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Dear Carol: Countless articles, including yours, report that older adults are taking too many prescription drugs, some with potentially harmful side effects. Yet, it seems that every time my mom goes to see her doctor, she comes back with another prescription. The family wants her to have whatever medications she needs, but we’re afraid that some of them are not just unnecessary but might be harmful. Mom’s comfortable with the doctor she’s seen for 30 years and she came from an era where you didn’t ask questions. Can you suggest an approach that might convince her to see another physician? – BN
Dear BN: I agree that changing doctors might help your mom maintain better health. Her current physician may be providing fine family care, but treating older adults requires a change of focus where more isn’t necessarily better. Don’t put her previous doctor down. Simply emphasize that like all older adults, her body is changing, and she needs a doctor who specializes in her age group to maintain the best quality of life possible.
Geriatricians (doctors who specialize in older adults) are scarce but see if you can find one with an opening. If that’s not possible, look for an internal medicine specialist who sees a lot of older adults and understands their unique needs.
Assure your mom that if she’s not comfortable with her new physician, she can always go back to her old doctor, but she should see this specialist at least once. Then she can decide.
Her new doctor will probably de-prescribe (take her off) some of her medications. There are two reasons for this: Firstly, older adults are often beyond the point where they will benefit from some medications they’ve taken for years if not decades, so they are left with negative side effects and little or no benefit. Secondly, an astounding number of drugs can increase the risk of falls as well as create or exacerbate memory and thinking problems.
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Additionally, it’s important that she use only one pharmacy since it’s far easier to check for potential problems when prescriptions are in one computerized system. Her pharmacist can tell her what each medication is for, how she should take it and note red flags signaling potentially dangerous side effects. While her doctor will check for problems arising with her combined medications, pharmacists are experts on drugs. Double checking with a pharmacist doesn’t imply that a patient doesn’t trust their doctor. It’s simply a tool to make certain patients understand as much as possible about their medications.
Congratulations for being on top of your mom’s needs, BN. Your current challenges will be twofold: find a physician who is more in tune with the changes in an older person like your mom and convince your mom to see a different doctor. If at first, she resists, step back and try again when you sense another opportunity. Even if she just considers it a second opinion, once she’s gone that far she may accept this new physician as her primary.
