Living Well Mary celebrated her 93rd birthday... slumped over in her seat at Olive Garden.
The whole family was there. And she, the guest of honor, was fast asleep at the table.
But Mary had seemed "out of it" before then, too. "She couldn't hold a conversation or even finish a sentence," her daughter Leslie would tell the New York Times three years later in 2021.
The Olive Garden meal finally spurred Leslie to book her mom an appointment with a geriatric-medicine specialist at Johns Hopkins Hospital. There, Mary took a test to check for cognitive impairment... and failed spectacularly. She got only three of the 30 questions right.
Mary had also long been dealing with health conditions common for her age: hypertension, diabetes, nerve pain, and anxiety. Mary was taking 14 different drugs. One was an acid-reflux medication that Leslie couldn't remember why her mom even needed in the first place. Another made Mary's blood-sugar levels too low.
Mary was a victim of an epidemic that'll only get worse...
That epidemic is polypharmacy, or being on too many prescriptions.
A 2021 PLOS ONE study of more than 2 billion patient visits for folks aged 65 and older found that from 2009 to 2016, as many as 65% of older Americans fell victim to polypharmacy. Nearly 65% of folks were on at least two meds. And like Mary, about 49% were on five or more drugs.
Medications come saddled with all sorts of possible side effects in addition to their intended effect. So the more complex medications you have, the higher chance you have of suffering serious symptoms and even dying from them.
For example, you probably (and hopefully) know the risk of excessive bleeding if you take blood thinners. But as a March 2024 study found, if you're one of the tens of millions of Americans prescribed a common antidepressant (i.e., an SSRI), that ramps up your major bleeding risk by 33%.
You're also opening yourself up to a greater chance of getting prescribed a medication that'll do more harm than good, or a "potentially inappropriate prescription." And that ups your risk of having...
- Your health harmed by the med in what's called an adverse drug event.
- The med interact with another drug you're taking, leading to unexpected side effects.
- The med interact with – and worsen – an existing disease or condition.
So, what can you do?
Be your own IRS, or "Internal Remedy Service"... Regularly do an audit of any and all remedies. That includes over-the-counter drugs, prescriptions, vitamins, and supplements you regularly take and have recently taken or discontinued. One way to start is to...
"Brown bag" it. Leslie did something like a "brown bag" review. The term, coined in 1982, refers to chucking all of your prescriptions into a bag and having your doctor or pharmacist review them for any new recalls and dangerous drug interactions. Your provider can also reevaluate if the dosage should be adjusted or if you can even stop taking the med.
Whipping up a list like Leslie's gives you a more portable solution. Jot down details like:
- The name of the drug (generic or brand name).
- The long National Drug Code ("NDC") made up of three groups of numbers (separated by dashes or asterisks) on your prescription label and over-the-counter packaging. It'll let your provider know of any recalls. The three groups, in order, identify: the "labeler" (i.e., the drugmaker), what the drug is, and the packaging (i.e., the size and quantity).
- How often and what time you take it.
- How you take it (i.e., the form it comes in, like a shot versus a pill, and whether you take it with food).
At the bare minimum, do a full medication review once a year at your annual physical (or biannual visit for most seniors). Even better, do it any time you see your primary-care doctor or specialist.
Thanks to Leslie taking the first step, the specialist outlined a plan to whittle down Mary's laundry list of meds.
But Leslie didn't stop there... She also "went online and looked everything up" and "started questioning her [mom's] doctors" at subsequent appointments.
She'd ask questions like whether her mom still needed to take the drug, whether the dosage could be lowered, and whether she could even stop taking it.
That leads me to my other tip...
Speak up and read up. The next time your provider prescribes a new medication, ask questions like:
- How long will it take to work?
- How long will it take to see any side effects?
- How safe is it?
- Can it interact with any of the other meds I'm on?
- How much will it roughly cost? Is there a generic version?
- How should I store it?
Even if your doctor tells you that it's safe, always double-check...
Go home and read up on the medication yourself. You might even find a "black-box warning" that your doctor may have glossed over. It's the strongest warning that the government slaps on a label if a drug's side effect can seriously harm your health, put you in the hospital, or even kill you. You can also check drug interactions here.
Thanks to Leslie being proactive, Mary's follow-up visit 10 months later was a complete 180 from the last visit. Mary was alert, responsive, and scored a 25 out of 30 on the cognition test. Her next birthday was also a reversal from the prior year's... As Leslie put it, her mom "was the life of the party" at her 94th birthday celebration.
Medications can completely change your life for the better – or for the worse. As I always say, you are your own health advocate. The same goes if you're the one managing a loved one's care.
So be fearless – ask questions and get answers. And know what you're putting in your own body.
Last night, in the latest issue of my Retirement Millionaire newsletter, I shared a drug-free way to treat one of the most common ailments in Americans today. If you're not already a subscriber, click here to get started today.
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Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
May 9, 2024