A silent epidemic is going on now in America, according to researchers. They warn that older Americans are taking too many unnecessary drugs, often prescribed by multiple doctors, for dubious or unknown reasons.
For example, estimates are that 25 percent of people ages 65 to 69 take at least five prescription drugs to treat chronic conditions. This figure jumps to nearly 46 percent for those between 70 and 79. Doctors say it is not uncommon to encounter patients taking more than 20 drugs to treat acid reflux, heart disease, depression or insomnia.
Unlike the overuse of opioid painkillers, this multiple prescriptions problem has attracted little attention, even though its hazards are well documented.
Silent: The Over-Medication of Seniors
At least 15 percent of seniors seeking care from doctors or hospitals suffer from a medication problem that is preventable. Studies have linked multiple medications to unnecessary death. Older patients, who have greater difficulty metabolizing medicines, are more likely to suffer dizziness, confusion and falls. Moreover, the side effects of drugs are frequently misinterpreted as a new problem, triggering more prescription. This process is known as a prescribing cascade.
For example, this path to overuse can be gradual. 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. A slippery downward slope.
Silent: Pills, Pills, Pills
For many patients, problems arise when they are discharged from the hospital on a host of new medications, layered on top of old ones.
A 2015 report by the National Institutes of Health, found that the share of Americans of all ages who regularly took at least five prescription drugs nearly doubled between 2000 and 2012. And the percentage of people older than 65 taking at least three psychiatric drugs more than doubled in the nine years beginning in 2004. Nearly 50% taking these powerful medications, which include drugs used to treat schizophrenia, had no mental health diagnosis.
Silent: De-Prescribing Medicines
Currently, doctors are trying to counter the blizzard of prescriptions through a grass-roots movement called “deprescribing”, systematically discontinuing medicines that are inappropriate, duplicative, or unnecessary.
Interest in deprescribing, which was pioneered in Canada and Australia, is growing in the United States, supported by physician-led efforts, such as the five-year-old Choosing Wisely campaign. The Beers Criteria, a list of overused and potentially unsafe drugs for seniors first published in 1991, has been followed by other tools aimed at curbing unnecessary drug use.
For example, Kathryn McGrath, a Philadelphia geriatrician, said she tries to begin every appointment with a review of medications, which she asks patients to bring with them. “I think having the pill bottles” is much more powerful than a list, said McGrath, who has written about how to deprescribe safely.
Silent: De-Prescribing Pills
Older people taking lots of medication was what Canadian pharmacist Barbara Farrell encountered when she began working at a geriatric hospital in Ottawa. Her experience, was a catalyst for the Canadian Deprescribing Network, a consortium of researchers, physicians, and pharmacists she co-founded. The group seeks to drastically reduce inappropriate medication use among Canadian seniors by 2020.
Farrell, a clinical scientist at the Bruyere Research Institute, has also helped write guidelines, used by doctors in the United States and other countries, to safely deprescribe certain classes of widely used drugs, including proton pump inhibitors and sedatives.
“I’ve found a lot of receptivity” to the guidelines among physicians, Farrell said. “We know there are pockets around Canada and the world where they’re being implemented.”
Silent: Case History
One of Farrell’s most memorable cases involved a woman in her late 70s who was using a wheelchair and was nearly comatose.
“She would literally slide out of her chair,” Farrell recalled. The woman was taking 27 drugs four times per day and had been diagnosed with dementia.
After reviewing her medications, Farrell was able to weed out duplicative and harmful drugs and reduce the doses of others. A year later, the woman was feeling much better. She was able to walk with a cane and live mostly independently. Plus, she reported that her doctor said she did not have dementia after all.
When Farrell asked another patient why she was taking thyroid medication, the woman replied her doctor had prescribed it for weight loss after her last pregnancy, in 1955.
“The patients I see are the tip of the iceberg,” Farrell said.
“In geriatrics, less is more.”