Addition to Prescription Drugs among the Elderly: A Right under Physician Monitoring - Research Paper Example

Addition to Prescription Drugs among the Elderly: A Right under Physician Monitoring April 25, Western pharmaceuticals have gained popularity and widespread use in modern times, but many elderly also use additional supplements and/or traditional medicine for their illnesses or for general health improvement needs. The paper aims to examine drug-drug interactions (DDIs) that result from these combined drugs. DDIs refer to the consequences of mixing several drugs to the health of patients, where interference in effectiveness of original prescription drugs may occur. The paper argues that adding medicine or therapies to prescription drugs is a right of the elderly who possess diverse cultural and personal values and beliefs and who have autonomy in their health care. However, physicians must closely monitor these practices for toxicity and other effectiveness concerns, while the government must regulate traditional medicine by studying potential negative DDIs and other effects and ensuring the general safety of these alternative medicines. Student name Class April 25, 2014 Dear ______, While writing this paper, my favorite parts were using the databases, reading the articles, and learning new facts and insights about prescription drugs for the elderly. These parts helped me improve the time spent on the research and were enjoyable because of the learning process. The most frustrating part of doing the research was actually integrating the sources because it was hard to know which information to add or remove. Putting transition sentences and making sure that the whole essay has coherence are some difficulties. The most helpful things I learned about researching are that accessing articles off campus and doing Internet-based research is time-efficient and will help me easily access materials wherever I am, and that creating an outline and annotated bibliography help organize information better. I would advice future students to give enough time for both traditional face-to-face and online research though to ensure that they access all the relevant materials for their papers, and to also make outlines and an annotated bibliography to help understand the materials and to integrate them properly into the paper. Sincerely, < student signature > < student name typed > The popularity of Western medicine has different effects on traditional medicine use, although some individuals are merging prescription and traditional medicine to cure their illnesses or improve well-being. The use of traditional, also called alternative, medicine, is not new to the elderly who mix it with their prescription drugs from physicians, but findings of several sources show that drug-drug interactions should not be overlooked when using multiple drugs and nutritional supplements. Drug-drug interactions (DDIs) refer to the impacts of mixing several drugs to the health of patients, particularly the interference of one drug on the presumed effect of another drug that a patient already uses (Johnell & Klarin, 2007, p.912). Adding to prescription drugs is a right of the elderly who have different cultural and personal beliefs and who have autonomy on their treatment course, but this practice must be closely monitored by their physicians because of the DDIs of additional prescription and non-prescription drugs, while the government must regulate herbal supplement and alternative medicine for their potential negative effects on consumers. To understand the context more of using numerous kinds of drugs, its background deserves further description and analysis. Many corporations are now selling different supplements and “traditional” or “organic” medicine that attract many people who are tired of the side effects and ineffectiveness of Western medicine. Some of the elderly who are familiar with traditional treatment, or who are open to its use, access traditional medicine for treatment or health promotion purposes (Costello, Leser, & Coates, 2009, p.554). Polypharmacy or polyherbacy are terms used to describe the use of multiple drugs or medications, although polyherbacy applies more to the use of two or more herbal products (Loya, González-Stuart, & Rivera, 2009, p.423). Loya et al. (2009) noted that estimates of polypharmacy vary, although national surveys reported that one-fourth to one-half of older U.S. citizens ingest five or more medications everyday (p.424). The use of several kinds of herbs has also increased for the past decades with national survey of adults saying that around 19% used an herbal product for the past twelve months (Loya et al., 424). Another concern with polypharmacy is misusage of prescription drugs. The Administration on Aging (AOA) (2012) stressed the growing problem of prescription medication misuse and abuse among older adults, which is already a public health problem. Misuse and abuse of prescription drugs pertain to non-medical use of prescription drugs. These studies on polypharmacy underscore that, despite varying effectiveness of alternative medicine and usefulness of prescription drugs, the elderly should use additional drugs with caution because not all drug-drug effects are well-studied, and instead of helping improve their health, these drug interactions might be worsening it (Djuv, Nilsen, & Steinsbekk, 2013, p.295). Older adults are particularly vulnerable to medication misuse and abuse because they ingest more prescription and over-the-counter (OTC) medications than other age groups. The elderly are prone to experiencing problems with even small increases in medication because they are more sensitive to medication and they tend to have metabolism and bowel movement problems (AOA, 2012, p.1). Older adults face high risk for misusing prescription medicine too because of common conditions of pain, sleep disorders, and anxiety that may encourage them to take more prescription drugs than proper for their conditions (AOA, 2012, p.1). The elderly who receive psychoactive medications tend to have the highest misuse and abuse prevalence, such as employing pain and anti-depressant medication more than originally prescribed for them (AOA, 2012, p.1). The specific conditions and illness trends of the elderly make them vulnerable to DDIs. While polypharmacy/polyherbacy is present among the elderly, physicians must also remember that patient autonomy and cultural beliefs are important to effective and relevant