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Overprescribing of meds to older adults is a big concern

Years ago, I called an elderly aunt, who was then living alone in an apartment in Cleveland, only to find her almost incoherent and complaining of dizziness.
“Sit down right now.

Years ago, I called an elderly aunt, who was then living alone in an apartment in Cleveland, only to find her almost incoherent and complaining of dizziness.

“Sit down right now. I’m going to call an ambulance,” I said.

Fortunately, her symptoms weren’t the result of a stroke or other catastrophic medical event. Instead, they had been caused by the interactions of her medications.

I was stunned to learn she was taking 11 different drugs at the time. My family quickly switched her to a different primary-care doctor, and within weeks she was taking only four medications. We eventually moved her here to Minnesota, where I was able to keep close watch on her care. She lived another 14 years — to the age of 97.

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I thought of that scary phone call to my aunt while reading an article in the Journal of the American Medical Association (JAMA) this week about multiple medication use in the elderly. As the article points out, such use is a big concern — or should be:

“Nearly 20% of community-dwelling adults [people who live in assistant living facilities or nursing homes] aged 65 and older take 10 or more medications, a figure that can easily be reached by following practice guidelines for a small number of coexisting conditions. Multiple medication use is associated with greater use of inappropriate medications and with nonadherence, and imposes substantial cost burdens on older patients even when they have prescription drug insurance. In addition, the frequency of adverse drug events increases in proportion of the number of medications used, including drug-specific phenomena as well as nonspecific syndromes including weight loss, falls, and decline in functional and cognitive status. Such adverse drug events affect 5% to 35% of older patients living in the community per year, and are responsible for approximately 10% of hospital admission in older adults.”

Interestingly, as the article also points out, giving older adults so many medications may result in them not getting enough of the medications that they actually need.

Here are some other disturbing facts from the article:

  • “Studies of community-based older patients have documented an average of 1 unnecessary drug per patient, including drugs with no identifiable indication or that provide little benefit for the indication for which they are prescribed.”
  • “In the hospital setting, a large study found that 44% of hospitalized frail older patients were discharged with at least 1 unnecessary medication; common culprits include proton pump inhibitors, central nervous system medications, and vitamin and mineral supplements.”
  • “[H]ighly anticholinergic antihistamines, tricyclic antidepressants, and other high-risk drugs described in drugs-to-avoid lists for older patients are used by approximately 20% to 30% of adults older than 65 years, whereas in many cases, drugs with better safety and/or efficacy would be a more appropriate choice for the target conditions.”
  • “Other common problems with misprescribing include use of inappropriately high or low doses, drug-drug and drug-disease interactions, incorrect directions, and choice of expensive drugs when less expensive alternatives would provide similar benefit at lower cost.”

The article, which is addressed to physicians as a “how-to-better-manage-the-care-of-your-elderly-patients” educational piece, also notes that often “the only way to know whether or not a symptom is an adverse effect is to temporarily stop the drug(s) and see whether the symptoms improve. Although these are individualized clinical decisions, it can be useful to remember the adage that ‘any symptom in an older patients should be considered a drug side effect until proven otherwise.’ ”

Of course, patients should never stop taking a medication on their own. Doing so can have life-threatening consequences. But if you or someone you care about has been prescribed a long list of medications, this would be a good article to download, read, and discuss with your doctor. Fortunately, the article is available free online. Unfortunately, only the abstract is available online. But you can use that as a starting place for a discussion with your doctor.