Reversing overprescribing trend among older adults
People in this country are taking more prescribed medications than ever before, and the problem has reached epidemic proportions among older Americans.
A recent article in Kaiser Health News (“An overlooked epidemic: Older Americans taking too many unneeded drugs”) states that 46 percent of people ages 70 to 79 take at least five prescription drugs to treat chronic conditions.
As a longtime family medicine physician at The Ohio State University Wexner Medical Center, I specialize in geriatrics and the care of older patients, and it’s not uncommon to meet patients taking more than a dozen medications a day to treat a variety of symptoms, some of which were prescribed to remedy the side effects of other prescribed drugs.
Geriatricians at Ohio State are working to combat this growing problem of overprescribing.
In my experience, I’ve found that older patients are good about taking their medications and respect the guidance of a physician. Some patients will set their alarms early to take certain pills on an empty stomach and save others that need to be taken with food for after breakfast. Some older adults tell me that they worry if they don’t take their pills they’ll end up in a hospital or nursing home. There’s a lot at stake, and they’re more vested in being compliant with medications.
Preventing a prescription cascade
Traditionally, we’ve been good about prescribing medications, but not about taking them away. People have more access to medication than ever before, so it’s common to perceive side effects as new problems and attempt to eliminate them with new prescriptions.
As we get older, we may not be able to metabolize medications, or we may experience interactions between medications. For instance, a patient could experience diarrhea from taking a laxative. We’ve just got to get laxative out of the system to eliminate that symptom — we don’t need to put more drugs into their system. This scenario becomes more complex with conditions that warrant a lot of medications, such as a heart attack, which has four medications.
We don’t want to be under-prescribing either. While the patient has to determine their own goals, in geriatrics, it’s the core of our mission to make rational medical decisions and be an advocate for our patients. It generally falls on the patient and their primary care provider and geriatrician.
De-prescribing medications
The tendency for patients is to have fewer pills, so we whittle away unnecessary medicines prescribed over time by multiple doctors. Again, this goes to the goals of the patient. There can be short-term and long-term benefits of specific medications. What makes sense and what doesn’t make sense? A lot of people feel they need to take sleeping pills or anxiety pills, but some pills can increase the risk of falls. My goal as a geriatrician is to talk about these options, weigh the risks and rewards. What is realistic for you to do?
Building a better polypharmacy clinic
Ohio State has a polypharmacy clinic. Polypharmacy is the simultaneous use of multiple medications. Our pharmacy team does a lot to make sense of a patient’s prescriptions and de-prescribe medications when possible. They try to make prescribing decisions that are more rational for their elderly patients.
Most physicians are trying to get rid of harmful medications, some of which create an increased risk for falls or delirium. The American Geriatric Society reviews data on where medications go wrong. One example of such guidance is the Beers Criteria, or the Beers List, which describes medications that could be harmful to those over 65 in cases where the risks outweigh the benefits.
What should people do next if they think they or an older loved one are taking too many pills? Talk to the primary physician. Get a second opinion from a pharmacist, geriatrician or polypharmacy clinic.
When there gets to be too many pills, it can be daunting for an older adult and their caregivers to manage them all. But when we work together, it can be done.
Dr. Donald Mack is a family medicine physician who specializes in caring for geriatric patients at The Ohio State University Wexner Medical Center.
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