When the time came for Ginny Erickson-Ebben’s elderly mother to move into a senior living facility in 2018, the entire family agreed the best place was near Erickson-Ebben. The weather was warm where she lived in Texas, and Erickson-Ebben lived just a mile down the road from the facility. She also had the time to help with her mother’s care. While happily and willingly taking on those duties, she didn’t realize what a big job she’d signed up for.
Ebben did have physical help from a caretaker at the facility, but she was not authorized to manage medications – Erickson-Ebben’s mother took 20. Even for a bright, middle-aged woman like Erickson-Ebben, the medication management was a complicated task.
“I was ignorant of how overwhelming the job would be,” Erickson-Ebben admits. “There was a nurse at the senior living facility who stopped in once a day to check on my mother, but otherwise the job fell to me, and it was stressful.”
Erickson-Ebben developed a system to keep everything straight. She made regular trips to the pharmacy to pick up the medications, and then, once a week, carefully counted out the meds and placed them in her mother’s pillboxes, separated by morning, afternoon, and evening doses. “It was scary at first, because I didn’t know what pill did what, but after a month, I learned them all and knew what I was doing,” she says. “But I was always worrying about what would happen if she missed a pill or if she took the wrong one at the wrong time.”
Like many seniors, Erickson-Ebben’s mother had a host of ailments and illnesses, and managing the prescriptions to keep them all in check is a huge undertaking. Recently, the American Medical Association took steps to help with the problem, issuing a new policy called “Reducing Polypharmacy as a Significant Contributor to Senior Morbidity.”
The doctor who championed the new policy is Louisville, KY-based Tom James III, MD. He’s been concerned for some time about the complicated picture of patients – especially seniors – taking multiple medications.
“There’s an inverse relationship between the number of prescriptions a patient takes and their longevity,” he explains. “Of course, patients who are sicker are on more medications, but while all drugs are tested for their side effects, they’re not tested in combination.”
As a result, says James, every patient taking multiple medications becomes their own individual test site. Compounding the issue, he says, is the fact that in medical school, doctors receive training for adding medications, but not subtracting them.
Another compounding issue is the fact that, like Erickson-Ebben’s mother, many senior patients have multiple doctors treating them at once. Today’s modern medicine means that, often, doctors don’t really have opportunities to discuss their mutual patients in person.
“It used to be that we’d chat in the doctor’s lounge, often comparing notes on a patient,” says James. “Now we often put information into electronic charts, but don’t talk face-to-face.”
What’s sometimes lost, says James, is a chance for multiple doctors to be on the same page about a patient’s medications. “Medication profiles often don’t catch all the drug interactions,” says James, “because the tools we use are not discriminatory.”
This spills over into over-the-counter meds and supplements, too, which can sometimes interact with prescription drugs. All in all, many elderly patients are at risk for the complications of over-medication.
Erickson-Ebben found it essential that she and her family research the medications her mother was taking, and why. “You have to advocate for the patient,” she says. “Unfortunately, if there’s a reaction to a medication, you need to research that, too.”
In the case of Erickson-Ebben’s mother and her 20 medications, if one caused a rash, it was difficult to know which. “You can’t just take them off one medication,” she points out. “Talk to the doctors about your concerns, and don’t let them be dismissive of patients just because they’re elderly.”
Creating a Safety Net
The new AMA policy aims to create a network of caretakers to educate patients about the significant effects of all medications, as well as many supplements. It encourages pharmacists, doctors, and other caretakers to teach patients to bring lists of all updated medications/supplements to each point of care.
The idea is to “get patients thinking in terms of becoming the victim of too many medications,” James says. “Ask questions when you need answers.”
Many doctors have limited time with patients these days, so advocacy is crucial. “If there’s an adult child or home-health nurse in the picture, they should review the medication list at least twice a year with the patient’s primary care physician,” says James. “Too often, if a doctor didn’t write a prescription on the list, he or she won’t mess with it. So we hope a pharmacist might catch the potential interaction.”
Erickson-Ebben’s family specifically chose to work with one hospital system, hoping there would be good coordination between doctors. But that didn’t happen. “The doctors didn’t always communicate well with each other,” says Erickson-Ebben. “We found that each specialist was focused on their specialty only.”
This is part of the current gap in care, one that James hopes to begin resolving with the new AMA policy. In the end, he says, the current system relies too much on the “I hope this will work,” approach. “We need to go beyond the resolution and add in an educational approach, too.”
The new AMA policy is a good first step on the road to improving health care for seniors, and James hopes to keep moving the needle. “There’s universal agreement that there’s a problem,” he says. “There’s not yet a universal agreement on the approach.”
Tom James III, MD, Louisville, KY.
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