After many years in medicine you have seen most things. Then one day something takes you by surprise. This was a person who was on 19, yes 19, different medications. Given some of these were taken more than once a day and the dose of some was more than one pill this person was taking over 30 tablets per day.
Most had been started by a variety of specialists who, as specialists do, look at one part of the body in isolation. Hence each additional tablet added could be justified in some way. Taking two steps back tough the overarching questions are what are all these tablets doing and are they all needed?
There has been a view forming in some quarters that we confuse prescribing with care. This is particularly the case in the elderly. The solution to most things is to whack in another tablet.
This next statement may come as a shock. There is no evidence that we are doing any good by doing this. Medications are trialed in isolation and in people who are generally under the age of 60. There are no trials, which show that, for example cholesterol lowering drugs when given to a 70 year old who is also on drugs for diabetes and high blood pressure, work! We assume it does because of trials in different population groups but we do not know for sure. More importantly we have no idea if it makes any difference to the person or just to a number on a piece of paper.
Worse still is the potential for the drugs to interact with each other in ways that would not be recognized and of course the more tablets you take the higher the chance of side effects. These may also not be recognized as side effects and be seen as another problem needing another pill!
A recent piece in the British Medical Journal touched on this. It describes one family’s efforts to reduce the amount of medication given to their 88-year-old relative. Johanna Trimble, who is quoted in the article, has now become a patient advocate in Canada promoting the notion that the best prescription can be to stop prescribing.
Here in Australia it was disappointing to see that only 16% of people think that families are best placed to care for elderly relatives and 53% think government care is best. I suspect this is because we do not actually understand what care is or what elderly people actually need and want.
What elderly people want (indeed what people at any age want) is love, support and understanding from those around them. Studies show that strong social relationships have been correlated with a 50% reduction in mortality. Pleasant surroundings, and a reason to get up in the morning matter too. Governments cannot provide this but families can.
Some years ago I was fortunate to share a stage with Patch Adams at a medical conference. He asked the doctors to raise their hand if they wanted to end up in a nursing home. No hands went up. He then asked why do we keep building them if nobody wants to go there.
There is a mountain of research that shows the key to healthy aging is a sensible diet, regular exercise and good relationships. Having companionship and interests that make you want to get out of bed in the morning are far more important than taking tablets. One group that gets this is the Eden Alternative.
Scientific medicine is fixated on the quantity rather than quality of life. The older you get the less valuable is having a few months added on, just for the sake of it. This is especially if the trade off is a lower quality of life.
Life expectancy continues to increase and the world’s population is aging. We need to move away from medical based notions of “care” which involve prescriptions and “treatment” and towards people orientated care that focuses on quality of life for the mind body and spirit.