The prescription pad is probably the most dangerous tool at a doctor’s disposal. The legalized permission to prescribe drugs to alleviate pain and discomfort can often result in unintended consequences, especially in elderly patients. “This is America’s other drug problem,” says Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica, California. “And the problem is huge” (The Washington Post, August 15, 2016). The elderly are simply taking too many pills, “raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don’t communicate with each other.” When followed by several physicians, many elderly patients end up taking a dozen or more prescribed medications every day.
Americans aged 65 to 69 take an average of 15 prescriptions each year and those 80 to 84 take an average of 18, according to the American Association of Consultant Pharmacists. Making matters worse, a Duke University investigation suggests that approximately seven million Americans over the age of 65 are taking unsuitable drugs (WebMD.com).
Too often, the side effects of drugs can be worse than the health issue being treated. “Plus adverse effects brought on by the combination of multitude drugs are thought to be responsible for nearly a third of all hospital admissions” (Huffington Post.com, April 30, 2015). “Each year 32,000 seniors suffer hip fractures caused by medication-related problems. It’s simple: They are over-medicated, feel dizzy when they stand, and fall. Or worse, get behind the wheel of a car.”
It’s not only the physical side effects of too many prescribed drugs. The elderly are sometimes labeled as suffering from dementia when, in fact, their confusion and personality changes are medication-related. Even small dosages of so-called “benign” drugs can be problematic because of age-related physiologic changes that can magnify the risk of adverse events.
Given the power to prescribe, the blame for over-medicating patients rests squarely on the shoulders of the medical community. According to the Merck Manual, adverse drug-related problems in the elderly can be prevented almost 90% of the time.
First, avoid prescribing an inappropriate drug. “A drug is inappropriate if its potential for harm is greater that its potential for benefit.” Second, be mindful of initiating a “prescribing cascade” — “when the adverse effect of a drug is misinterpreted as a symptom or sign of a new disorder and a new drug is prescribed to treat it. The new, unnecessary drug may cause additional adverse effects, which may then be misinterpreted as yet another disorder and treated unnecessarily, and so on.” Third, avoid starting treatment with a high drug dose unless the higher dosage is clearly indicated.
A list of potentially inappropriate drugs and combinations is available online at “Drug-Disease Interaction in the Elderly” (based on the American Geriatrics Society 2012 Beers Criteria Update). The Beers list includes some drugs and classes of drugs that need to be avoided altogether in the elderly, while others should be used with extreme caution.