Dr. Michael Tehrani, MD is an award-wining doctor and CEO of MedWell Medical whose practice is located right here in Long Beach near the traffic circle. In his desire to educate the community, here is a Q&A delving into the issue of “polypharmacy” or “too many pills.” A major problem he sees in geriatrics today, which he is trying to correct!
Why do so many seniors get to a place where they’re taking so many pills each day?
Often when seniors don’t have a close relationship with their Primary Care Physician (PCP) it leads to their care not being coordinated. For example, they may see one specialist for heart, another doctor for kidney, another doctor during a visit to urgent care, but there is no captain of the ship. No one specialist knows what the other is prescribing so they prescribe what they feel treats a particular problem without having context for the patient.
Typically, when we see patients on 10-15 medications there is a lot of overlap or offsetting in what the medications do. A lot of times you can have three different brand names for the same generic medicines and people end up on all of them.
Don’t the specialists ask what the patients are already taking?
Unfortunately, the average person doesn’t know precisely what they’re taking, for example, the exact name and milligram. They’ll know something is a blood pressure medication, but they don’t know exactly why they’re taking it or what its side effects and benefits are.
Americans are taught to think medications have benefits. It’s true every medication has a benefit, but every medication also has risk.
We must consider whether the side effects are greater than the benefits for each pill.
Once a senior is prescribed a medication or pill, do they take that forever or does the need for a certain pill dissipate?
By nature, medications are active when you take them and then your body breaks them down to inactive which is why you have to take a new pill every day.
As you get older, your body takes longer to break something down, so it hangs out in our body longer. That means, as you age, many pills should be taken less because your body breaks it down slower.
Also, when you think about it, when we’re younger we are under a lot of pressure from work and expectations, etc. When we are under pressure, we have hypertension. But as we get older and we retire, the pressures go away making us less stressed. Therefore our blood pressure naturally lowers. If you retire and you don’t stop those blood pressure medications you were prescribed in your younger years then you can run into low blood pressure problems.
Low blood pressure can lead to dizziness. Dizziness leads to falls, falls lead to bone fractures. So many older adults end up with bone fractures because they’re on too many medications.
So how much is too much, when it comes to taking pills?
You’re born with no medications in your body…as we get older, we should want to head more and more in that direction. Life is a circle, right? You want to be able to take off as many as possible as you age.
We’d like to see most of our patients under 5 pills a day. Just 1 or 2 is even better. When you see people taking 10-15 daily pills, that is where there is definitely a concern and that patient needs to review those medications with a Primary Care Physician.
If so many seniors are on too many medications, do you think they’re not asking their doctors the right questions?
Patients who don’t have a close relationship with their Primary Care Physician, or rarely visit a doctor, might feel it’s taboo to ask questions about medications because they don’t want to “question” a doctor who prescribed them. But you’re not questioning the doctor. You have to know all the benefits and all the side effects. If you’re taking any pills, then at least once a year you should reassess if you still need to be on them and at the same dose. If you’re on more than 5 medications, you should reassess even more often.
If you’re prescribed a medication, how is it possible to get off of it?
I think the key is just speaking with your doctor and understanding why you take everything you take and understanding the risks of everything you take.
You should constantly be asking, “is there a behavior modification such as diet or exercise I can make to get off a certain drug?” Because if you’re able to get off that drug you’re able to avoid its side effects.
What is an example of a common behavior modification that affects your medications?
Well right now, we’re seeing less of our seniors eating out at restaurants. That means they’re actually eating healthier, for example, eating less salt.
A diet change like this will naturally lower your blood pressure. If you’re still taking a high dosage of a blood pressure medication in addition to a new low salt diet, this may lower the blood pressure too much leading to dizziness. If a senior is feeling dizzy, they need to contact a doctor right away. People can end up falling because their blood pressure is too low.
Another example is sometimes patients in their older years are not eating as much. You have to look at their medications and see if appetite depressant is a side effect.
If seniors remember one thing from this interview, what is it?
It is SO important that your Primary Care Physician (PCP) is evaluating your pharmaceutical intake. Every time you see ANY doctor, you should bring in ALL your pills to show them. All your prescribed pills and even all your over-the-counter medications and herbal supplements. It is vital to your health that someone is comparing the benefits and risks with your overall health in mind.
Every time you see a specialist or urgent care and they prescribe something, you should immediately schedule an appointment with your PCP to review the medications and make sure there are no negative interactions with the other medications you are taking. Talk to your PCP to see if they provide geriatric services. Geriatricians are experienced in being the “Captain of the Ship” and give seniors the extra time they need to regularly assess their health as well as reduce outside visits to specialists. 908
If you’re looking for a Primary Care Physician or Geriatrician, Dr. Michael Tehrani and his team are accepting new patients. Please visit www.medwellmedical.com or call 562-498-2481. -sponsored