treatment options. The elderly has the right to choose treatment that works for them. Their advanced age levels are not obstacles to their need for and right of independence. Physicians must not assume that because their patients are old, they no longer want autonomy in their health care decisions (Leino-Kilpi et al., 2000, p.67). Patients have autonomy rights in health care options, including choosing medicine that can improve their health. Doctors and the government should not withhold or stop them from accessing medicine that they believe is good for them, unless studies validly show them as toxic or lethal to patients. In addition, the elderly has cultural and personal beliefs that affect their treatment options and decisions. An example is a Chinese patient, who, aside from drinking Western medicine, also uses alternative medicine to treat arthritis and diabetes. These patients who believe in traditional medicine may prefer adding alternative medicine to their prescription drugs, such as eating garlic or undergoing acupressure or reflexology too. They may also buy health supplements that are quite dominant nowadays, but are not seriously monitored and regulated by the government (Costello et al., 2009, p.554). Some elderly patients may even think that Western medicine is ineffective, so they may not use it and choose alternative medicine instead without the knowledge of their doctors. These concerns highlight patient autonomy and the pursuit for safe, effective drugs. They are legitimate concerns that health care professionals must respond to, so that they can acquire and maintain the trust of their patients by treating their autonomy and cultural values and practices with respect and consideration. The problems with adding to prescription drugs, however, cannot be overlooked, beginning with poor regulation of supplements and other drugs in the market. Loya et al. (2009) underscored the absence of regulation of supplements and drugs that make claims about what they can do, if not publicly, through their marketers or sale agents. An example is a “natural” drug made of soursop that claims that it can cure cancer, which does not have scientific proof, only anecdotal evidence. A cancer patient, who feels discouraged by the effects of chemotherapy, might use this drug without the knowledge of his doctor. The drug is used with chemotherapy and other prescription drugs that can have toxic effects on the body, however, due to lack of studies that show how these drugs and therapies interact and affect patient wellbeing. This is a hypothetical example that is not far from reality, especially when national reports show the increasing demand and consumption of alternative medicine and herbal supplements in the U.S. and other countries (Djuv et al., 2013; Johnell & Klarin, 2007; Loya et al., 2009, p.424; Slabaugh et al., 2010). As polypharmacy spreads among adult populations, researchers and physicians demand for greater government regulation on alternative medicine and herbal supplements. Costello et al. (2009) indicated the lack of regulation on available alternative medicine in the market, while Johnell and Klarin (2007) asserted that DDIs are understudied, which suggests that the government is also failing in regulating polypharmacy, especially among adults where this practice appears to be dominant. DDIs are of polypharmacy are understudied because the government does not have strict regulations for monitoring DDIs. Until these traditional medicine and supplements are regulated for quality and claims, patients do not know how effective they are per se and how effective they are when combines with prescription drugs. In addition, patients should know the negative effects of potential drug interactions that are currently under-studied. Several studies revealed that polypharmacy has potentially harmful DDIs. Johnell and Klarin (2007) studied the connection between drug quantity used and potential DDIs for the Swedish elderly. Findings showed that there were potentially relevant DDIs among the elderly, though the risks decreased as the ages of the participants increased, and that women seemed to have lower DDIs than men. The study showed the elderly has high prevalence for DDIs that can have health repercussions leading to sicknesses and hospitalizations because they tend to be vulnerable and already have existing illnesses. Another study showed potential DDI effects of polypharmacy. Loya et al. (2009) studied the incidence of polypharmacy and polyherbacy for 130 older adults living in the U.S.-Mexico border. They discovered that those who were in the border had higher multiple drug use than those in Mexico. They added that those in the border were at risk of at least one drug-drug interaction, with potential negative effects of DDIs among prescription drugs, nutritional supplement, and herbal drugs. Costello et al. (2009) noted potential harmful polypharmacy effects too. Their study underscored that drug interaction risks between herbal supplements and prescription drugs of the elderly are high because the elderly usually consume more medicine than younger adults. Djuv et al. (2013) conducted a cross-sectional study to comprehend the co-use of existing drugs and herbs among Norwegian patients, including the elderly. They learned that almost half of the patients use different herbal medicine and prescription drugs and the elderly do not always tell their physicians about these drugs. These researchers argued that non-reporting of polypharmacy can result to negative drug interactions because of the elderly’s generally lower health conditions. These studies prove that there are potential side effects of mixing drugs. When these alternative and supplement drugs are not even monitored for potency, toxicity, and drug interaction effects, the knowledge and certainty of their efficacy are also decreased. To resolve the problems with unreported and under-studied additional medicine used to prescription drugs, physicians should advice and monitor patients for these drugs, without necessarily discouraging them, but guiding patients on what their best treatment could be. Physicians must be open to mixing alternative medicine to Western medicine, and this attitude must be sincerely expressed to the elderly to gain their trust. Once trust is gained, the elderly might be more open in telling their doctors about the additional medicine and therapies they want to use and why. Once older patients inform their physicians, the