As a geriatric healthcare professional, I’m able to prescribe medications. But in practice, when it comes to medications, I generally “de-prescribe,” rather than prescribe. And there is good reason for my approach; when medicines cause elders more harm than good, it may be time to de-prescribe. Let me give you an example.
Recently, I visited with an 80-year-old woman who had had several falling episodes. As a result, she was left with a badly sprained knee and experienced great difficulty getting up from chairs and walking up and down steps and stairways safely.
Her medication list revealed the likely culprit behind her falls: She was taking 10 different medications, including three to lower her blood pressure. These medications caused her blood pressure to drop when she stood up; consequently, she lost balance and fell. In order to prevent further falls, I reduced (or de-prescribed) her blood pressure drugs and dosages. She no longer falls and her blood pressure is stable.
In many ways, stopping a medicine often brings more benefit than prescribing another. It’s really a matter of figuring out what elders need, versus what they can survive without. And this patient is not alone. She is just one of many elders with long medication lists. Nearly 60 percent of Americans — the highest ever — are now taking prescription drugs. More than half of elders take five or more medications.
Why such lengthy medication lists? There are several reasons:
- Doctors often respond with medications to fix health complaints. This is usually the right thing to do, but if the need for medication is not reviewed on a regular basis, then the number of medications (and the risk of side effects) increases.
- Patients expect treatment, typically with medication, whether it’s needed or not. This wouldn’t be a problem if medications caused no harm, but as medication lists grow, so does the list of side effects.
- Patients bounce from doctor to doctor. Many elders are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don’t communicate with each other. Some of the drugs they prescribe may actually be unnecessary or unsuitable.
- In a 15-minute doctor visit, physicians often prescribe without thinking of the consequences of a long-term medicine. This may be the fault of medical training, which emphasizes prescribing rather than de-prescribing.
Polypharmacy, or taking multiple medications, is America’s other drug problem. While medications do help elders, drugs also cause confusion, excessive bleeding, low blood pressure, respiratory problems and, of course, falling!
One way to address this problem is through consumer awareness campaigns on the risks of drugs and benefits of de-prescribing. Just as awareness education has nearly eliminated smoking in America, a similar effort could be geared toward the increasing threat of polypharmacy.
Rein Tideiksaar Ph.D., PA-C (or Dr. Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, N.J., a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr. Tideiksaar is a gerontologist (healthcare professional who specializes in working with elderly patients) and a geriatric physician's assistant. Check out Dr. Rein’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Rein at firstname.lastname@example.org.