Q: I hope that you can offer me some advice about how to help my mother. She is 79 years old and has quite few medical problems. She is able to live independently in her house, drive and manage her life rather well. Both my brother and I live in another state and visit as often as we can, but not often enough.

About two months ago I had a chance to spend more time with my mother and live close by for a while. This is when I noticed that she takes way too many medications. She has at least 20 of them. When I asked her what they were for, she said, "My doctors gave them to me." She visits doctors all the time. I talked it over with my brother and we both feel she may be overmedicating herself. What would you suggest we do to help her? — Steven

A: I see your mom's problem quite often in my daily work. I think that we can come up with some strategies to minimize the harmful effects of too many medications. The first question you and your brother need to ask is: Does your mom really want to be helped? There is a reason elderly patients end up with too many pills. Our system of health-care delivery does not take into consideration chronic diseases and complaints. It is heavily weighted toward acute, aggressive, procedure-oriented medicine. Physicians are not properly paid for listening to patients for extensive periods of time. As a matter of fact, the average amount of time a doctor will listen without interrupting the patient is about 22 seconds (it is

Advertisement
true!!!). Therefore, patients with many complaints end up being sent to many specialists. These specialists often prescribe medications. They try to communicate with one another, but they are not always very successful. The number of medications a person takes keeps growing.

There is actually more to the story of too many medications. You may not like what I am going to say, but we do not like to put much effort into staying healthy. Given two choices, one requiring our time and determination, and the other taking yet another pill, many people will choose the medication. Let me give you just one or two examples. Most "mature" patients have some degree of leg swelling at the end of the day. This is a normal process and can be helped by reducing salt intake, wearing tight stockings and walking more. Many patients will choose instead to take a water pill to get rid of the swelling. Many doctors will choose to prescribe it. Then the side effects of the water pill bring the patient back to the doctor and yet another pill is given, this time to counteract the side effects of the first pill. This process can go on for a while, resulting in what geriatricians call a "prescribing cascade." The person may end up on three to four pills instead of just putting a little more time and effort into getting rid of the problem which started it all.

Finally, we need to acknowledge that your mom may be lonely and not have much of a social life. I do not question her need for medical care and do not want to diminish the importance and the impact of her complaints. They are all real and they need attention. Some patients, however, do treat doctor's visits like social events. It gives them a reason to start their day and to go on. For these individuals it is very difficult to change this lifestyle and limit the number of doctors involved in their care.

There is also an assumption that one needs a specialist for any minor problem. High blood pressure or upset stomach does not warrant a visit with a cardiologist or gastroenterologist. Our primary-care doctors are perfectly capable of managing more than 90 percent of all of our issues. What they need is a system which would encourage them to listen to their patients and an incentive to manage multiple complaints and illnesses at the same time. I sincerely hope we will eventually have such system. How can you help your mom? Make an appointment with her primary doctor, and if she does not have one, find an internist she will have as her primary. Ask the doctor to review ALL of the medications, including the vitamins, supplements and "as-needed" medications. Ask what each medication is supposed to do for your mom and how will she know that it is working. Agree on a plan between your mom and her doctor to slowly eliminate as many pills as possible. Ask about nonmedication ways to treat your mom's complaints, provided she does agree to try them. Be patient. It can be done. Please let me know what happens! Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.