Last summer, I spent a few weeks experiencing what it feels like to be a really old person. Not because my creaky knees were creakier or my foggy brain was foggier, but because I was spending way too much time in the presence of doctors.
I managed to escape without tumbling into the Big Pharma vortex, declining my doctor’s invitation to begin taking statins to lower my cholesterol and/or blood pressure, opting instead to improve my exercise and diet regimen. But I got a taste of the kinds of decisions most geezers have to make in their golden years — choices that, once made, are awfully tough to change.
Some 40 percent of Americans 65 and older take statins — only one of several drugs that have come to define health maintenance for the elderly in the past 20 years. And, according to a recent study out of the University of Michigan Medical School, once these prescriptions begin getting filled, they tend to keep getting filled, whether the patient needs them or not.
Dialing Back Dosage
Eve Kerr, MD, MHP, and her team reviewed case files of nearly 400,000 diabetes patients over 70 whose blood sugar and blood pressure were at levels that would have called for changing their prescription dosage. Only about one in four of those patients actually had their dosage changed.
In some cases, it’s the patient who neglects to request a lower dosage, but doctors — even when asked — are seldom inclined to cut back on the drugs. An accompanying study by Kerr’s team found that only about half of the nearly 600 practitioners surveyed said they would drop the dosage of a hypothetical diabetes patient with very low blood sugar levels — even if those levels raised the risk of hypoglycemia.
“Physicians are used to thinking about when to start medications, and if a patient isn’t complaining and appears to be doing fine, stopping medications may not be the first thing on their mind,” said Tanner Caverly, MD, MPH, who led the study of healthcare providers. “As we get more precise evidence about the degree of benefit and harm from using these medications, it’s showing us that we need to dial back in some patients.”
Kerr said she was “surprised” to learn that doctors were so hesitant to re-evaluate drug dosages, even as their patients moved into the final stages of their life. “As physicians, we want to make sure patients get the care they need, but we should also avoid care that might harm them,” she said. “This is not happening, despite guidelines to aid providers in determining who qualifies for de-intensification.”
After last summer’s brief encounter with the Mainstream Medical System, I’m not at all surprised by what Kerr and her colleagues discovered. And I’m more convinced than ever that the only way to maintain some control over my health in the years ahead is to just say no.