitalization. Furthermore, what was prescribed 20 years ago may not remain the best option as you get older. Changes in kidney and liver function that occur with aging can affect what dose of medication is advised.
That’s why it’s important for older adults and their care providers to revisit their medications from time to time. But in a world of rushed appointments and too much paperwork, the humble medication review is sometimes overlooked. We doctors often give in to the temptation of “prescribing inertia,” and continue to reorder long-term medications without much thought.
You can help overcome that inertia by simply asking your primary care provider for a medication review. There are no explicit guidelines for how often this should be done, but it is reasonable to expect it to be a part of your periodic preventive health visits. For those over age 65, reviewing your medications at least annually is reasonable.
Here are some ways to make the process easier.
1. Bring an up-to-date list
While you might expect your primary care provider to have an accurate list of what medications you’re taking, this isn’t always the case. Unfortunately, with ongoing reliance on faxes and e-prescriptions, what is communicated to your community pharmacy may not be the same information your family doctor receives. This is particularly true at times of transition of care, such as discharge from hospital or after a specialist consult. Contacting your preferred pharmacy and asking for a recent printout of your prescription medications can save your primary care provider time in tracking down the records themselves.
2. Write down what you take besides prescription meds
It’s important to let your doctor know about over-the counter products, too.
A recent study from StatsCan polled Canadian adults between the ages of 40-79 years, and found that 83 per cent take one or more non-prescription medication on at least a monthly basis. This could include over-the-counter drugs or health products such as vitamins or minerals. While these drugs and supplements don’t require a prescription, their use may carry risk in the form of possible drug interactions or side effects.
3. Consider when it all started
One of the most challenging parts of a medication review for a physician is figuring out when and why a drug was initiated, particularly when a medication start predates our electronic medical records.
Take a few minutes to reflect on your own understanding and memory of why you’re taking certain prescriptions. Whether it was the baby aspirin that was started years ago “just in case” or the antacid ordered in hospital that stuck around, jot down a few notes before your appointment. Don’t worry if the reason eludes you; that fact can also provide clues about whether the medication is still needed.
4. Be patient: winding down medications takes time
Once you and your provider determine that a medication may not be of benefit or may be causing harm, it will likely take time and multiple appointments to taper or stop it. Reducing a medication’s dose slowly may reveal benefits of which the prescriber or patient were not completely aware. Conversely, suddenly stopping certain medications may result in rebound symptoms or withdrawal. Changes to prescription medication should always be done under medical supervision. Those of us who frequently work with older adults take the mantra of “start low and go slow” to heart.
Dr. Carolyn Wong is a family physician in Calgary with a focused practice in caring for older adults. She works in clinical settings, long-term care, and on home visits in the community. Dr. Wong is also heavily involved in medical education at the Cumming School of Medicine and Department of Family Medicine at the University of Calgary.