Overmedicating Our Elders

overmedicating elders

Story at-a-glance -

  • More than half of American adults are regularly taking prescription medications; nursing home residents are frequently prescribed antipsychotic drugs to control dementia-related behavior
  • Although inappropriate use of antipsychotic drugs in nursing home residents has decreased by nearly 30 percent since 2012, the Human Rights Watch believes more can be done to strengthen the effort
  • Elderly are at risk for overmedication, including narcotic painkillers, significantly increasing their risk for adverse effects that may lead to further disability or death

By Dr. Mercola

According to a survey conducted by Consumer Reports,1 you may be in the minority if you don't regularly take a prescription drug. In a sample of nearly 2,000 American adults, more than half regularly took prescription medications and the average adult took four. The total number of prescriptions filled by Americans increased by 85 percent from 1997 to 2016. However, the total population increased by only 21 percent during that same period.

Every age group is at risk for being diagnosed with a condition they may not actually have, and subsequently being prescribed medications they do not need. Many choose an over-the-counter (OTC) or prescription medication to feel better. You might assume that OTC drugs are safe, but availability does not equate to being risk-free. Some current OTC medications were once available by prescription only.

In an increasingly litigious environment, and under a very real fear of medical malpractice lawsuits, physicians often feel pressured to prescribe medications designed to relieve symptoms, but not seek the foundational cause of your condition. When physicians do not follow published standards of care and instead seek to provide individualized care to their patients, they may be publicly criticized by colleagues and potentially rebuked by their professional organization.

One group of individuals who are at high risk of receiving prescription medications for diseases or illnesses they do not actually have are nursing home residents who suffer from dementia.2

Alzheimer’s disease Changes Cognition and Behavior

Alzheimer's disease is a progressive and irreversible neurological disorder that slowly destroys memory and cognitive functioning. Eventually, the individual is unable to carry out even some of the simplest tasks and cannot remember people in their lives who were once very important. Although estimates vary, many experts suggest that more than 5 million Americans may have Alzheimer's disease3 and it is currently ranked as the sixth leading cause of death in the United States.

Some of the first signs of Alzheimer's disease and other forms of dementia are memory problems.4 Early symptoms do not often interfere with everyday life, but as the disease progresses, symptoms continue with a decline in cognition and impaired reasoning or judgment. Ultimately, changes occur throughout the brain leading to difficulty communicating and a complete dependence on others.

In a study published in Cognitive and Behavioral Neurology,5 researchers concluded patients with Alzheimer's disease experience emotions that persist well beyond their memory of what happened to cause the emotion. This has important implications in management and care, and may offer an explanation for behavioral changes that occur as the disease progresses.

Alzheimer’s disease can trigger sudden changes in mood or behavior6 for no apparent reason, and changes in personality, including extremely confused, suspicious or fearful behavior. These emotions lead to significant changes in behavior, during which individuals may become violent or attempt to flee their environment.

Chemical Restraints Increase Risk of Death

In an effort to control difficult behaviors common with dementia and Alzheimer’s disease, it has not been uncommon for physicians to prescribe antipsychotic drugs to individuals in nursing home facilities, even when there is no diagnosis of schizophrenia or other serious mental illness for which these drugs are intended. In essence, the medications are being used as a chemical restraint.

In a 2018 study published by the Human Rights Watch,7 researchers found approximately 179,000 nursing home residents were being given antipsychotic drugs with the intent to control their behavior. Although the use of antipsychotic drugs has dropped by approximately 30 percent since 2012 when the government began a national partnership with nursing homes8 to reduce the use, a significant number of residents continue to receive prescription medications for which there is no medical cause.

Medicare and Medicaid Services have requested an additional 15 percent reduction by 2019, but Human Rights Watch contends this is not nearly enough.9 The study also strongly suggests informed consent procedures should be strengthened and nursing homes should have established minimum staffing levels in order to reduce the use of sedation to make it easier for the staff.

While the need to reduce risk of harm to an individual with dementia is real, the use of antipsychotic medications comes with a black box warning from the U.S. Food and Drug Administration (FDA), stating:10 “Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.”

The Alzheimer’s Association11 suggests drugs to control behavior needs to be minimized, and only be used when the patient is at risk of harming themselves or others. The dosage should also be tailored to the individual’s symptoms and circumstances, and the physician must account for the underlying medical cause of dementia, as this may influence the selection of any medications chosen.

For instance, it is inadvisable for individuals with dementia with Lewy bodies (abnormal proteins inside nerve cells of Parkinson’s patients) to take antipsychotic drugs.12

Older Americans Take Too Many Drugs

The study from the Human Rights Watch underscores the necessity for greater control over prescription medications in the elderly population. Nearly 25 percent of people ages 65 to 69 are taking at least five prescription medications each day to treat chronic health conditions.13 That figure increases to nearly 46 percent among those aged 70 to 79. While the overuse of painkillers has received national attention, the problem with multiple specialists and pharmacy use, and overprescription in the elderly, has not.

