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PUMPING IRONY: Problematic Pills

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Hospitals are commonly sending their elderly patients home with prescription drugs that do more harm than good.

Back when I was more ambulatory than I am now, my brothers and I, along with assorted relatives, gathered every year during the holiday season for a spirited game of football. We typically sloshed around in the snow for a couple of hours or until someone was injured. On one such occasion — Christmas Day, 1987 — I was the one who brought the festivities to an abrupt halt. Tackled on the sideline after hauling in a pass, I heard a sharp crack and quickly realized I’d broken my ankle.

I spent a couple of days in the hospital after the surgery and recall the experience with some fondness — no deadlines (I was the editor of a weekly newspaper at the time), a competent staff, effective painkillers — despite a dwindling reservoir of sympathy from My Lovely Wife (who was six months pregnant). Back home, the pain meds kept me happily inert for the next several days, while I contemplated the cast on my leg and watched MLW clear the snow from the sidewalk.

Despite a steady diet of athletic adventures over the past three decades, I’ve somehow managed to avoid another hospital stay. And, given the current state of in-patient care, I have to count myself more fortunate than most of my aging peers.

There’s no shortage of reasons why geezers may want to avoid hospitals these days, and I’m not just talking about superbugs, bland meals, and the chance that you’ll return home with a sponge lodged in some part of your surgically repaired anatomy. You’re also likely to leave with a prescription for drugs that may do more harm than good.

Recent research suggests that “potentially inappropriate prescribing” has become commonplace in hospitals. And the elderly are particularly vulnerable.

An analysis published last week in the British Medical Journal caught my eye and reinforced my anti-hospital sentiments. Researchers found that about half of seniors discharged from Irish hospitals left with prescriptions for drugs associated with negative “outcomes including emergency hospital attendances and admissions, adverse drug events, and poorer quality of life.”

I’m not planning a trip to Dublin anytime soon, but those results corroborate a trend identified in earlier U.S. research. A 2017 study published in the Journal of the American Geriatrics Society discovered that as many as 67 percent of elderly hospital patients were prescribed inappropriate drugs upon their discharge during a five-month period.

There are multiple reasons why this occurs, but it’s mostly about dysfunctional healthcare protocol: poor communication between primary and secondary caregivers, little involvement by pharmacists, and lax patient monitoring. As Frank Moriarty, MD, who led the Irish study, put it, “Documenting and clearly communicating the intended prescription duration or planned review date would ensure that other clinicians, such as GPs, would have complete information for reviewing and stopping such prescriptions. It is vital to identify optimal management strategies for older people to ensure the risk of inappropriate medications is minimized following their time in hospitals.”

But there may be more going on here than simply poor patient management. There’s some evidence to suggest that the Medical-Pharmaceutical Complex may not always have the best interests of the elderly in mind as it goes about its business. A 2016 study from the University of British Columbia, for instance, found that nearly one in three women over 65 were prescribed inappropriate drugs. More recently, University of Minnesota researchers reported that physicians often prescribed anticholinergic drugs for older adults, despite the high risk of adverse side effects. And a University of Exeter study linked a commonly prescribed heartburn drug to pneumonia in seniors.

I’m not talking conspiracy here, but people smarter than me have pointed out that geezers are seldom included in the clinical trials Big Pharma needs to gain FDA approval for its new drugs. As a result, dosages can be a crapshoot, especially considering that most seniors are taking multiple pills every day. “Adults aged 65 years and older are a growing population and represent the largest consumers of prescribed medications,” Moriarity notes. “When caring for older patients in primary care, achieving the balance of maximizing patients’ benefits from medicines while minimizing harms and cost can be challenging.”

I don’t doubt that Moriarity and other researchers are doing their best to figure this out, but all evidence seems to indicate a tough road ahead for the hospitalized senior set. I like to think of myself as an optimistic guy, but when MLW and I head out to visit my siblings this Christmas, I think I’ll leave my football at home.

is an Experience Life deputy editor who explores the joys and challenges of aging well.

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