latter must be respectful of these choices, but also inform the elderly of further monitoring of their health conditions. In addition, physicians must be updated of DDIs in polyherbacy and polypharmacy and be prepared in advising their patients about it. To avoid sounding defensive of Western medicine, physicians must be excellent communicators who have empathy and intercultural management skills. It will help if they can offer new or revise treatment programs that have herbal medicine integrated and which will avoid potentially negative drug interactions. In this manner, patients will not feel that their doctors want to reject or entirely avoid alternative medicine that they may prefer or desire to be integrated into their treatment plans. Furthermore, doctors should monitor potential DDIs with drugs that patients are determined in using. Careful monitoring includes determining the usage and dosage of alternative medicine and herbal supplements and how they are reacting with prescriptions. Doctors can call these monitoring practices as mini-case studies. Better yet, they can launch empirical studies on their patients’ polypharmacy and polyherbacy to further document DDIs for future reference. The main point is asking doctors to not disregard patient autonomy when it comes to their medicine of choice. Society should not depend on physicians alone, however, and the government must also monitor these drugs for efficacy and safety. Lawmakers must pass laws that monitor, but not ban, polypharmacy and polyherbacy, and study DDIs. The government can fund studies on the effects of adding medicine to prescription drugs. The government must see elderly health care research as also central to its social justice concept. In addition, the government must also monitor existing alternative medicine, especially those in packaged formats. Some important tests are on toxicity and safety levels. The government cannot stop the elderly from using alternative drugs, but it must have the power to study existing traditional medicine and making sure that they are safe for public consumption. Apart from toxicity and safety, the government must also study how to improve the effectiveness of herbal medicine. It should also fund studies that test the success of herbal medicine and what forms and dosage are more effective. The government should be at the forefront of studying and monitoring the science of alternative medicine, in order to improve the empirical support for it. Otherwise, without government regulation and implementation of safety levels, the elderly are in danger of suffering from a mix of drugs that can worsen their health conditions. Opponent of government regulation of alternative medicine could say that it will stifle the latter’s freedom because the government is already biased for Western medicine. They would argue that the government has a record of rejecting alternative medicine in support of big pharmaceuticals’ medicine. They can even say that the bureaucracy supports capitalism because the latter funds its election programs and other public/private goals. Indeed, such marriage between the government and big pharmaceutical companies cannot be undermined. However, the welfare of the elderly deserves government regulation too, where regulation will not necessarily lead to banning alternative medicine, only to collecting enough information about it that can be passed on to buyers. The idea is to help patients make informed choices. Moreover, these opponents to regulation should not forget about reports of tainted or unsafe alternative medicine. Regulation will decrease potential negative health effects, even death, from unregulated harmful medicine. The argument is balance of regulation and alternative medicine study and promotion, not termination of traditional medicine use. Polypharmacy and polyherbacy are not fads to the elderly and other people seeking for healthier and less side-effect alternatives to Western medicine. Scholars cautioned them, nevertheless, to be mindful of drug interaction when they are already consuming prescription drugs. These studies suggest the importance of patient-physician communication regarding additional drugs and use of alternative medicine. However, patients could hardly be honest to physicians who express an attitude that they look down on alternative medicine. Physicians and governments, hence, must work closely with patients in finding the best treatment plan that respects autonomy and cultural beliefs to reduce negative drug interactions. They should empower the elderly in making relevant decisions through helping them choose the right mix of medicine that are suitable for their health conditions and medical beliefs and goals. Thus, the elderly preserves autonomy in decision-making, while gaining access to helpful medical guidance. References Administration on Aging. (2012). Older Americans behavioral health issue brief 5: Prescription medication misuse and abuse among older adults. Administration on Aging. Retrieved from http://www.aoa.gov/AoARoot/AoA_Programs/HPW/Behavioral/docs2/Issue%20Brief%205%20Prescription%20Med%20Misuse%20Abuse.pdf Costello, R.B., Leser, M., & Coates, P.M. (2009). Dietary supplements: Current knowledge and future frontiers. In C.W. Bales, & Ritchie C.S. (Eds.), Handbook of clinical nutrition and aging (2nd ed.) (pp.553-634). New York: Humana Press. Djuv, A., Nilsen, O.G., & Steinsbekk, A. (2013). The co-use of conventional drugs and herbs among patients in Norwegian general practice: A cross-sectional study. BMC Complementary and Alternative Medicine, 13, 295. Retrieved from http://www.biomedcentral.com/1472-6882/13/295 Johnell, K., & Klarin, I. (2007). The relationship between number of drugs and potential drug-drug interactions in the elderly. Drug Safety, 30(10), 912-918. Retrieved from Academic Search Premiere. Leino-Kilpi, H., et al. (2000). Patients autonomy, privacy and informed consent. Vancouver: IOS Press. Loya, A.M., González-Stuart, A., & Rivera, J.O. (2009). Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States-Mexico Border: A descriptive, questionnaire-based study. Drugs & Aging, 26(5), 423-436. Retrieved from Academic Search Premiere. Slabaugh, S.L., Maio, V., Templin, M., & Abouzaid, S. (2010). Prevalence and risk of polypharmacy among the elderly in an outpatient setting: A retrospective cohort study in the Emilia-Romagna Region, Italy. Drugs & Aging, 27(12), 1019-1028. Retrieved from Academic Search Premier. Read More