Managing of multiple medications for elderly patients

DEAR DOCTORS: My wife and I are lending my parents a hand during the lockdown. They’re in their 80s, and one thing we’ve noticed is how many meds they are taking. They’re from a bunch of different doctors, and some may even be duplicates. How do we get things organized?

DEAR READER: You’re not alone in being surprised to discover how many medications an older parent is taking. As people age, they often begin to experience a variety of ills and health conditions that lead them to seek out specialists. This can result in multiple diagnoses, each accompanied by prescriptions for medications to help manage the problems. If a patient isn’t wellversed in the medications they are taking and there is limited or no communication between their physicians, it is indeed possible for them to wind up with prescriptions that overlap, or that lead to adverse interactions. Taking more pills than one actually needs is known as polypharmacy, which has become increasingly common as a large portion of the population reaches older age.

The good news is that, with just a bit of detective work and a few organizational tools, you can tame the medication tangle. Start by gathering all the medications that each parent takes. Note the name of the drug and its purpose, the dosage, the prescribing doctor and contact info, and the directions for taking it. Be sure to include over-the-counter meds, vitamins and supplements, as these can contribute to adverse interactions. If possible, make an appointment with each parent’s primary care physician for them to evaluate the meds list and, if needed, recommend changes. We know that immediate office visits can be difficult to schedule, so if you have pressing concerns, your local pharmacist can identify problematic combinations. However, don’t make any changes without first checking with a health care provider.

Once the necessary and appropriate meds have been identified, create and print out a master list for each parent. Have them take their own list to each medical appointment and share it with that health care provider. This creates a scenario where the meds list gets reevaluated on a regular basis, which greatly reduces the risk of duplicate prescriptions or an adverse drug interaction. When changes are made, be sure to update the master list.

Meanwhile, invest in weekly pill organizers. They come in a variety of sizes and formats, so you should be able to find one that works best for each parent’s needs. Once you’re filling the boxes, it’s just as easy to set up two or three weeks’ worth of meds as it is to do a single week. Keep all of the medications in one safe location, away from heat, moisture or direct sunlight, and — this is crucial — secure from children. It’s also important to keep an eye on expiration dates, which are printed on the labels. Yes, there’s debate over when meds actually expire, but we recommend honoring those dates. Also, review how to dispense of expired meds. Local pharmacies and police stations often have drop-off boxes for that specific purpose.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.