Seniors face a drug problem, but it’s not the opioid crisis of headlines.
The problem is that thousands, likely millions, of elderly people take so many prescriptions and over-the-counter medications that they are doing themselves more harm than good.
“It’s a huge problem,” says Dr. Serge Lindner of Bellingham, medical director of PeaceHealth Medical Group’s Center for Senior Health.
Dr. Katherine Bennett, a faculty member in the Division of Gerontology and Geriatric Medicine at the University of Washington, defines the problem as “the use of more medications than is clinically indicated.”
Her definition is precise and objective, with such flesh-and-blood consequences as dizziness, bone-breaking falls, cognitive impairment, even death.
“There can be horrible side effects if you stack up too many medications,” Bennett says. “We see a lot of people who have fallen down and broken bones, which can be a life-changing circumstance.”
Calculating the harm
There’s no firm figure on the number of seniors impacted by overprescription, but studies suggest the problem is widespread.
A 2017 University of Michigan study estimates more than 3.5 million doctor visits a year could result from seniors’ increased use of such “brain-affecting” drugs as opioids, antidepressants, tranquilizers and antipsychotics. The problem is exacerbated because nearly half of the seniors studied weren’t formally diagnosed with the types of problems those drugs are intended to treat.
It’s not surprising that more than half of all prescribed medications are for people older than 60. As people grow old, they fall victim to chronic health problems that are usually treated with medications.
At the same time, older people have a harder time clearing medications from their body because their liver and kidneys function less efficiently. That means their medications need to be closely monitored, which often isn’t done.
The downside of taking too many medications – both prescribed and over-the-counter – extends beyond physical complications. Patients might not take helpful prescriptions because they’re taking wrong ones, and the added expense can prompt patients to cut back on useful medications.
Further, many patients take pills instead of pursuing a healthier lifestyle with fewer drugs, and doctors might not realize that excess medications – not underlying health issues – are the cause of new, worrisome symptoms.
Causes of overprescribing
A variety of medical practices and bad habits contributes to seniors taking more medications than necessary.
As seniors face the ailments of aging, doctors and emergency-room caregivers often prescribe medications as each new condition arises. The approach can be benign in intent, but the resulting cascade of prescriptions can pose grave risks.
Sandra Boodman, writing for Kaiser Health News, describes a typical sequence of how medications can multiply: “A patient taking a drug to lower blood pressure develops swollen ankles, so a doctor prescribes a diuretic. The diuretic causes a potassium deficiency, resulting in a medicine to treat low potassium. But that triggers nausea, which is treated with another drug, which causes confusion, which in turn is treated with more medication.”
Health-care routines contribute to the problem. General practitioners often don’t question medications prescribed by a specialist, a practice deemed “professional courtesy” by some and “clinical inertia” by others.
Even if a family physician is inclined to monitor their patient’s prescription from a specialist, incompatible computer systems can mean the information isn’t accessible.
With doctors and other health-care providers pressed for time, it’s quicker and easier to prescribe a pill than to conduct a detailed discussion with a patient about their problems and their options for treatment. Fully reviewing a patient’s medications can take 30 minutes to an hour, but most doctor visits last 15 to 20 minutes, Lindner says.
“You need to review all of these medical conditions one by one,” he says. “It’s much easier to write a prescription for a pill.”
What can be done?
An array of forces weighs against the effort to “deprescribe” medications, but change is coming. While relentless advertising urges patients to ask doctors about new drugs, research and education programs are underway to deal with overprescription, and some government and medical systems are adopting a thoughtful approach to reducing prescriptions that are harmful or unnecessary.
“There’s a lot that’s happening,” Bennett says, “but it’s incremental.”
In the meantime, she says, patients should become advocates on their own and seek support from their doctor. Steps that patients can take include:
▪ List the prescriptions and over-the-counter medications you take, and note changes in your symptoms, especially after starting new medicines. Bring your medications with you when you talk to your doctor.
▪ Discuss your health goals with your doctor as part of your medications review. How you balance, for example, length of life versus quality of life, or living at home versus living in a group setting, can help determine which medications are most beneficial to you.
▪ Ask your doctor about side effects of suggested medications, how they interact with what you are already taking and how long you should take them.
▪ Be sure your doctor documents the reason a new drug is being prescribed.
▪ Don’t stop taking a medication without checking with your doctor. Stopping or reducing prescriptions should be handled as carefully as starting new ones.
▪ Realize that a review of your medications might result in prescribing a new one, because some conditions, such as osteoporosis, are undertreated in older adults.
In 1991, geriatrician Mark Beers created the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
Health-care professionals use the list to help them safely prescribe medications to seniors. The list has been updated by the American Geriatrics Society, and can viewed at HealthinAging.org (click on “Medications & Older Adults”).
Use the list as a starting point for discussions with your doctor, rather than change your medications on your own.