Preventing Overmedication in the Elderly

One in three Americans over the age of 65 take 5 or more prescription medications daily.

Overmedication in the aging population is an area of concern that is drawing attention as the population of people over the age of 60 grows rapidly. It is described as the use of medications that aren’t clinically indicated or are overly aggressive for the condition that they are being treated for.

Because the elderly are prone to chronic conditions such as hypertension, arthritis, diabetes, and more, elderly patients are often prescribed multiple medications; also known as polypharmacy. According to various studies, it has been shown that one in three Americans over the age of 65 take 5 or more prescription medications daily.

Recognizing the signs of over-medication is critical to preventing serious prescription-induced health problems in the elderly. Prescriptions meant to help, when inadvertently over-prescribed, can instead have a detrimental effect on that patient’s health and quality of life.

Signs of over-medication can often be mistaken for normal aging symptoms. Some of the signs to watch for can include but are not limited to: falls, depression, dry mouth, tremors, decreased alertness, tiredness, diarrhea, confusion, and constipation. It’s important to watch for early warning signs such as changes in behavior and sleeping for long periods of time. These signs can be easily overlooked and negatively impact a patient’s overall well-being.

Patient over-medication has several root causes. As patients age, they’re often prescribed a variety of medications. But it doesn’t stop there. Most patients aren’t limited to just one physician who oversees all of their medical care. Instead, most elderly patients are seen by an assortment of different doctors which can result in miscommunication or lack of communication for the fluidity of the patients care.

Additionally, poor or irregular diets as well as taking over-the-counter medications and supplements can adversely affect the efficacy of prescription drugs, compounding the problem.

One medication’s side effect can be misdiagnosed as a new disease that requires treatment by yet another doctor. To avoid these problems it’s important to make sure providers are aware of all other treatments and medications, including over-the-counter medications and supplements.

If at all possible, it’s recommended that the patient have all prescriptions filled at only at one pharmacy. While this can sometimes be an issue due to varying prescription insurance coverage at different pharmacies, having prescriptions filled at one location allows pharmacists to identify drug-drug interactions and contact doctors if any changes to therapy are recommended.

The CDC reported that adverse drug events cause 1.3 million emergency department visits every year.

The biggest risk factor when it comes to polypharmacy is the higher probability of adverse drug reactions. The CDC reported that adverse drug events cause 1.3 million emergency department visits every year. These instances of overmedication are associated with incidences such as falls and heart attacks. In addition, it can also cause a poor quality of life, greater expenses, and decreased medication adherence.

When overmedication in a patient is suspected, a comprehensive medication review and risk assessment should be made by the health care provider. If you are a patient or caretaker concerned about the possibility of overmedication, reach out to your health care provider immediately.

Clinical pharmacists are integral when it comes to reviewing medications and improving treatment regimens. The patient should be involved in the conversation, if possible, to assess whether symptoms are related to the medication use. Patients should also be questioned about their use of over-the-counter products such as vitamins, supplements, and herbals. For elderly patients potentially at risk of polypharmacy, it’s recommended that medication regimens be evaluated monthly.

More specifically, it should be prioritized that patients should only be started on a single drug for one condition if possible. Low doses should be initially started and gradual increases should be made if need be. Any suspected drugs that cause more risk than benefit, provide no therapeutic benefit, or are unessential should be discontinued. Medication regimens that are less tedious in comparison to those that require multiple daily dosing are advantageous for the elderly and promote adherence.

One third of all prescription related mortalities are among the elderly population. Over-medication is a health concern that needs to be taken seriously by patients, caregivers, family members, and medical providers. Being aware of the signs is the first defense against what is a preventable hazard to the health and well-being of elderly patients.

Patients and caretakers should immediately alert health care providers about any questions or concerns they may have about their medications and health.

References

Maher, R. L., Hanlon, J., & Hajjar, E. R. (2013). Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety, 13(1), 57–65. https://doi.org/10.1517/14740338.2013.827660

Polypharmacy and Inappropriate Drug Use among Older People—a Systematic Review. (2013). Healthy Aging & Clinical Care in the Elderly, 5, 1–8. https://doi.org/10.4137/hacce.s11173

Rossi, M. I., Young, A., Maher, R., Rodriguez, K. L., Appelt, C. J., Perera, S., Hajjar, E. R., & Hanlon, J. T. (2007). Polypharmacy and health beliefs in older outpatients. The American Journal of Geriatric Pharmacotherapy, 5(4), 317–323. https://doi.org/10.1016/j.amjopharm.2007.12.001

Ruiz, J. G., Array, S., & Lowenthal, D. T. (1996). AVOIDING OVERMEDICATION OF ELDERLY PATIENTS. American Journal of Therapeutics, 3(11), 784–788. https://doi.org/10.1097/00045391-199611000-00008