Why elderly Americans are on multiple prescription drugs.
While America’s opioid epidemic is garnering national attention, another drug problem is quietly developing: The elderly are popping too many prescription pills.
The phenomenon is called polypharmacy, and multiple studies trace its dramatic rise. A 2015 report published in the Journals of Gerontology, for instance, found that the median number of drugs doctors prescribed to Americans age 65 and older doubled from two to four between 1988 and 2010. Over that same period, the percentage of seniors taking five or more daily medications tripled to nearly 50 percent.
Scientists have linked this trend to an increased risk of death, which may be preventable in many cases. One study of elderly patients at Veterans Affairs medical centers found that 44 percent of them were taking at least one unnecessary drug.
Because seniors metabolize medication more slowly than younger people, they’re more likely to suffer dizziness and other side effects. They’re frequently prescribed another drug to mitigate these reactions, which often causes additional problems — to be treated with yet another medication.
This cascade of prescriptions is magnified by several factors, including many physicians’ traditional reluctance to overturn another doctor’s orders. As a result, patients often continue taking medications longer than necessary, compounding the potential for side effects and interactions with other drugs. It also increases costs — both for individuals and for the healthcare system.
The efficacy of many prescription treatments for seniors may also be in question, explains Michelle Odden, PhD, a coauthor of the Gerontology report. “Because older adults with multiple chronic conditions are often excluded from randomized trials, we don’t have a solid understanding of the benefits and harms in these populations.”
The rise of polypharmacy is due in part to the increased use of two classes of drugs: cardioprotectors and psychiatrics. Doctors often prescribe cardioprotective medications, such as statins, to older patients to reduce cardiovascular complications. They do this despite the drugs’ side effects and ample evidence that lifestyle changes are a more effective route to reducing the risk of heart disease.
Doctors frequently recommend antipsychotics, which are typically used to manage schizophrenia, to allay agitation and confusion. But they come with dangerous side effects to which seniors are more vulnerable.
As Sandra Boodman reports in Kaiser Health News, the solution to the polypharmacy epidemic depends on doctors changing the way they practice. “That’s what we were taught as physicians: to prescribe drugs,” Ranit Mishori, MD, a professor of family medicine at Georgetown University, tells Boodman. “We are definitely not taught to take people off meds.”
And yet, some doctors are beginning to do just that. A grassroots “deprescribing” movement is gaining traction in the United States after similar campaigns showed promise in Canada and Australia. The effort to eliminate unnecessary prescriptions is assisted by tools such as the Beers Criteria, a list of drugs deemed unsafe for older adults.
It’s proving effective. A 2017 study published in the Journal of Family Practice found that patient-specific deprescribing is associated with improved survival, suggesting that for older Americans using medication, less may indeed be more.
For more on the polypharmacy crisis, read deputy editor Craig Cox’s blog at “PUMPING IRONY: There’s a Pill for That.”