It’s a chronic case of nationwide medication overload – and the consequences can be devastating. That was our take-away from this recent article from the NextAvenue website , written by freelance journalist Barbara Mantel. The problem even has a name: “polypharmacy.”
The trend of doctors over-prescribing prescription drugs to seniors isn’t new, but it is on the rise, according to the article. If you have a senior loved one in your life, whether spouse, sibling, neighbor or friend, this article could prompt you to have a serious conversation with them. Research shows that seniors who take too many prescription drugs are at far greater risk of severe side effects that can lead to hospitalization and even death.
Memory Loss, Weakness, Triggered by Polypharmacy
Mantel begins her NextAvenue article with the experience of New York resident Elizabeth Thaler, 84 at the time of the following story. When her daughter, Ruth Thaler-Carter, began to notice worrying changes in Elizabeth—memory slips, an inability to do simple tasks like cooking, and eventually becoming bedridden—she stepped in and hired an experienced caregiver to find out what was going on.
The caregiver suggested that Elizabeth’s medications should be checked. But when Ruth took her mother to her longtime doctor, he didn’t change anything about the meds.
Mantel writes, “Thaler-Carter was disappointed. Her mother had no chronic conditions other than low blood pressure. Yet she was taking at least six prescription drugs. Thaler-Carter worried that some might be unnecessary or interacting with one another and doing more harm than good. So she signed her mother up for a service that sends doctors, nurses and technicians to people’s homes.”
This ended up being a good decision. The team evaluated Elizabeth and managed to cut some of her medications entirely, while reducing the dosage of others. Not long after, Elizabeth was more coherent and “more like her real self,” according to Ruth. Elizabeth lived for five more years, much more alert and engaged, and finally passed at the age of 89.
Older Populations Are Taking More Drugs Than Ever
Elizabeth’s story is not uncommon. Mantel writes, “More than 40 percent of Americans age 65 and older take five or more prescription drugs, a phenomenon known as polypharmacy, entailing a 200 percent increase over the past 20 years, as the Lown Institute (2020) reported. In addition, nearly 20 percent of older adults take ten drugs or more.”
Older Americans are particularly susceptible to polypharmacy. Because aging can increase the risk of developing or worsening chronic conditions, says Judith Garber, a senior policy analyst at the Lown Institute, “Multiple medications can be beneficial for some patients.” But the risks are frightening.
Mantel writes that, in spite of possible benefits of multiple drugs, “research shows that each additional medication raises a person’s risk of suffering an adverse drug event by 7 to 10 percent. Such events send as many as 750 older Americans to the hospital each day.”
Garber explains, “Side effects can range from dizziness or digestion issues to much more serious side effects such as falling, hemorrhaging, brain bleeds and even death.” She adds that “when the harms of polypharmacy outweigh the benefits, medication overload results.”
Factors Driving Medication Overload
According to experts, the following comprise the most common factors driving medication overload. We have included these verbatim from Mantel’s article.
- Pharmaceutical company advertising:Only the United States and New Zealand allow direct-to-consumer ads for prescription drugs, which may lead patients to pressure doctors for a prescription. Companies also advertise to doctors and visit their offices, often bringing food and small gifts. “It’s been shown in study after study that giving a free lunch or even pens can make a difference in what doctors prescribe,” says Garber.
- Culture:“There is a prevalent view in the United States, and other countries too, that a pill is the best way to deal with every health issue you have. And that is not always the case,” says Garber.
- Cascade effect:Doctors may prescribe a drug for one condition and then prescribe others for the resulting side effects, says [pharmacist, Barbara] Zarowitz. “Rather than someone stopping and saying, ‘What started this whole cascade?’ it just continues.”
- Miscommunication : Specialists caring for a patient may not communicate with one another, which can result in medication duplication or dangerous drug interactions.
- Time pressures:Doctors often have only 10 minutes to spend with each patient. “If the physician feels that pressure of a full waiting room and having to turn people around to make a profit, then there is an incentive to write a prescription and get them out the door,” says Zarowitz.
Determining Problem Drugs Isn’t Always Easy
Dr. Michael Steinman, a professor of geriatrics at the University of California, “would like to see more physicians regularly review the necessity of their older patients’ medications,” Mantel writes. “But it isn’t an easy task.” As Dr. Steinman puts it, “If someone comes to their clinician with concerns about their medications, it’s not always clear to that clinician how to figure out which medications might be causing which symptoms because people can feel bad for all sorts of reasons.”
This is Steinman’s field of study as co-director of the US Deprescribing Research Network, founded in 2019 with a grant from the National Institute on Aging. The network’s stated intent is to “support and coordinate research into deprescribing,” research that Mantel describes as “scant” until recently.
The network defines deprescribing as “the thoughtful and systematic process of identifying problematic medications and either reducing the dose or stopping these medications in a manner that is safe, effective and helps people maximize their wellness and goals of care.”
Steinman explains, “The network’s broad research mandate includes using Medicare data to identify common medications that cause problems and studying how to deprescribe safely without a rebound in symptoms.”
Communication is also key in this research, since simply suggesting a patient stop a medication can confuse or scare them. “The network posts evidence-based guidelines for clinicians about how to deprescribe. It also has handouts with advice for patients interested in reducing their medications,” Mantel writes.
Some medical societies, especially in the cardiology field, are beginning to include deprescribing in their guidelines, but the progress is slow of inspiring change across the medical field. “I think raising awareness is a collective responsibility,” says Steinman. “It can come from government, individual doctors and from patient advocacy organizations.”
What Families and Patients Can Do
What to do if you have concerns about polypharmacy for yourself or a loved one? Mantel writes, “Patients and their families with concerns about polypharmacy and its possible harms should not wait for their health care providers to bring it up.”
Instead, she recommends the following steps:
- Read medication inserts and become familiar with your medications’ side effects.
- Consult with a pharmacist about side effects and drug interactions. If your local pharmacist is too busy, you can find a senior care pharmacist at the American Society of Consultant Pharmacists.
- Armed with this information, make a list of questions for your health care provider.
- Use ‘I,’ statements when talking with your doctor, says Zarowitz, such as, “I wonder if I need all these medications,” or “I would find it easier if I had to take only five medications instead of eight.”
Mantel concludes with the following advice from Zarowitz, a pharmacist: try to avoid confrontational statements, such as, “You have me on too many medications.” In this way, “you are not threatening their authority or their judgement, and you’re not accusing them of overprescribing,” says Zarowitz.
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(originally reported at www.nextavenue.org)