Med Mix Up

February 8th, 2016

My husband is British. I have never met any of his relatives because they all live in London. For years he was estranged from his relatives until his brother was very ill and my husband was forced to interact with his mother. They had a chance to say the words they each held in their heart but had never spoken. Since then, my husband has taken his mother on a trip to Paris and, they spoke on the phone, weekly, for over a year.

For the past six months or so, we have started communicating via Skype. It is cheaper than long distance calling and we can get to know each other. The children can see what their Gran looks like and show off their gymnastics tricks. I can talk to my mother-in-law, face to face and get to know her mannerisms. Since these weekly Skype sessions began, we have heard her sing, discovered her sense of humour and heard many personal stories. I am so thrilled we got a chance to connect before it was too late.

She plans to come over for a visit this summer and we couldn't be more excited. We have been discussing these plans with her for months now. However, lately, she hasn't been feeling too well. She said she was feeling tired, run down then sick. Her energy fluctuated as well. Last week, my husband asked her which meds she was on. As she listed her prescriptions, I jotted down the information. My husband and I looked at each other, worried that she was being over-medicated. Later that day, I searched the names of her medications and came to the conclusion that she is taking four doses of medications for hypertension, five doses of medications to treat her diabetes, something for stomach acid that she may have needed at one time but likely hasn't needed for quite some time and, another medication to lower the fat content in her blood. This medicine is NOT safe for people with diabetes and can lead to kidney failure.

I went to our local pharmacist to discuss our concerns but he suggested we have her meet with her doctor as she lives in the UK and this pharmacist is in Ontario. I suspected this process would not be a smooth one. You see, I've been here before, with my grandparents and, with the many residents I worked with in long term care. They visit many specialists, each one prescribing a new medication to address the issue the older adult is presenting at the time. Older adults are from a generation that worships doctors and never questions their judgement. If you look at their medication and you ask them, "What's this one for?", they don't know because they don't understand why they are taking their pills. The doctor prescribed them so it must be ok. It doesn't help that the same medication can have multiple names. My grandfather was on the same medication from three different sources because it had a different name. He was behaving very sluggish like he was having a stroke. It was a result of the multiple doses.

I have seen it so many times in long term care where residents are admitted and the nurse and doctor assess their medication. Often, they improve as soon as the amount of pills they take is reduced. Most medications have side effects so the more pills they take the harder it gets to determine whether they have a symptom that requires a new prescription (like heart palpitations or anxiety) or whether they just need a lower dosage of the medication they are already taking. When it's a loved one who is being over-medicated, things can get complicated. They may not go to the doctor's office or, they go and don't ask questions or, they do ask questions but feel intimidated or pressured for time and leave the office more confused than ever. If you phone the doctor on their behalf, they may not be able to answer your questions due to the parent's right to privacy and confidentiality. It gets so complicated.

If you are responsible for your aging parents, keep an eye on their medication. Look up each medication so you know what they are taking and why. Ask your parents if you can come to their medical appointments with them to take notes and ask questions. Use the same pharmacist for each prescription and ask about contraindications with other medication or food. I know, for example, that taking iron pills with orange juice helps my body absorb it but milk cancels it out. This is important information.

It's also a good idea to jot down any changes in them over time. These could be an indication that their medication needs to be changed, increased or decreased. When I worked on the dementia unit, I documented every time one of the residents was particularly aggressive. When I read over the nurse's and physician's notes, I realized there was often a correlation between the resident having a urinary tracy infection and the likelihood that s/he would be more aggressive. Information is key.

Be your own advocate, ask questions and remember that pharmacists are a great resource. Bring all your medication to your pharmacist and ask for help understanding how they all work to keep you healthy.

Anne Walsh
www.artnsoul.org