A Hard Pill to Swallow: The Importance of Managing Your Medication

Andy Donald likes to poll his audience for effect. 

“I asked the room, mostly 80- and 90-year-olds, ‘How many of you think dizziness is a normal part of aging?’ The entire room lifted their hand. So, then I asked, ‘How many people here are on five or more medications?’ Again, almost the entire room lifted their hand. Then I asked, ‘How many of you, every year or two, seem to get on another medication and get even dizzier?’ Now, there’s more peer pressure to lift up their hand — some of the men are — people are laughing and lifting up both hands.”

Donald, a certified geriatric pharmacist, explains — as he did at the aforementioned meeting of the London, Ont., chapter of CARP (a ZoomerMedia affiliate) — that ongoing dizziness suggests you’re on too many medications or the wrong dose for you. But often, he says, side-effects of one drug — dizziness being a common one — are treated by another drug. “That’s how we get a whole mittful of meds, the whole prescribing cascade.”

For further effect, Donald cites statistics from a report by the Canadian Institute for Health Information. In 2016, nearly two-thirds (65.7 per cent) of Canadians aged 65 and older were taking five or more prescriptions, more than a quarter (26.5 per cent) were taking 10 or more and one in 12 (8.4 per cent) were taking 15 or more. “That’s shocking,” he says. “But here’s the big one, a third of all senior hospital visits in Canada were directly due to them taking one potentially inappropriate medication.” Often referred to as the Beers List — named after U.S. doctor Mark H. Beers, who first compiled such a list of potentially inappropriate drugs, in 1991 — these are meds known to be poorly tolerated by seniors, with the potential to cause adverse drug reactions. To add insult to (potential) injury, 31.1 per cent of Canadians over 65 were taking at least one of those meds every single day. 

Donald, the founder and CEO of The Health Depot Pharmacy (a ZoomerMedia partner), is quick with another stat: Half of Canadians don’t take their meds as prescribed because of the negative side-effects, which are more likely to happen the older we are and which — like a night out — take longer to bounce back from as we age. 

If that’s the case, the first thing to do is diagnose the problem, then act. “It might be too high a dose. Or we might need to switch to a suitable, safe alternative,” he says. 

Donald believes people should stay in regular contact with their pharmacists. “You need to be hungry to learn and know more about your meds and your conditions,” he stresses. For example, our kidney and liver functions — which we use to break down meds — naturally dampen with age. Your pharmacist can track those changes in your blood work, which, with the advent of electronic health records, they now have access to. As one of only 400 geriatric pharmacists across the country, Donald specializes in adjusting a person’s medication as they age and knowing suitable alternatives and communicating that to their doctor. “If your body is continually changing, so too should your meds.”

It’s not only meds which we should be consulting our pharmacist about, but everything we take. 

Last summer, Health Canada recommended that health products containing CBD, or cannabidiol — an active yet non-hallucinogenic compound in marijuana — should be available only in pharmacies, and consultation with a pharmacist encouraged if you’re taking other medications. “It’s probably one of the worst drug interaction substances out there,” says Donald, explaining that CBD slows down your body’s ability to break down drugs. As a result, medications may stay in your system longer, increasing their potential to cause negative side-effects. But if your pharmacist knows, they can tweak your prescriptions accordingly. “CBD can be a game changer; it helps with pain, sleep and mental health – an important trifecta,” he says. “But you have to have your meds adjusted and constantly followed.” Another reason to speak with your pharmacist, regularly. 

A version this article appeared in the Aug/Sept 2023 issue with the headline ‘A Hard Pill To Swallow’, p. 26.

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