Polypharamcy is rampant in today's society. I would define polypharmacy as the over prescribing of medications and often being done by multiple physicians. Unfortunately today polypharmacy has become a way of life for many people, and carried out by too many physicians. Often this occurs due to patients visiting their physicians for everything that occurs in their life. Many things in our lives will get better on there own. People tend to want instant and immediate solutions for everything. Too many physicians respond by adding another medication. All to often, they do this without evaluation as to the possibility that some of the medications the patient is taking, might be contributing to the new problem.
Part of my pharmacy practice included consulting and monthly medication reviews for LTC facilities. Many times, nurses would tell me that a patient had started experiencing new problems after starting a new medication. Often, I would find that the most likely culprit was the new medication. I remember visiting a facility one day and the nurse asking me to look at a patient's chart. The patient entered the facility one week earlier. Now, the patient was barely functioning . The nurse told me that she had called the physician and was told to monitor the patient a few more days and call them back. I reviewed the patient's chart and found that he had started a new medication about ten days earlier. I suggested to the nurse that I was suspicious this patient was toxic on this medication. This particular drug has a narrow therapeutic threshold for positive results versus being toxic. I suggested that the nurse call the physician and request a lab test that would check the blood levels of the medication. The results came back that the patient was toxic. The dosage was decreased and within less than a week, he had returned to his admission status.
Several days ago, someone called me and asked me to evaluate their spouse's medications. This spouse had been diagnosed with moderate dementia about one month earlier. Within the past month, the spouse's diagnosis had been changed to advanced dementia. I reviewed this persons medications. A light bulb went off inside my brain. There were five of the fifteen medications that could possibly account for the change of moderate dementia to severe dementia. This person has seven doctors. Not a single one them had taken into consideration that there was a possibility of five medications attributing to the change from moderate to severe. They were choosing to add another medication to treat the new symptoms without evaluating this possibility.
The question that must be asked is: "How do we stop this from happening?". First, I think patients must be more attentive to what is taking place in their own body and be able to describe to their physician. Most importantly, physicians need to evaluate the list of medications that a patient is taking prior to ever ordering a new medication. It becomes incumbent upon the patient to remind the physician to review their medication list before prescribing new medications. This is extremely important in situations where the patient is on multiple medications. Disease state, age and medications must be part of this review. Before starting a new medication, we must rule out possible medication related issues that might occur in the person with dementia. Working together with our physicians as a team can have a huge impact on our outcomes.
©2015 Robert Bowles
Robert Bowles, Jr.