Do You Really Need All of Those Pills?
A medication review with your doctor could reduce the number you take
Taking more medications than you used to? You’re not alone; as you get older, you’re more likely to take prescription medicine.
According to the Centers for Disease Control, 72 percent of adults ages 45-64 had taken at least one prescription drug in the last 30 days in 2011-2014; 39 percent had taken three or more in the last 30 days and 20 percent had taken five or more. For adults ages 65 and over, the figures are even higher: 92 percent have taken at least one prescription drug in the last 30 days; 68 percent, three or more and 42 percent have taken five or more.
The average number of prescription drugs taken has risen, too. One 2015 study found that the median number of prescription drugs taken by people 65 and over doubled from two to four and that nearly 40 percent of people were taking five or more prescription medications. (The study authors attribute some of this increase to more prescriptions being written for cardioprotective and antidepressant medications.)
Most people 65 and older would like to reduce the number of medications they take, according to a recent study of nearly 2,000 Medicare recipients published in October, 2018. More than 90 percent were willing to stop taking one or more of their medications if their doctor said it was possible, and two-thirds wanted to reduce the number they were taking.
So why are more of us taking more prescription drugs? “I think the issue is that a lot of times people see more than one specialist, and they may be given more than one medicine [by each specialist],” says geriatrician Dr. Lee A. Lindquist, associate professor of medicine at the Northwestern University Feinberg School of Medicine in Chicago. “And people think medicines will make them feel better, so there’s a push to prescribe … (but) “deprescribing is a very hot topic among geriatricians because of issues including side effects and drug interactions. The fewer medications someone is on, the better.”
Reasons Why Medication Needs Change
Changes in your health and lifestyle may eliminate the need for some medications. For example, “some people may have had stressful full-time jobs when they were in their 40s, 50s, and 60s, and may have had conditions like high blood pressure or gastroesophageal reflux disease,” says Dr. Lindquist. But post-retirement, these kind of stress-induced conditions may disappear or no longer require treatment.
A change in your weight or exercise habits could also mean that your medication needs change. For example, working out regularly can help you maintain healthier blood sugar levels if you have diabetes, and allow you to reduce or eliminate diabetic medications. “Exercise may be even more beneficial than medications,” Lindquist says. “The more exercise you do, the more you can cut back...during retirement, when you’re taking better care of yourself or when you lose weight or are exercising more, you may not need the medication because your lifestyle has changed.”
The Right Time for a Medication Review
Scheduling a medication review lets you make sure that every medication you’re taking has a purpose, and that every medication is still appropriate. It’s smart to have one review annually, along with one during a health care transition, like when you’re going from the hospital to a rehabilitation center, or coming home after surgery. “A lot of times medications will be added during the transition — that’s where a lot of unnecessary medications get added on,” Lindquist says.
Age-related changes in your body that affect drug metabolism can also impact how you react to certain drugs, which is another good reason for an occasional medication review. Some drugs are fine to take in earlier adulthood, but as you get older, they can last longer and/or have a more pronounced effect. Even an over-the-counter medication like Benadryl can be over-sedating for someone in their 60s or 70s, says Lindquist.
A medication review also is a good time to talk about when and how you’re taking your medications. Some people take medications five or six times a day when it may be possible to combine them, while others need to be taken on their own.
Talk to Your Pharmacist and Doctor
Your pharmacist is a good place to start, Lindquist says. “Pharmacists know medicines and what medicines are used for. They’re great at guiding people to have better conversations with their doctors,” she says.
Since your doctor might not ask you about your medications, you should feel free to bring it up on your own. “Many times when a physician sees a patient who’s looking good and is on a list of medications, he or she doesn’t want to rock the boat, so it’s fair for the patient to be proactive and say, ‘can I stop this medication?’” Lindquist explains.
Bring your list of current prescriptions to every doctor’s visit (along with any over-the-counter supplements you may take). At your medication review, ask if the medications you’re taking are necessary for you and what their risks are. Also ask if there are other options for the drugs you’re taking; this includes taking a different drug or other ways you can manage your symptoms. However, do not stop any prescribed medication — even if it’s producing side effects — without talking to your doctor first.
If you’re concerned about the number of medicines you take, don’t be afraid to bring it up with your physician, adds Lindquist. “Medications should support your health, instead of interrupting your life,” she says.
How to Safely Dispose of Unneeded Medications
If you have medications you no longer need, get rid of them as soon as possible to ensure that they won’t be accidentally taken or misused by other people. However, it’s important to dispose of the medications in a safe way to protect people and to ensure they won’t end up polluting the environment. The Food and Drug Administration (FDA) has these guidelines for safely disposing of prescription and over-the-counter drugs:
- Best option: take-back programs and sites. The U.S. Drug Enforcement Administration (DEA) periodically hosts National Prescription Drug Take-Back events. Also, many pharmacies and health care organizations have secured medication disposal containers where you can simply bring your drugs in and drop them in a bin. To find a site near you, check out this DEA webpage.
- Second-best option: throwing them in your household trash. If there are no take-back programs or drop-off locations near you, you can dispose of medications in your trash. The FDA recommends you first mix different medications together and place them in a container, like a sealed plastic bag.
- Flush only if instructed to do so. A small number of medications specify that you should flush them down the toilet if you have no take-back option available. These drugs are especially harmful if taken the wrong way or by someone other than who received a prescription. This is the reason flushing is recommended over putting them in the trash. However, a take-back program/site is the safest option.