Too many seniors are prescribed too many drugs. About four of every 10 older adults take five or more medications, triple the rate from two decades ago. Almost 11 million Americans, or two of every 10 seniors, are on 10 or more drugs.
As a career geriatrician, I’ve seen it firsthand: One of the best ways to improve your personal health is to work with your doctors to edit down your prescription list.
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Polypharmacy—when one patient takes multiple drugs—is responsible for a vast but underpublicized American tragedy. Medication overload will contribute to the premature deaths of 150,000 seniors over the next decade, one study found, while causing the hospitalization of 750 seniors per day.
It’s a sad but true reality of the medical business: Doctors often prescribe new drugs without knowing how they will interact with a patient’s existing medicine regime.
How this happens is no mystery. Our siloed medical system means seniors often see many different doctors who don’t talk to each other. It’s not uncommon for people to be riding a conveyor belt of specialists who prescribe different medicines for heart conditions, bone issues, diabetes, depression, insomnia, and cancer. It’s as if a senior is a collection of ailments instead of a living, breathing whole person.
Consider the example of an 85-year-old grandmother with mild memory problems. She lives alone with very few health issues. She may have elevated blood pressure at her checkup, so her doctor starts a drug called amlodipine, which can prevent heart attack and stroke, but has a side effect of causing swelling in the ankles.
That medicine brings down her blood pressure, but the ankle edema worries her doctor. He sends her to the cardiologist, who says her heart looks good, but she needs a water pill like furosemide to treat that swelling in her ankles.
The water pill makes her incontinent; she has to go to the bathroom all the time. So she sees a urologist who prescribes a medication to stop her bladder from contracting. That medication, oxybutynin, has a side effect of leaving her confused, and she starts acting a little delusional and accuses her son of stealing her money. This worries everybody. She goes to the hospital and is prescribed an antipsychotic.
In less than six months, she’s gone from no medications to four different drugs. She’s a mess. She never gets back home.
That all may sound a little hysterical, but drug cascading like this is happening every day in medicine across the nation.
Nobody in health care gets out of bed in the morning trying to harm this grandmother. But too often, that’s how our siloed medical system works: each doctor is paid to prescribe treatment through the lens of their medical specialty and only their medical specialty.
Our health care system fails to integrate all the different prescribers in a way that adds up to a safe plan for the patient. The one doctor who is expected to sort this all out is the overworked primary care physician. In a 20-minute office visit, the primary care doctor is expected to make sense of a medication list of 10 or 15 different drugs that were prescribed by four or five specialists. It’s like trying to solve a Rubik’s cube, while juggling and playing beat the clock on a merry-go-round.
So what should seniors and their loved ones do?
The No. 1 piece of advice is to schedule a doctor’s appointment to specifically consider the risk and benefits of every medication being taken, and how they may interact with one another.
It’s crucial to let your physician know in advance that this is the purpose of the visit. That way, the doctor can prepare and research. Don’t just slide in such an important topic when you’re on a routine follow-up or in for a different concern. The key point is that the doctor should know this appointment is about polypharmacy, identifying potential drug cascades, and de-prescribing.
Seniors may want their adult children to accompany them to help with both advocacy and understanding of this important matter.
One other key point: Do not attempt to pare down your drug list on your own. No one should decide to just taper off without consulting a medical professional. Eliminating drugs is a complex decision that can be just as risky as adding them.
Still, there’s little doubt de-prescribing is a worthy goal. The American Society of Health System Pharmacists recommends: “Do not prescribe medications for patients currently on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications.” The American Geriatrics Society similarly advises: “Do not prescribe a medication without conducting a drug regimen review.”
People on fewer medications can function better, think better, and feel better. Cutting down your drug list may require some patient advocacy and an extra appointment, but it’s worth it.
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