Overmedication Among the Elderly

 

A man in Oklahoma receives a phone call from his sister after she leaves town to watch her favorite college football team. She is concerned because their mother had left several messages asking what day it was, and whether it was daytime or nighttime.

After finding her stumbling around her home, confused and slurring her words, the man takes his 66-year-old mother to the hospital. She is diagnosed with possible Alzheimer or Pick's disease. After seeking a second opinion, it is found that she has neither of these conditions - she is overmedicated.

Similar scenarios are being played out all too often across the nation. There are several reasons why overmedication among the elderly is a growing problem, including:

  • An ageing U.S. population - there are currently nearly 40 million Americans 65 years of age or older. Not only is this number growing rapidly, the proportion of elderly in the U.S. is also growing.
  • Although the elderly currently comprise 12.4 percent of the U.S. population, they consume nearly a third of all prescriptions and half of all over-the-counter medications.
  • 20 percent of hospital admissions of elderly patients are due to medication-related complications.
  • One third of prescription-related deaths are of elderly persons.
  • 55-59 percent of elderly patients are administered more medications than are clinically indicated.

Why is this happening?

  • Few clinical trials studying medication use among the elderly - doctors often have little clinical data to base the dosing and use of medications in seniors.
  • The elderly absorb, distribute, metabolize and excrete medications differently than their younger counterparts. Less water, more fat, and less lean body mass also contribute to increased levels of medication in the bloodstream. In fact, because of overall decline in liver and kidney function, some medications should be entirely avoided in seniors with hepatic and/or renal impairment.
  • Noncompliance - not taking medication as prescribed is common among the elderly. Reasons for this include:
    • Forgetfulness
    • Confusion
    • Side effects
    • Dislike of taking medications
    • A perception that the medication is not necessary
    • A belief that "if one is good, two are better"
    • Cost
  • Drug interactions - overmedication can increase the likelihood of harmful drug interactions, side effects, and increased medical costs.

To prevent overmedication and adverse drug reactions in seniors:

  • Medications should be clearly marked
  • Drug regimens should be as simple as possible
  • Verbal and written directions should be easy to follow
  • Consider using pillboxes and setting up other ways of providing reminders for the elderly patient
  • When appropriate, physicians should start with a low dose and increase or titrate the dose up as needed and tolerated by the patient
  • The dose should be adjusted taking any kidney and liver impairment into account
  • Physicians and patients should not automatically attribute side effects to old age
  • To avoid drug interactions and unnecessary side effects, elderly patients should let their healthcare providers know which other drugs, over-the-counter products, vitamins and herbals they are taking

Elderly patients, their family members, doctors, pharmacists, and other healthcare providers can all work together to prevent overmedication among seniors, thereby greatly impacting their quality of life.