Being prescribed new medications as we age is common. In fact, 91% of adults over 80 are on prescription medications, and the average number of medications for this age group is twenty-two.
These medications improve quality of life and slow the progress of conditions. However, all medications are accompanied by the risk of side effects — and many medications interact with one another or even with dietary elements. Additionally, certain medications can make others less effective.
For all of these reasons, seniors taking multiple medications — especially those prescribed by multiple physicians or filled at multiple pharmacies — should have a regular medication review to make sure their medications are working together and achieving the desired outcomes.
What is a medication review?
During a medication review, a healthcare professional — usually a pharmacist — takes a look at all of the medications you're on. Things they look for include:
Do you still need to take this medication?
They may review a list of your current diagnoses to ensure you're still suffering from the problem that led to the prescription in the first place.
Are you suffering side effects?
Your pharmacist will review chart notes to identify common side effects and then weigh the risk and benefits to determine whether it's beneficial to continue the medication.
Is this medication safe for you?
Some medications are not safe for people with certain conditions, and sometimes those conditions are diagnosed long after the medication is initially prescribed. A periodic review can identify new factors that make a medication less safe for you.
Is the medication working?
Occasionally, your physician or pharmacist might find that your medication isn't achieving the desired outcome. Perhaps you're taking blood pressure medication but your blood pressure still isn't well-managed. It may be time to adjust the dose or explore other treatment options.
Is there any risk of medication interactions?
The professional reviewing your medications will also look for potential interactions between medications or medications that shouldn't be prescribed together. This can happen when you have more than one doctor prescribing medications or more than one pharmacy filling your prescriptions.
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Are there redundancies?
Sometimes medication orders are discontinued after a medication review because a pharmacist or physician finds that you've been prescribed two different medications that essentially do the same thing.
The medication review typically ends with recommendations. Your physician or pharmacist may discontinue some drugs, prescribe some drugs, change the dose of some drugs, and explore alternative medications or therapies to improve outcomes or reduce side effects based on their findings.
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Who conducts the medication review?
Both primary care physicians and pharmacists should conduct annual medication reviews on their patients. Physicians will look at efficacy and side effects, as they have the information available to do that, while pharmacists look at interactions and redundancy.
Who should be involved in the review?
If you're a senior who makes your own decisions about medical treatment and care, you should request a face-to-face review with your physician and with your pharmacist every year. If you know your medical history, are able to share any signs or symptoms you're experiencing, and understand the information provided by your doctor and pharmacist, nobody needs to attend with you.
However, if you have a medical Power of Attorney (POA), you're unable to effectively communicate your medical history, or you have trouble understanding your pharmacist or provider's direction, it would be a good idea to bring your POA, partner, or other trusted friend or family member with you to your medication review appointment.
If you're on the care team for a loved one in assisted living, it's recommended that you attend medication review meetings to ensure you're able to ask questions and that you fully understand the reasoning behind any medication changes that are made.
The benefits of periodic medication review
Studies have been conducted to evaluate the efficacy of medication reviews, and the results of these studies have encouraged ongoing, periodic review.
Periodic medication review can lower out-of-pocket and insurer costs for prescription drugs by discontinuing medications that are no longer necessary, no longer effective, or redundant. This also decreases the total number of drugs prescribed, which can reduce the likelihood of adverse events, unwanted side effects, and interactions between different prescription drugs.
The recommended frequency of medication reviews
According to guidelines, a complete medication review should be done at least once a year. Additional reviews should be performed following a hospitalization, when a number of new medications can be prescribed in a short period of time, to ensure there are no discrepancies or interactions between existing prescriptions and new prescriptions.
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