There’s a word doctors use when talking about a patient who’s taking multiple medications: polypharmacy. Sometimes there is a rational reason for a patient to take many drugs: several coexisting medical problems or a single condition that requires several medicines to control. But disturbingly there are often too many medicines with the dangers implied: drug interactions, side effects, excess costs, overdose when a patient takes two or more similar medicines.

The older the patient, the greater the risk of polypharmacy. Even though people over 65 make up about 13 percent of the population, they account for roughly 30 percent of all prescriptions.

How does polypharmacy happen? There are several ways. First, patients often take over-the-counter medicines or herbal supplements. Just because something is available without a prescription, that doesn’t mean that it’s OK to take as much as desired, as often as desired or without regard to other medications. The most common categories of over-the-counter medicines are pain relievers and cough/cold preparations. Manufacturers are limited to a few active ingredients for pain relievers: acetaminophen, aspirin, ibuprofen, naproxen or ketoprofen. And the last three all fall into the class of non-steroidal anti-inflammatories (NSAIDs), which have similar side effects and risks and should not be used together. There are similarly only a limited number of available active ingredients from which a manufacturer can concoct a potion to treat “colds and flu”: decongestants (pseudoephedrine and phenylephrine), antihistamines (diphenhydramine, loratidine, and cetirizine), expectorants (guaifenisen) or cough suppressants (dextromethorphan.)

So, with so few basic ingredients available, why does the average pharmacy’s shelves hold dozens—or perhaps hundreds—of remedies for cough, cold, congestion, fever, aches and pains?

In one word: marketing.

Each manufacturer combines various ingredients and comes up with a catchy name and catchier advertising.

In order to understand what he or she is really taking, a consumer has to read the fine print, and to understand which ingredients might interact with other over-the-counter or prescription medicines.

At least with over-the-counter medicines, the dosages and ingredients are standardized. But items marketed as “supplements” are subject to much less stringent standardization of active ingredients and dosage reliability. “Supplements,” even when touted as “natural,” carry the potential of adverse reactions or interactions with other medicines.

Another easy way for patients to fall into the polypharmacy trap is to visit multiple doctors who each prescribe medication to treat their area of specialization, while unaware of medications prescribed by other physicians. This can happen also during a visit to an emergency room or urgent care. After a hospital admission, a patient may be discharged with new or different medications. If he continues these medicines plus medications taken before hospitalization, he may wind up with drugs that interact or that have duplicate effects.

If you suspect that you, or a loved one, are taking too many drugs, start by gathering all medicines. Everything: prescriptions, over-the-counters, supplements, eye drops, skin creams, etc. Then bring them to your doctor and review each medicine.

Discuss the following questions with your doctor.

• Is this medicine necessary? Over time, the underlying condition for which the drug was prescribed may change. Or the patient may have modified his lifestyle so that the medicine is no longer needed. And sometimes new information changes the way medicines are used; what was considered state-of-the art ten years ago may be outdated today.

• Is this drug contraindicated in the elderly? As people age, it may be necessary to alter their medication regimen to ensure that the risks do not outweigh the benefits.

• Are their duplicate medications? For example, a patient taking a prescription NSAID may not realize that it can’t safely be combined with an over-the-counter medicine in the same class. Similarly, one specialist might prescribe a beta-blocker medicine to prevent migraines while another doctor might prescribe a beta-blocker to treat blood pressure, placing a patient at increased risk for side effects.

• Is the patient taking the lowest effective dose? As people age, the organs that clear various drugs, such as the liver and kidneys, age too. The dose prescribed a decade earlier might need to be reduced to refl ect the altered metabolism. Is the medication being taken to counteract the side effects of another medicine? This is surprisingly common. Perhaps the first medicine can be changed, reduced, or eliminated, thus eliminating the need for a medicine to treat its side effects.

• Can the regimen be simplifi ed? Sometimes a single combination medicine can replace two individual drugs. Or a medicine that requires multiple daily doses can be changed to a once daily alternative.

• Are there potential drug interactions? That’s one reason why it’s vital to bring all medicines, even non-prescription substances, to the offi ce visit. Whenever possible, patients should try to obtain all their medicines from a single pharmacy. Often the pharmacist will be the first to recognize a potential drug interaction.

• Is the patient actually taking the medicine? Just because a medicine is sitting in the medicine cabinet, it doesn’t mean that the patient is actually taking it. If not, it’s important to find out why in order to address the problem. Is it the cost? Are there side effects? Is the dosing too complicated? If these issues can’t be resolved, it makes no sense for the patient to have the medicine hanging around at home. Otherwise, years later, the patient may discover the medicine, restart it, and experience a problem.

