Wellness

Too Many Meds? A Tale of Medication Overload

Taking lots of medications is, for many of us, an inevitable part of getting older. While some of these drugs help keep us healthy, there are serious risks to taking too many. For my husband, the drugs he was prescribed to alleviate his symptoms became a cascade of medications that eventually destroyed his health.

Joe’s Story: Medication Overload

My husband Joe was in remarkable shape in his mid-50s, effortlessly running half marathons and competing in racquetball tournaments. But when he sought treatment for a flare-up of Crohn’s disease, his list of medications escalated from one to six to 20, with each medication presenting a new side effect.

The steroids and other immunosuppressants he was prescribed to treat Crohn’s led to bone loss, skin infections, fistulas, and a temporary colostomy, a bag worn outside of his body to collect his waste. An antibiotic for the infections caused painful nerve damage in his feet. He couldn’t sleep from the pain so he was prescribed three different sleeping pills and two pain relievers. Another class of drugs called biologics activated tuberculosis around Joe’s heart. This life-threatening condition required a month of hospitalization.

My husband’s health and medications continued to spiral over the next decade and he had numerous doctor visits and hospitalizations due to side effects from prescribed medications. At the time of his death, Joe was taking 20 different drugs daily, yet none of his physicians saw his medications as a problem worth addressing or considered that his symptoms were caused by the drugs and not the Crohn’s disease.

Side Effects of Overmedication

Unfortunately, my husband’s story is not unique. Every day in the U.S., 750 older adults, age 65 and over, are hospitalized for an adverse drug event (ADE) due to side effects from medications. Each additional prescription drug increases one’s chance of an ADE and older adults are taking more medications than ever. More than 40 percent of older adults are taking five or more medications—the threshold that many health professionals believe puts patients at high risk for ADEs—triple the rate in the mid-1990s.

However, in my many years as a patient advocate, I have found there are steps that patients and caregivers can take to avoid harm from too many medications. Many of these steps are outlined in greater detail in Eliminating Medication Overload: A National Action Plan, recently published by the Lown Institute (I served on the working group that developed this plan).

The first step is to become a smarter consumer and recognize that taking more medications puts you and your loved ones at a greater risk of ADEs. Every doctor’s appointment does not need to result in a new medication.

Second, you can take preventive action to reduce the risk of harm. Before adding another medication to your or a family member’s regimen, ask your health care provider the following questions to better understand the potential risks and benefits of the medication:

  • What is this medication for?
  • How many patients like me are helped by this medication?
  • When should I stop taking this medication? How will we know when it’s working?
  • Can I start on a lower dose and see if that works?
  • Are there side effects I should watch out for if I take this medication?

Lastly, if you or a loved one are troubled by medication side effects or the burden of managing too many pills, ask your doctor for a “prescription checkup” to talk about any side effects you’re concerned about and identify medications that can be stopped or tapered. Remember to never stop or adjust your medications without first discussing it with your doctor.

Personal Responsibility Isn’t Enough

Working for the last year with the Lown Institute on its National Action Plan, I’ve come to realize that the forces that drive medication overload are embedded deep in the culture of medicine. We can all take responsibility for asking our doctors more questions about the prescriptions they are writing, but we also need to demand action from health care leaders and policymakers. These include:

  • Launching public awareness campaigns that inform consumers about the risks associated with taking too many medications.
  • Improving health care professional education by including stronger content on the risks of medications for older adults and information on how and when to deprescribe. As many physicians have said during this project, “It is easier to prescribe than deprescribe.”
  • Improving care coordination so that the multiple providers we see are working together and have, at their fingertips, a full list of the medications prescribed—and for what reason.
  • Reining in pharmaceutical company advertising, which is designed solely to convince us to take medications and does not adequately explain the benefits and risks.
  • Ensuring Medicare pays for annual prescription checkups for all older adults taking multiple medications. We should be able to spend an hour with our primary care provider to review our medications and ensure they are aligned with our current health and quality of life goals. These change as we age.

The Lown Institute predicts that if current trends continue, medication overload will lead to the premature deaths of 150,000 older Americans over the next decade. Millions will have a poorer quality of life as a result of serious medication side effects.

As the National Action Plan concludes, “Strong, coordinated, and immediate action is needed to stem the tide of this epidemic, which harms people of all ages, but especially older generations. We must address the pervasive culture of ‘more is better’ in medicine, conduct needed research to provide better information at the point of care, and light a path to minimizing the number of unnecessary and potentially harmful drugs patients are taking.”

Gayle Esposito, is a retired Instructional Technology Specialist and teacher in Atlanta, Georgia. She volunteers with Mothers Against Medical Error, JDRF, and Crohn’s and Colitis Foundation. Her interest in patient advocacy stems from her experience as the caregiver for her husband, Dr. Joseph Esposito.

Discussion1 Comment

  1. When I see polypharmacy in a patient in the ER, I send them with a 2 section, 5 question list to ask each prescribing physician.
    Section 1:
    A: What is this medication for; what is it to treat?
    B: Do I (still) have that disease.
    I use pregnancy as an example. If a woman is passed menopause, she no longer is at risk for the “disease” of pregnancy, so there’s no point in taking birth control pills.
    Medically, some patients can come off meds if they’ve activated lifestyle modifications: weight loss (DM), sodium restriction (hypertension, CHF.)
    Section 2:
    A: What is the purpose of this medication?
    B: How many people are likely to achieve that goal (A)?
    C: How likely am I/this person to be the one who receives that benefit (B.)
    The general concept here is the purpose (A) is not a number but, e.g., to delay a stroke or heart attack for one year. It’s a simple query to get the Number Needed to Treat for question B. Question C is the art of physicianship; if this patient is in the last stage of life, having them on a medication that is intended to prolong disease-free survival (e.g., cholesterol medication) is not a reasonably achievable goal.

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