My father was a great doctor, a fine magician and a mean saxophone player. But around the time he turned 77 years old, he started slurring his words and spending long periods of time sitting and staring into space.
I suspected he had begun a gradual slide into dementia. Given our family history and his age, it seemed inevitable. Then I happened to take a glance at his medicine cabinet.
There were over 100 bottles of pills, in an astounding array of shapes, colors and sizes. Each had dosage instructions neatly printed on the label but not a single one included an explanation about what particular ailment their chalky inhabitants were supposed to resolve. Every single bottle had my father's name on it.
I sorted the pills into more than a dozen unique prescriptions ordered by four separate doctors. Then I cross referenced each drug against all the others as well as with his various supplements and medical conditions. After that, I called his doctors and demanded they walk me through his entire drug regimen. In the end, I was able to trim his daily medication list in half, and within a few days my father came back to us.
In my father's case, no one doctor was in charge of his medical care. One of his doctors didn't even use a computer to manage his practice. So, my father kept going to different appointments with different physicians and filling his prescriptions at various pharmacies all over town. His medications began to interact and overlap until they gradually turned him into a ghost.
This is such a common occurrence that it even has a name: Polypharmia. That's the shorthand used to describe older patients who take more drugs than they actually need. Now a new study shows just how much of a problem it really is.
Reporting in the open access journal PLOS ONE, Dutch researchers combined data from 19 separate studies conducted in 11 Western countries. They used a reference known as the Beers Criteria, which physicians use as a guide to determine the safety of prescribing medications to older adults and identifying medications that are ineffective or carry a high risk for adverse events.
Though the criteria might oversimplify what happens in the real world, the study found approximately one in five prescriptions written for elderly patients were inappropriate. And, the analysis showed, common drugs classed to treat allergies, depression and pain were among the most overprescribed, and also the ones most likely to produce adverse reactions.
Many physicians say these findings highlight a growing and significant health problem. Dr. Daniel Mendelson, a geriatrician and associate professor of medicine who practices at the University of Rochester Medical Center affiliate Highland Hospital, believes more bad outcomes occur for seniors from mis-prescribing than from medical procedures. Often this happens for reasons just like the ones that got my father into trouble: they tend to see multiple physicians and use multiple pharmacies.
Mendelson notes that older adults with memory issues have difficulty keeping track of the medications they take, or they don't take them correctly. Advancing age also changes the body's ability to metabolize medication, which can increase sensitivity and magnify reactions.
"By some estimates, approximately 30 percent of hospital admissions of elderly patients are related to medication toxic effects," said Dr. Barbara Paris the director of the division of geriatrics at Maimonides Medical Center in Brooklyn.
From 2007 to 2009, there were an estimated 99,628 emergency hospitalizations annually for adverse drug events in individuals 65 years and older. The Institute of Medicine estimates the cost of medication-related problems among the elderly in the billions of dollars.
Some medical experts aren't impressed with this latest research. Dr. John J. Messmer, an associate professor of family and community medicine at Penn State Hershey College of Medicine, warns that this is a bad study and only a hands-on review of patient charts can determine the real frequency of inappropriate drug use.
"The problem with these studies is these 'errors' get put into quality reviews and physicians doing a completely appropriate job of treatment get accused of using inappropriate drugs just because they appear on a list," he said. "I agree there is some inappropriate use of potentially harmful drugs, but I believe we do not yet have any reliable data as to its prevalence and this study does not help the matter."
Dr. Heidi Auerbach, who practices geriatric medicine in Needham, Mass. at the Boston Medical Center, said another issue with the study is that it may confuse both physicians and patients. "The meds identified as being the most commonly inappropriate are not actually the ones I have seen listed in studies I've looked at in recent years," she said.
Still, even the physicians who take issue with this particular study agree that polypharmia is a growing issue. I can tell you firsthand that it is.
If you have an older parent and they're taking prescription medication, make sure you have their back. Here's what the medical professionals recommend you do to protect them from overdosing on prescription drugs:
Keep an up-to-date log of all medications. Include over the counter medications and supplements, even multivitamins.
Bring all medications and supplements to each appointment with a primary care provider and ask for a review. Make sure you pay attention to frequency and dosage, which may need to be adjusted with age.
Let the primary care doctor know about any changes made by other providers to medications and treatment as well as any new supplements.
Make sure you or your parent understands what each medication is for. If you don't know, ask.
If your parent falls ill, don't assume symptoms aren't related to a medication, even if no new medication has been added.
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