Pushing Back on a "Pill for every Ill"

What happens when a patient decides they don't want to take all these pills anymore? How can help them reduce the need for taking so many medications? Nurses Education Article

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Pushing Back on a "Pill for every Ill"

Polypharmacy has swept the country. More than 40 percent of older Americans regularly take five or more prescription drugs, and nearly 20 percent take 10 or more. In addition to side effects, many medicines disrupt key nutrients in the body. There's also the potential of drug-drug interactions.

On top of this, there's increasing reluctance coming from patients, who would like to be taking fewer, not more medications. How often have you heard:

You're not adding ANOTHER pill, are you?

I take so many medications now, it's ridiculous!

That's it! I'm not taking any more medication! In fact, I'm going to stop taking the ones I'm already on now! Get rid of this garbage!

As a matter of fact, I had a patient make this last statement to me.  He did so as he slammed his pills down on his bedside table and they all popped out of the cup and clattered onto the floor. Luckily, I was able to talk him into continuing to take his medicine until he could talk to his doctor and figure out a better plan.

Many patients are not compliant with their medications. With so many onboard, they struggle trying to remember what to take when: before, during or after meals? On an empty stomach? Before bed or first thing in the morning?

It can get frustrating! How can we help our patients who don't want to take "a pill for every ill?”

Here are a few non-pill things we can suggest to our patients, with a doctor's approval, of course.

Diet Modifications

You are what you eat.

This is one we all know about, but sometimes it's just easier to give a pill than to try to convince someone to eat differently.

Sometimes a diet change can keep a patient from needing medication for a few more years, or maybe indefinitely.

Of course, you should always remind the patient to not discontinue a medication without first speaking with their doctor. They should also discuss any diet changes with their doctor. Some diet changes, and even losing weight can affect medication dosage. Diet modification is usually a positive option to reduce the need to take more pills.

Exercise

Most medical conditions can be improved by a bit of exercise.

Encouraging our patients to find exercises that work for them and their particular situation, and then encouraging them to stick with it, will help them maintain their health and perhaps delay the need to add a new medication.

Even adding something as simple as stretching, taking more steps each day, or gently jumping on a mini trampoline for 15 minutes a day can make a big difference in someone's life.

Neurostimulation

This one was new to me up until about a month ago. I want to try it for myself!

gammaCore has developed a small, hand-held neurostimulator that is FDA cleared to treat migraines and cluster headaches. This thing is small enough to fit into your pocket, purse, or backpack and can be used in conjunction with other medications, with no side effects.

In the United States, it is only FDA cleared for headaches at this time, but ongoing studies are being done for use in:

  • Post-traumatic stress disorder
  • Parkinson's disease
  • Gastroparesis
  • Post-op ileus
  • Opioid use disorder
  • Acute stroke
  • Subarachnoid hemorrhage
  • Traumatic brain injury 
  • ... and probably other things

You do need a medical provider's order, but they can approve it right on the site.

Check it out for your headache patients now, and keep an eye on it for future approvals. It might be just the thing you or your patient needs.

Vitamins, Supplements, Herbs

My mom swears by red yeast rice. She tells me her doctor has been threatening to put her on a hyperlipidemia medication for several years now, and she has been able to keep her levels where her doctor wants them using red yeast rice.

Supplements, vitamins, and herbs may be just the thing to stave off one more pill for your patient. Just be sure to remind your patient to talk to their doctor and do their own research before adding any of these things to their diet. While many drugs are known to disrupt nutrient absorption and metabolism, there are a few supplements that can interfere with medications. You can look up drug-nutrient interactions on mytavin.com.

Summary

I think we would all agree that adding one more medication is not always the answer. Not for us, our families, or our patients. Navigating the sea of pharmaceuticals and balancing their use with lifestyle, nutrition, and intelligent supplementation can be tricky, to say the least, but it is very worth it to help patients reach higher levels of well-being.

Helping our patients find the best solutions to their health challenges can be, well, challenging, but knowing that we made a difference in someone's life simply by providing options can be very rewarding.

References/Resources

Medication overload and older Americans

gammaCore

3 Votes
Kristi Van Winkle

About Kristi Van Winkle, BSN, RN

I am an RN turned freelance medical writer and editor/proofreader. I especially enjoy and excel at writing articles that provide education for patients and their families.

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Specializes in Holistic Nurse Coach and Freelance Writer.

Thank you for sharing this interesting article Kristi. How much better would it be if our patients could reduce their medication intake by improving their overall lifestyle? Exercise and improved nutrition can't be overestimated!

