Pharmacy or provider? For seniors and medication, it matters

Senior at pharmacy

Here’s an eye-opening observation from John Rinker, MD: Some people think just because you can get a medication over the counter, you can play fast and loose with its use.

“Because it’s widely accessible and they can easily get it from their grocery store, they sometimes don’t even view it as actual medicine,” says Dr. Rinker, an internal medicine physician at OSF HealthCare. They view it more like a vitamin, he says.

Complicating matters: Due to issues like a lack of mobility, older adults might skip getting the right prescription from a health care provider in favor of a pharmacy shelf option. Dr. Rinker warns that route could lead to unintentional medication misuse and possibly deadly side effects. Luckily, there are tips to steer your loved one back onto the right path.

Common barriers and issues

A big issue for older adults is not being able to move like they used to. So, if someone is dealing with a health problem (back pain, for example), it’s tempting to skip the long drive to the doctor’s office and just go to the pharmacy a block away. Or, the person might have medication delivered and not leave home at all.

Seniors can also be more forgetful or have trouble reading medication labels, leading to instances where they take too much of a drug. And Dr. Rinker says as we age, our ability to break down medicine and clear it from our body diminishes. The liver and kidneys just don’t work as well as they used to.

“That’s why we often adjust doses of medicine for adults as they age. We deescalate the dose. Less is more in certain cases,” Dr. Rinker explains. “The dose can last longer. The byproducts of the drug are more likely to create another problem.”

Some common over the counter medicines that are unintentionally misused, according to Dr. Rinker:

• A pain reliever like ibuprofen or Aleve (the technical term is a non-steroidal anti-inflammatory)
  
  “If it’s used temporarily, it’s probably not problematic. That’s how those drugs are meant to be used. But so many people have chronic conditions like arthritis. They’ll take these drugs for long lengths of time,” Dr. Rinker says. “That’s when we start to run into more of those long-term effects. You worry about gastric ulcers or bleeding in your gastrointestinal area. If you have underlying kidney issues, those drugs can make that more harmful.”
   
• Acid reflux medication like Nexium or Prilosec (technical term: proton pump inhibitor). Again, Dr. Rinker says a person might keep taking these drugs past their intended use.
  
  “This can create issues with how you absorb nutrients like calcium and vitamin D. It can lead to bone and kidney problems,” Dr. Rinker warns.
   
• Sudafed (also called pseudoephedrine) or Afrin for nasal congestion.
  
  “If you have an enlarged prostate, [overuse of Sudafed] can create more of an issue. You’ll have more problems urinating,” Dr. Rinker warns. Sudafed can also raise your blood pressure, he says.
  
  Afrin, meanwhile, should only be used for a few days, Dr. Rinker says. If you use it longer then stop, he says you can actually get “rebound congestion” that’s worse than before.
   
• Benadryl (also called diphenhydramine) for allergies or to aid sleep.
  
  “It can impair cognition and increase the risk of a fall,” Dr. Rinker says. Falls can lead to serious injuries in seniors like hip fractures.

And for all medications, Dr. Rinker adds they can negatively interact with each other. For example, he says you shouldn’t take ibuprofen with a blood thinner because it could impact how the blood thinner works and make you more prone to internal bleeding.

Strategies to stay healthy

Things for seniors and their caregivers to consider:

• Look into ways to remove the travel barrier to visit your health care provider. See if a friend, family member or social service agency can give you a ride. Or, see a provider virtually. Dr. Rinker says this could be as simple as calling or messaging your provider on your patient portal and asking, “Is it safe for me to take this drug?”.
   
• Caregivers should closely watch their loved one’s medication use and their behavior afterward. For example, did one particular pill make grandma woozy? It’s worth looking into if the regimen should be changed. Don’t be afraid to ask tough questions like, “I saw you take that pink pill earlier today. Are you sure you need another?”.
  
  “Just because they’ve taken it for a while doesn’t mean the drug is OK,” Dr. Rinker says.
   
• When you do visit a health care provider, make sure they know your health history and which medications you’re taking.
  
  “You can read medicine packaging, but sometimes it’s really difficult to understand the language. It’s not always clear cut for the average person,” Dr. Rinker points out. “So, your primary care provider is the best person to ask questions of. They’ll have your chart and other information. They can give you a response that’s tailored to your needs.
  
  “Your provider might have a different prescription medication or a safer over the counter alternative that works well for you. Or maybe they can figure out a way for you to take your current drug in a healthier manner,” Dr. Rinker adds.

Learn more

Read more about staying healthy in your golden years on the OSF HealthCare website.