Wash.Post,Dec.9: The other big drug problem - Older people taking too many pills

Time to "deprescribe"! Great article.

 

"At least 15 percent of seniors seeking care annually from doctors or hospitals have suffered a medication problem; in half of these cases, the problem is believed to be potentially preventable. Studies have linked polypharmacy to unnecessary death. Older patients, who have greater difficulty metabolizing medicines, are more likely to suffer dizziness, confusion and falls. And the side effects of drugs are frequently misinterpreted as a new problem, triggering more prescriptions, a process known as a prescribing cascade."

 

https://www.washingtonpost.com/national/health-science/the-other-big-drug-problem-older-people-taking-too-many-pills/2017/12/08/3cea5ca2-c30a-11e7-afe9-4f60b5a6c4a0_story.html?utm_term=.1946dab71258 

 

I came across this article thanks to toxicologist/pharmacologist Dr. David Juurlink's tweet:

 

 

And there was a follow-up tweet by this pediatrician:

 

https://twitter.com/rvanwylick/status/939856680883453953 

 

 

I've seen this firsthand. I've also noticed that when you are prescribed a pill by a doctor, other doctors are too respectful of that and don't question it. I've been on Amlodipine, a drug that caused terrible pain and swelling in my leg. I complained to the doctor, and he prescribed a diuretic and compression stockings instead of getting me off of it. Unfortunately, I am far too hooked on it, and for me it's been very difficult to lower my dosage in benzo recovery. I'm at a low dose now, which doesn't cause swelling, but here I am, still taking the diuretic. I'm weaning myself off of it slowly.

 

Older people cannot handle lots of drugs! They're more fragile. I wish that doctors could drum this into their heads. Hopefully this article will do some good. It's amazing to think that someone could even keep track of all the drugs they are given. When I got out of the hospital in February of 2016, I was given seven drugs. They caused liver and platelet problems really badly. So I was given tests for Hepatitis. Nope, it was just the drugs. As soon as I got off all of them (except the Amlodipine), everything cleared up.

 

All I can say, Lapis, is beware! Of course, I know you study up on everything, so I think you'll do fine. But I sympathize with those who cannot speak for themselves or have family members that believe whatever the doctor is saying without researching themselves.

Hi Terry,

I'm so sorry to hear about what happened to you, but it seems like such a common thing now. I keep coming across scholarly articles on the topic of "potentially inappropriate medication" and its associated problems. I'm glad to see this article, though, and I do hope it will awaken some people to what's happening to them or to their loved ones. Obviously, elderly people may not be able to advocate for themselves due to illness, cognitive issues or out of respect for their doctors. The older generation tends to venerate medical doctors, and as a result, they might be reluctant to challenge them or ask questions.

 

I was glad to see the mention of the Canadian lead taken by pharmacist Barb Farrell and the organization Deprescribing.org. The other doctor involved is Dr. Cara Tannenbaum, a geriatrician, but I don't believe she was mentioned in the article.

 

http://deprescribing.org/

 

Here's a nice quote from their website:

 

"It is an art of no little importance to administer medicines properly; but it is an art of much greater and more difficult acquisition to know when to suspend or altogether omit them.”

 

Philippe Pinel 1745-1826

 

 

 

 

I was quite struck by the dynamic in the headline, which contains all the bias one might expect: "Older people taking too many pills" versus "doctors prescribing too many pills to older patients" which is the truth of it. The entire pill-prescribing phenomenon is littered with little subtleties like that, because 'doctors can't ever be wrong' (or be seen to be).

 

TERRY: awful sorry you are in that position. I had a quick look at the side effects for your medication - fatigue & stomach problems!

 

Because we don't have enough on our plate!   

 

 

 

Thanks again Lapis!

Excellent point, NightWatch!

Great article, Lapis.

The fear of responsibility is one of the reasons for overprescribing: if a patient dies because of a medication, it is the manufacturer's fault, but if he dies without medication, it is easier to blame the doctor.

Geez, I hope not. I do wonder where the pharmacists are too. Aren't they supposed to be looking at what people are taking and pointing out issues with interactions?

I don't know, here pharmacists interfere very little with prescriptions

Their job is to educate patients and to prevent serious interactions. A number of years ago, I had a great pharmacist who questioned the way a doctor prescribed a particular medication (time of day), and he even made a call to that doctor on my behalf. The doctor chose to keep the prescription as is, and it had a terrible effect on me. I wish he had listened to that pharmacist. 

Yes, it would be fantastic if pharmacists were a last line of safety, since doctors don't know that much about the drugs they prescribe. But I don't see this happening in practice

I just hope that when they're deprescribing, they do it slowly. Doctors seem to want to rush things, and each individual body is different. I was told to get off 3 pills in a month's time. That would have put my CNS in jeopardy. It's now happening in some places with benzos. Doctors who now know they're not good long-term want to cut their patients off quickly, stating that the pill is a low dose and won't harm. They obviously are showing their ignorance when they say something like that. I've found that, in general, doctors are too cavalier in their approach to deprescribing, making offhanded remarks and not understanding how difficult it is for seniors to suddenly stop or switch over midstream.