2 Votes

Great article! 

Allopathic medicine which is considered evidence-based medicine in the civilized countries does not allow, in the practice of it, deviation from big pharma. The practitioners of allopathic medicine are not taught to prevent, reverse, and cure disease. They are very good at fixing broken bones and acute processes. Vaccine use has helped with control and eradication of many conditions.  However, allopathic medicine has failed at getting chronic disease under control and reversed. 

To reduce prescription drug use or even the use of supplements for chronic disease, another model needs to sharply rise to the occasion.  Aging needs to be reevaluated and not seen as the enemy. Allopathic medicine is the enemy of aging. 

 

1 Votes
Specializes in Freelance Health Care Writer|End-of-Life Educator.

Here's a pill. And here's a pill to counteract the side effects of the first one...and so on....when I handed an elder a 30cc cup filled to the top of mostly pharmaceuticals, I choked along with them as they attempted to swallow them, day after day. It's one of the reasons it is documented that people who go on hospice (early admissions) get BETTER for a few months. So many meds are reduced in strength or DCd upon admission and they go on a permanent drug holiday to their benefit. We need to advocate for our elders. Great article. 

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Specializes in Critical Care.

Appreciate this article. I think this stuff is so important...

Personal experience example share: I grew up in a dysfunctional home. Many addicts, personality disorders, gaslighters, physical/emotional abusers in immediate family and all throughout generations existed. 

I struggled a long time to figure out what was "wrong with me" - I felt overwhelmed, anxious, sad, angry, mis-understood, awkward, and lonely, often. I felt like I didn't belong. I didn't feel good about myself nor did I feel good at anything in particular most times. I had very few friends. I was reactive, defensive, unfocused in school, and considered "rebellious" "defiant" "difficult" "lazy" "irresponsible" "selfish" "useless" by my parents growing up.

From ages 17 to 25 I was in and out of therapy: multiple counselors, psychologists, specialists.. 90% of time, was just given another pill to try. I was told I could be bipolar/ have MDD, or "mild" schizophrenia, eating disorders (which was valid and developed as a way to "cope" with things... it was like a control thing or something..). I was also told that I might have a personality disorder, or a panic disorder. Maybe it was OCD, ODD, general depression & anxiety disorder, and / or other things... 

The number of medications just kept growing and was ridiculous. I have been on Prozac at multiple dosages, 4 times. Zoloft twice. Also been on Wellbutrin, Seroquel, Ativan, Trazodone, Klonopin, Pantoprazole, inhalers, some other bipolar meds I don't remember anymore... lifestyle changes were very generalized and glazed over and non specific. Medications were pushed but not giving me the desired outcomes, Just made things worse actually, since I got none of the benefits and experienced only the side effects of taking those meds. Plus, nothing changed about how I felt about myself, my behavior, and how I saw the world. On top of my eating disorder, I ended up drinking a lot to cope. 

Nearing age 26, having SI thoughts, I decided to try a counselor one more time... and thank God I did. She suggested we try something else. She gave me a question-air to complete, and after reviewing it, asked that I bring it to my PCP. My PCP connected me to someone who did a very thorough intake, a more detailed questionnaire, evaluation, intake process etc, about my medical, mental, & social history. After that, my "case" was forwarded to a psychiatrist who specializes in treating ADHD. I was diagnosed with ADHD at age 26 (PTSD was also added a bit later. It took me awhile to get to the point where I felt comfortable enough to share traumatic events / family stuff). 

I'm in my 30s now, and still meet with the same psychiatrist regularly for medication management. That, with some cognitive behavior therapy + someone who specializes in counseling those with ADHD & PTSD, I learned about ADHD/PTSD, how it affects me and those around me, and what I can do about it with specific goals/ steps over time that would help me.

The ADHD meds calmed me in such a weird way - my personality didn't change but the unhelpful thinking patterns and over emotional side of of me began to settle, which allowed me to "get out of my head" and take action, which in turn all complimented one another. I could focus more on what I needed to do: stop drinking, sleep better, build routine, eat healthier, exercise regularly, build a tool box that I can dive into when challenges arise. I developed more confidence in myself with time, and actually began to enjoy life. I have hobbies and healthy relationships now. I do yoga, running, backpacking, drawing/ paint / videography. I meet with a group of girls for a bible study. I have a kind, wonderful, supportive boyfriend.

I went from a medication list that neared almost 10 pills a day at varying dosages to just 2 daily scheduled meds and 2 PRNs, no dosage changes in years. Feel like my life has made a 180 and am very thankful. 

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