Polypharmacy and Nutrition in Elderly Patients


Simon D. Murray, MD: What about the effect of polypharmacy on nutrition and the effect of medicines on nutrition? I sometimes think we don’t pay enough attention to that as doctors—what patients are taking and how it might affect them.

Jane Schwartz, RDN: Yeah, I think that’s a really good point, because I have a lot of people coming into my office, and they often don’t know why they’re on certain medications. They’re like, “Yes, I’ve been on that for years, and I’m not even sure what that does anymore.” One of the biggest things I think physicians should pay more attention to are the proton pump inhibitors.

Simon D. Murray, MD: Yes.

Jane Schwartz, RDN: There are studies showing that they can interfere, potentially, or have an effect on the bones and also stomach ascites. Again, that goes back to the B12 issue and iron deficiencies and things like that. You’re really not supposed to be on those medications for long periods of time, but people are on them for years. And it’s really hard to come off them. Make sure, if they have to be on something, to try to get them off as soon as possible and to be evaluating them. “Does this person really need to be on this medication?”

Also turn to possibly helping them make better nutritional choices versus jumping right to medications. Because it helps a lot of people, for instance, with reflux or GERD [gastroesophageal reflux disease], if they can reverse their conditions sometimes without going on medication. So just to be aware of that.

Simon D. Murray, MD: Yeah. And all the recommendations to guidelines. Before you start people on medicine for a certain disease, they say to try for lifestyle changes. Well, none of us do that.

Jane Schwartz, RDN: Yeah.

Simon D. Murray, MD: I mean, most don’t. I think we just jump to medicine because it seems to be a quicker, easier way to do things.

Jane Schwartz, RDN: Yeah.

Simon D. Murray, MD: And it may not always be the best solution.

Jane Schwartz, RDN: Right.

Simon D. Murray, MD: I think the less medicine people take, in some regards where they can do things naturally, is better.

Jane Schwartz, RDN: Yes.

Simon D. Murray, MD: But to change your behavior, you have to really believe it. You have to really believe that the science is there and that the evidence is there that it’s going to make a difference.

Jane Schwartz, RDN: And that’s where the physician can really come into play, because most patients really trust their doctors. They pay attention to what the doctor tells them. “You take this medicine.” Then they’re going to take the medicine. There are physicians now who actually have prescription pads that have “Eat X amount of fruits and vegetables a day,” or “Have nuts every day.” I mean, they’re literally ripping this off and telling them to have the food, and that’s on the prescription pad. It’s just incredible. And so they will listen to their doctor if the doctor is more impassioned and believes that this can help them.

Simon D. Murray, MD: Yeah. I think the practice of contempt prior to investigation is rather common. “What do you think about this?” “No, it doesn’t work?” “What do you know about it?” “Nothing.”

Jane Schwartz, RDN: Right.

Simon D. Murray, MD: But it doesn’t work.

Jane Schwartz, RDN: Right.

Simon D. Murray, MD: Yeah, we have to be careful of that.

Jane Schwartz, RDN: Yes.

Simon D. Murray, MD: Because there’s a lot of hype in that field.

Jane Schwartz, RDN: That’s true.

Simon D. Murray, MD: In the nutrition field, there’s a lot of nonsense, a lot of hype, and a lot of stuff that we hear that just doesn’t make sense.

Jane Schwartz, RDN: Yes. It goes to the other extreme as well. They think that if you take this pill, you’re going to lose weight or your brain is going to be fine, or…

Simon D. Murray, MD: Some people think taking 60 vitamin pills a day is good.

Jane Schwartz, RDN: Right. I’m not a huge taker of supplements. I do take them when it’s necessary, but food is the main source.

Simon D. Murray, MD: Yeah, that’s great. That’s been very helpful. I think I’ll eat better too.

Thanks, Jane, for this insightful discussion. And thank you to our audience for watching this HCPLive® Geriatrics presentation on the importance of proper nutrition in the older-adult population.

Transcript edited for clarity.

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