Are you taking too many meds?
If you’re an older American, chances are your medicine cabinet is crammed with bottles of pills to reduce cholesterol, lower blood pressure, and treat everything from acid reflux to underactive thyroid.
Forty-two percent of adults over 65 take five or more prescription drugs, and nearly 20 percent take 10 or more, according to the Lown Institute, a health care think tank in Brookline. The institute warns of a growing epidemic of overmedication that’s sent millions of seniors to hospitals and emergency rooms in the past decade with often serious side effects.
Lown, which published a report on “medication overload” last year, will release a national action plan later this month alerting patients, caregivers, doctors, and pharmacists — as well as policy makers — to the perils of overprescribing. The plan was developed by a group of patient advocates, geriatricians, nurses, and health insurers concerned about the unintended consequences of the “pills for all ills” mind-set.
“We want patients to think it’s OK to question whether they need to be on all the drugs they’re on,” said Shannon Brownlee, a Lown senior vice president who’s leading its overmedication initiative. “We want doctors to think twice before prescribing new medicines. And we want it to be a normal part of a primary care physician’s practice to regularly see if there’s a way to get patients off one or more drugs.”
The action plan comes at a time when groups like the American Geriatric Society have been rethinking criteria for rational drug use, and community health plans across the country are stepping up “reconciliations” that review patients’ meds.
In addition to sounding the alarm on what it terms “America’s harmful culture of prescribing,” the action plan will call for educating and training health professionals on adverse reactions stemming from the interaction of multiple medicines. They range from such relatively minor symptoms as drowsiness, nausea, and incontinence, to more serious and life-threatening symptoms like delirium and associated cognitive changes, dizziness and falls, and internal bleeding in the brain.
The plan will also advocate plugging information gaps — often caused by a lack of coordination in electronic medical records — so specialists know all the meds their patients are taking. And it will champion “prescription checkups” where primary care docs regularly review their patients’ drug inventories with an eye toward pruning or cutting doses.
“When you’re old, your body processes drugs in a different way,” Brownlee said. “If you’re up to three, five, six, or more, people have no idea about how these drugs interact.”
Lown particularly faults drug makers for boosting consumption of prescription meds in the United States through television advertising and marketing to physicians. The action plan will seek tougher regulations that require more detailed disclosure about a drug’s risks and benefits.
“Culturally, every [message] is designed to get people on drugs,” said Judith Garber, a health policy fellow at Lown. “But every medicine that you add will add to the risk of an adverse drug event.”
Holly Campbell, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, a trade group known as PhRMA, said “it’s disingenuous to oversimplify” and blame the industry for side effects older patients suffer through harmful drug interactions. She said problems are often caused by poor communication between a patient’s doctors and specialists.
“If seniors have conditions that can be well controlled with medicines,” Campbell said, “it’s important for them to have that option — as opposed to hospitalizations, surgeries, and other procedures that have much higher risks and are much more costly.”
But too often it falls to individuals, most with little understanding of pharmacology, to balance the benefits of their medication lineups with the dangers, the Lown patient safety advocates say. Ideally, the patients will consult with their primary care physicians or geriatricians, but those docs are often overburdened and pressed for time.
For many older folks, managing multiple meds is a big part of their daily routines. They’ve become adept at handling syringes, pumps, inhalers. and pill-splitters. They deploy strategies ranging from smartphone alerts to reminders taped to the refrigerator.
“You have to be organized,” said Maureen Dixon, 67, a Medford resident who works at a women’s clothing store and takes a half-dozen pills and three injections every day, along with an assortment of vitamins recommended by doctors over the years. “I keep my pills in a two-tier container, morning and evening. I keep the injectables on the kitchen table.”
Dixon said she worries about adverse reactions. But she’s convinced the drugs have kept her healthy and allowed her to work well into her seventh decade. She was diagnosed with Type 1 diabetes when she was 7 and has had to take insulin shots all her life. She’s also developed heart and kidney diseases and rheumatoid arthritis.
“I feel that I take enough medicines, but they work for me,” Dixon said. “When I see my doctors, I say, ‘Should I stop taking these?’ They say, ‘Absolutely not.’ ”
Lown’s patient advocates don’t dispute that the medications and therapies emerging in recent decades have helped extend lives, especially cancer drugs and the statins and beta-blockers that prevent heart attacks and strokes.
But such advances, they say, have overshadowed the increasing risks from “polypharmacy,” the practice of prescribing multiple medicines to individual patients.
Adverse side effects accounted for more than 35 million visits to emergency rooms and more than 2 million hospital admissions over the past 10 years, according to the Lown report. Researchers say it’s often impossible to attribute individual deaths solely to overmedication.
But as the US population ages and more seniors take more medicines, they project there will be at least 4.6 million drug-related hospitalizations of older adults in the coming decade and a 15-fold increase in outpatient visits resulting from the side effects of medication.
Part of the problem, Brownlee said, is that too many medical specialists see patients as “a collection of organs,” focusing only on the parts of the body they treat without considering the whole patient.
Though patients have to be careful when eliminating meds or reducing dosages, drugs for some conditions — such as osteoporosis or gastroesophageal reflux disease — can become less effective over time or are no longer needed, according to medical professionals.
“It’s a balance,” said Dr. Katherine Dallow, vice president of clinical programs and strategy for Blue Cross Blue Shield of Massachusetts, the Boston-based health insurer.
Blue Cross, which wasn’t part of the Lown working group but supports “de-prescribing” when appropriate, sponsors so-called medication reconciliations where doctors assess patients’ drug regimens as part of its Medicare Advantage and Medicare drug plans.
But as patients age and develop more chronic health problems, doctors’ ability to review their patients’ drug lists is often limited because of different electronic medical records.
That often leads to what Brownlee calls “brown bag reconciliations,” where primary care doctors will ask their patients to bring all their drugs to the office.
“They come in with a paper bag filled with meds and dump it out,” she said.
Retired lawyer Martin Drilling, 71, takes seven prescription drugs to treat several chronic diseases, including hypertension and diabetes, and remains active walking around his hometown of Plymouth with his wife.
Two years ago, he was able to eliminate one drug, which treated a skin rash that hasn’t reoccurred. But he admits that was a rare victory in paring back his growing drug list.
“The doctors say I’m better off staying on most of them,” Drilling said. “They’re definitely working because I’m still here. We’re all aging. So obviously we’re all taking more pills than we did 10 years ago.”