Like many his age, 70-year-old T. Ramaswamy had to live with a host of ailments. It included diabetes, numbness of the limbs, hypertension, tremors, mild osteo-arthritis, gastritis and insomnia. On the surface, it seemed like he needed a dozen drugs a day to get well. But, perhaps not, had his doctors taken the time to sift through the various prescriptions he had been given for each ailment, before prescribing their own set of pills.
There are scores of people like Ramsawamy, who end up taking multiple drugs, some of them redundant and with harmful side effects, necessitating more drugs, which could work against one another. This phenomenon, known as polypharmacy, poses a huge challenge to the elderly, these days. First, it increases the risk of drug interaction and side effects. For instance, some anti-allergy pills make us feel drowsy. When taken by someone who is already on a sleeping tablet, it causes sedation. Second, a huge pill burden can set the dice rolling for a host of other concerns such as mounting financial expenses, with the burden tempting some to discontinue treatment on seeing a temporary improvement. Being dependent on so many drugs might again make the patient stressed or depressed. And, of course, it could be confusing for an older person, especially, to remember which drug is to be taken before food and which one after food, which drug is to be taken as half a tablet and which one as a whole.
Many prescriptions
“The phenomenon of polypharmacy is growing now. This is partly because the concept of family physicians no longer exists. People seek specialists directly, based on the symptoms they perceive — a neurologist for a headache, a gastroenterologist for stomach pain — who may prescribe a list of drugs that might duplicate, interact, or work against those already being taken by the patient for other ailments,” analyses senior geriatrist, Dr. V.S. Natarajan.
In Ramaswamy’s case, when the diabetes-related numbness hadn’t subsided after a month of treatment for diabetes, the elderly gentleman consulted a neurologist, who prescribed a cocktail of drugs, along with vitamin pills. Another specialist had prescribed painkillers for his arthritis and these had induced gastritis.
When Ramaswamy came to Dr. Natarajan for a consultation, the doctor looked for a way to reduce his pill burden. So while prescribing a drug regimen, he retained the drug for diabetes, prescribed a single vitamin pill to take care of the neuropathy and other ailments, and a single pill with a double drug combination to address both the blood pressure and the tremors. And rather than prescribing painkillers for his mild arthritis, Dr. Natarajan referred Ramaswamy to a physiotherapist, and prescribed antacids for gastritis. Finally, he included a mild tranquillizer to address the insomnia rather than a strong sedative. Effectively, Ramaswamy’s pill burden was brought down from 9-12 drugs per day to 4-5 tablets per day.
“When an elderly person comes to me with a problem, he must be considered as if he were under a special scanner,” remarks Dr. R. Parthasarathy, a senior general practitioner. The disease can be age-related like cataract, constipation or pigmentation; it might have started in middle age and progressed (like arthritis and hypertension); or it might be a geriatric disease like dementia or incontinence. And, then, the physician must evaluate if it is an active or passive problem. “A heart ailment has to be treated immediately, but mild arthritis need not be attacked by medicines immediately, not if there are other and more critical issues to be resolved. Once the active problem has been adequately tackled, the mild ones can be taken up. That is one way of reducing the pill burden at that point in time. It’s important to look at the deeper cause, and not treat according to the symptoms alone,” advises Dr. Natarajan.
However, mixed drug combinations or poly-pills are not ideal for all health issues, or for all individuals, and can’t be continued forever too, as the drug combination in a poly-pill can’t be altered.
It needn’t be a case of ‘a pill for every ill’. A mild nutritional deficiency can be addressed with a diet change, while counselling and mediation can work wonders for troubled minds. Consultant Psychiatrist Dr. Aswath Rangan adds, “Don’t use the word ‘lifelong’ for a prescription, which accentuates the feeling of drug dependency. Put it across as continued treatment, which can be altered, reduced or even eliminated in course of time.”
DOS AND DON’TS
* Don’t seek a specialist straight away, for every illness. Consult your family physician first, or at least, a general physician who has been seeing you for a while and is familiar with your health condition.
* Request your physician to prescribe according to your budget, if possible.
* Don’t try self-medication.
* Don’t change physicians frequently.
DOS AND DON’TS
* Don’t seek a specialist straightaway, for every illness. Consult your family physician first, or at least, a general physician who has been seeing you for a while and is familiar with your health condition.
* Request your physician to prescribe according to your budget, if possible.
* Don’t try self-medication.
* Don’t change physicians frequently.
The phenomenon of polypharmacy is growing. People seek specialists directly — a neurologist for a headache, a gastroenterologist for stomach pain — who may prescribe drugs that might duplicate, interact, or work against those already being taken by the patient for other ailments