Adverse drug events occur in at least 15 percent of seniors, and in nearly half of those cases the problem may have been prevented with greater communication between physicians and pharmacies treating the same patient.14 Taking multiple prescriptions often result in side effects that may be misinterpreted as a new problem and thus trigger the prescription of yet another medication. This can be a gradual journey, occurring over several years.

Additional medications are often prescribed following hospitalization and many times are not communicated to the individuals’ primary care physician. The elderly are at risk of overmedication and suffering side effects that can be life-threatening. A study published in 2015 showed Americans of all ages who took at least five prescription drugs had nearly doubled between 2000 and 2012.15

Another study from the University of Michigan reported those older than 65 taking at least three psychiatric medications had doubled between 1995 and 2004.16

University of Michigan geriatric psychiatrist Dr. Donovan Maust commented on a phenomenon he calls “clinical inertia,” which he describes as a reluctance to change the status quo on patient medications or treatments that originated with another practitioner.17 For instance, when a physician inherits a new patient, the doctor often assumes drugs were prescribed for a good reason, even if that reason is not documented in the medical record.

Another study18 documented the overprescription of antidepressants in older adults, even in the absence of a major depressive disorder. In comparing emotional distress between two groups of older adults prescribed with antidepressants, the researchers found those who had better emotional health were prescribed antidepressants in the absence of major depressive disorder, suggesting further research is needed into the effectiveness of antidepressant medications in the elderly.

Opioid Epidemic Is a Powerful Example of Overprescription

The heroin and opioid epidemic is killing an ever-increasing number of Americans at an astonishing rate. In 2014, nearly 30,000 people died from opioids, known as narcotic prescription painkillers, and heroin.19 This number exceeded those who died from car accidents in the same year. Prescriptions for these medications has risen by 300 percent over the last 10 years, feeding a heroin epidemic when addicts are no longer allowed to refill prescriptions or surpass their tolerance for their prescription dosage.

In 2009, the American Geriatrics Society changed guidelines to recommend “that over-the-counter pain relievers, such as ibuprofen and naproxen, be used rarely and that doctors instead consider prescribing opioids for all patients with moderate-to-severe pain.”20 Recommendations such as this are driving the rise in prescription medications, especially narcotic painkillers.

The focus of these recommendations is not reduction of pain in the elderly, but rather the experts’ financial ties to drug companies as paid speakers, consultants and advisers.21 According to the U.S. Department of Health and Human Services (DHHS), spending on opioids within the Medicare system has grown at a rate faster than spending on all drugs.22

The report clearly demonstrates Medicare recipients receive multiple prescriptions for opioids that are prescribed for reasons other than cancer pain or terminal illness (the traditional use of these strong medicines).23 Some states report prescription rates of over 40 percent in Medicare patients.24 Despite the number of opioids prescribed, there is no scientific evidence of long-term benefits from the use of these drugs.25

However, research does confirm the risk of addiction is high, and opioids have been identified as a gateway to heroin addiction when prescriptions are no longer available.26,27

Deprescribing Movement Slowly Gaining Momentum

Cardiologist Dr. Rita Redberg, professor of medicine at the University of California at San Francisco, is working with other physicians trying to reverse the trend of overprescription using a grassroots movement they call “deprescribing.”28

This is a process of systematically discontinuing medications that either are duplicates of other medications the patient is already taking, or are unnecessary for care. The idea originally began in Canada and Australia, but is growing in the U.S., with the hope of reducing the number of drugs unnecessarily prescribed to seniors.

Dr. Ranit Mishori, professor of family medicine at Georgetown University, describes the challenges, saying:29 “That's what we're taught as physicians: to prescribe drugs. We are definitely not taught how to take people off meds.” While support is growing for reducing the number of medications seniors are taking, the difficulty lies in understanding how best to do this safely.

Supporters are also facing advertising campaigns that encourage consumers to request medications and a strong inclination for physicians to continue treatment protocols established by their colleagues.

Talk Openly With Your Family and Physician About Prescription Medications

It is vital to the protection of your health and the health of your family that you speak openly with your physician and health care providers. Make sure you understand the side effects of medications, the necessity of the medication and whether there is potential for addiction. Also, inform your physician of other medications you use, and use one pharmacy to fill your prescriptions so the pharmacist is able to track potential drug interactions and adverse effects you may experience.

Before accepting a prescribed medication, speak with your physician about potential changes to lifestyle choices that may reduce your need for medication and improve your health. Consider alternative pain treatments that don't require medication and seek out a diet filled with organically grown, nongenetically modified whole foods. To help reduce your pain naturally and discover more about what you can do to prevent health problems, see my previous articles: