Over-Medicated Seniors

By John Ballard

No time this morning for a sales pitch, but interested readers are encouraged to read and pass along Medicare Costs Rise, Health Outcomes Suffer When Seniors Are Over-Medicated by Naomi Freundlich.

It's not your imagination. When you see old people taking what you think are too many pills, they really are taking too many pills. There is nothing I can do to intervene but in my post-retirment job as a senior care-giver I see it frequently.

...If you look at all seniors (those both in and out of the hospital) the American Society of Consultant Pharmacists reports that the average 65-69 year old takes nearly 14 prescriptions per year; by ages 80-84 that number averages an astounding 18 prescription drugs per year.

What�s troubling is that instead of improving the health of seniors, evidence is growing that the more medications an elderly person takes, the more likely he is to experience falls, cognitive decline, loss of mobility, depression and even cardiac problems. These adverse drug effects may be mistaken for Alzheimer�s disease or other dementias too. The bottom line: Experts estimate that up to one-third of the elderly in our communities may be over-medicated and some 20% of their hospital admissions are due to adverse drug events. The costs related to over-medication in the elderly are thought to exceed $80 billion each year.

�

Last week�s JAMA also included a powerful case study illustrating the impact of polypharmacy on the elderly. The report concerned an 84-year-old man with multiple medical conditions who was taking 13 medications at 16 scheduled doses per day. His wife (and primary caretaker) had noticed that her husband, once an active writer, editor and tennis buff, was deteriorating mentally and �doing almost nothing.� The wife and the man�s internist decided to conduct a detailed review of the patient�s drug regimen to see if some of this recent deterioration (both physical and cognitive) could be due to the adverse effects of medication. The resulting case study, �Managing Medications in Clinically Complex Elders� by Michael A. Steinman...reads a bit like a detective story�albeit for a medically inclined audience.

Discussions of another year of no COLA for Social Security beneficiaries invariably make reference to the increasing costs of prescription medicine.
I have two questions:

1. Do those "increased costs" in fact reflect too many prescriptions, prompted in large part by expensive direct-to-comsumer marketing campaigns?


2. If competition and free enterprise lead to more competitive prices for consumers, why does the drug industry continue to defy that economic law of gravity?

(I gotta go but I want to add more about how electronic health records are easily capable of flagging contraindications when too many drugs are ordered, or replications when various specialties overlap. It makes me angry every time I hear that stupid line in TV commercials "Be sure to tell your doctor is you are taking...."  We care for our cars and pets better than that.)