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Seniors must be cautious of multiple medications

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MILWAUKEE - The well-worn plastic grocery bag was starting to come apart at the seams.

It bulged with bottles of prescription medicines, vitamins and herbs, the pills rattling as Jean Lawson set the bag down.

"My daily meds," she said with a resigned smile as she settled into her easy chair. "Ten pills every morning, six every evening."

Lawson, a 63-year-old Milwaukee retiree, took the bottles out of her bag one by one and set them on the table.

First was Nexium for acid reflux. Then Plavix, a drug that helps prevent heart attacks and stroke.

Soon the line of bottles snaked along the length of the table. There was no room to set down the last one, a bottle of the cholesterol drug Zetia, so she dropped it back into the bag.

She surveyed her sizable collection of bottles for a moment and sighed.

"It's not easy getting old, it's just not," she said.

Like Lawson, many seniors typically take a broad range of medications.

That doesn't always have to be the case, said Richard London, the medical director of senior health for Covenant Healthcare in the Milwaukee area.

There is a host of risks associated with taking too many medications, London said, including an increased risk of drug interactions and a cumulative risk of side effects.

"When a doctor is seeing a patient, the old way was to ask what the problem is and think, `What drugs should I prescribe?'" London said. "What we (doctors) should be asking is: What's the problem, and what drugs should I take away?"

Sometimes the problem is a side effect of another medication, he said, so a doctor could eliminate the symptom by replacing or dropping that medication.

For example, an arthritis drug might cause stomach problems.

If the patient goes to a doctor complaining of the stomach pain, the doctor might prescribe a stomach remedy - and now the patient is taking two drugs.

The doctor instead could have replaced the arthritis drug with a similar one that might be gentler on that patient's stomach, eliminating the discomfort while keeping the patient on a single medication.

London is one of a growing number of doctors who want to reduce the number of medications prescribed for patients.

Michael Malone, medical director of senior services at Aurora Health Care, has made it part of his daily routine to critically assess and adjust each of his patients' medications.

"A doctor has to be cautious in adding another medication to someone who's taking 10 already," Malone said. "If a person has a mild impairment, say trouble in their knee, I'll prescribe physical therapy or exercise and try to avoid medications."

A person taking five medications has a 50 percent chance of experiencing an adverse reaction from drug interactions, London said. For a patient taking eight medications, the risk rises to 90 percent.

As people combine medications, they also run the risk of additional or more severe side effects.

But side effects aren't always easy for seniors to notice, especially when the symptoms mimic characteristics normally associated with aging, such as memory loss or fatigue.

Seth Banks, 59, is a general manager at GE Healthcare Technologies in Waukesha. Banks is in good health, but since he has a family history of angina, his doctor prescribed a statin drug to preventively manage his cholesterol.

Banks exercises regularly and sleeps well at night.

So he was surprised when he started becoming exhausted at work, to the point of nodding off in meetings.

The only possible cause he could identify was the drug, so his doctor switched him to a comparable cholesterol-lowering drug.

Within a month his energy returned but he noticed his normally strong memory failing him.

"I might be sitting across the table from someone I know well, and I wouldn't remember his last name," Banks said. "I used to have a photographic memory when I was younger, and, of course, it's not as strong now, but this concerned me."

His doctor switched him to yet another drug to keep his cholesterol in check. Within two to three weeks, Banks' memory problems were gone.

For Banks, it was easy to trace his problems to his medication.

He only takes one other medicine, a drug he has taken since experiencing a gastrointestinal disorder in college. He has been on that drug for 30 years, long enough to know its side effects.

He also knew his body and mind well enough to recognize when something was amiss.

"If someone is going to go on a new drug, prior to taking it, they should jot down what's normal," he said. "For exercise, know how long you can go without getting tired. Know your appetite, your eating habits. For your memory, your spouse can watch you and tell you if something seems to be different. The key is to have a baseline for comparison before you start so you know if anything changes."

Patients of any age should be cautious about taking too many drugs, but London counsels seniors to be especially careful. As people age, their livers and kidneys take longer to remove drugs from their systems.

"The drugs get in, but they don't get out (as quickly)," he said. "Because the drug stays in their systems longer, it has a much greater effect on them."

This increases the likelihood of unintended drug reactions, said James Gardner, who practiced family medicine for 25 years and is now vice president of medical staff services at Waukesha Memorial Hospital in Wisconsin.

"Many meds that seniors take have side effects that can cause mental confusion or deterioration. It's usually not so dramatic that people recognize it's because of the medicine, but when you start combining meds, the cumulative effect can be significant," he said.

Doctors might be more apt to prescribe drugs before prescribing non-medicinal therapies because doctors don't hear the holistic message enough, London suggested.

"Drug companies aren't spending a lot of time telling (doctors) not to prescribe meds," he said. "I think doctors get too much information from drug companies, but (doctors) should remember that that information is going to be biased."

Gardner agreed, but said patients sometimes contribute to the problem.

"Prescribing exercise and physical therapy might be good in practice, but a lot of people are looking for a quick fix.

They'd rather have a pill than have to exercise three or four times a week, unless you've got a really motivated individual," he said.

Lawson, the Milwaukee retiree, is aware of the risks of combining all of her medications.

She owns a well-worn copy of "The Pill Book" in which she looks up side effects and known drug interactions for every medicine she takes.

Her knowledge makes her cautiously optimistic.

"Because the majority of drugs I'm on are life-saving drugs, I'm more than comfortable with them," she said. "But for conditions that are not life-threatening, I'll take a very conservative route before I add any more drugs."


(c) 2005, Milwaukee Journal Sentinel. Distributed by Knight Ridder/Tribune News Service.

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