Take a look around your house today. This would be a good time to take an inventory of what medications you have. Dispose of any that are no longer needed or that are outdated. Make a list that you can carry in your wallet. Learn the purpose of each medicine. And if you think that you still have too many medicines, bring them in to your doctor for a medication review.

Eva Briggs, a board certified physician, works on the staff at Auburn Memorial Hospital’s two urgent care centers in Auburn and Skaneateles.

Warm weather means home improvement scams in Central New York, but there are effective ways to avoid becoming a victim, say those familiar with the situation.

Seniors are often the targets of fly-by-night contractors offering to perform cut-rate roofing work, painting, driveway sealing or remodeling jobs. Unscrupulous operators do substandard work or simply move on once they pocket a victim’s money. It’s a scenario repeated every year across the country once spring and summer arrive.

“It’s the prime time because people are trying to get work done on their house,” said Sgt. Tom Connellan, of the Syracuse Police Department’s Criminal Investigations Division. Be wary if someone knocks on your door and offers to do home improvements, Connellan advises. “A lot of them are traveling scam artists who will give you a hard sell,” he said. “They will give you a low price and a lot of these guys will insist you pay in advance. If somebody’s going door-to-door you should be very skeptical.”

Seniors are more likely to live in older homes that need repairs and are less likely to do the work themselves, said Bill Ferris, AARP’s New York state legislative representative. “A lot of older persons are rehabilitating their homes because they want to remain in their homes as long as possible,” Ferris said. “Fly-by-night operators come by and say, ‘I’ve got extra material and I can do your roof’ or ‘I can do your driveway.’ Never trust anyone who comes by and says they have extra material and they can do the job cheaply.”

A homeowner looking to hire a contractor “needs to know they are reliable and that they have an established business in the area,” said Peggy Penders, a spokeswoman for the Better Business Bureau. “They certainly should look for a reliable contactor,” Penders said. “They should ask for references and they really do need to do their homework as well.”

The BBB can be of assistance in finding a reputable contractor. The organization offers a free online service called “Request-A-Bid” that allows homeowners to write a brief description of the work they need done and can then review bids from BBB-affiliated contractors. More information is available on the organization’s Web site: bbb.org

“The other thing the Better Business Bureau advises is not to pay by cash and to make sure the home improvement they are embarking on is done by stages of payment. If the contractor asks for money up front that’s an immediate red flag,” Penders said.

The homeowner rate among Americans over age 65 is about 80 percent, Ferris said. And more than 26 million homeowners make improvements every year. He recommended getting at least three estimates from contractors, along with references. “One thing people don’t do is ask where they buy their materials and go there and ask [suppliers]. They can be used for a reference,” he said. “Ask their bank.”

Connellan, Pender and Ferris strongly advise not agreeing to any work unless there is a signed contract that specifies what will be done and when it will be completed. Connellan added that it’s also not a good idea to let someone soliciting work past the front door. “People should be very wary of letting strangers in the home,” he said. “We’re asking seniors if they get approached by someone like this to have someone else like a neighbor sit down with the guy.”

Many older homeowners have lived in the same location for years and know others in the community.
“Go with contractors you are familiar with. Ask your neighbors, family and friends who they have used,” Ferris said.

Here are some tips from the Better Business Bureau about how to find the right contractor for the job:

• Compare costs before making a financial commitment toward any home improvement project. Solicit at least two or three bids from prospective contractors based on the same building specifications, materials, labor and time needed to complete the project.

• Never let a contractor use pressure tactics to force a snap decision. A reputable professional recognizes individuals need time to consider all the factors involved before hiring a contractor.

• Consumers should hire a contractor with an established business in their area. Ask for references and do some homework. Look at the BBB Reliability Report available on the BBB Web site at bbb.org

• Research a contractor’s standard of work and his professional affiliations. Verify his insurance and check to see if he needs to be licensed.

• Don’t allow work to start without a signed written contract that includes all verbal promises made by the contractor. Make sure the contractor includes a start and completion date, a breakdown of the cost and information about the contractor, including license number, street address and telephone number.

• Refuse and become suspicious if asked to pay for the entire job up-front. Arrange for payment to be made as parts of the job are completed. Final payment should not be due until the job is done to the customer’s satisfaction. Homeowners should pay by check or credit card, never by cash.