Too many pills exacerbate perils of aging

While pharmaceutical advances have improved the quality and length of life for many older patients, there is still a dark side that requires attention.

That dark side involves medication overuse and the associated risk of adverse events. Strategies to address these persistent problems need to be implemented more widely, according to presentations at the 2007 Joint Conference of the American Society on Aging and the National Council on Aging, held March 7-10 in Chicago.

"A lot of prescribing is actually good medicine, because there's a lot more options for prevention," said Roger Weise, MD, medical director of the Alexian Older Adult Institute in Elk Grove Village, Ill. "But polypharmacy is an everyday occurrence in doctors' offices, nursing homes and hospitals, and the use of multiple medications can reduce a patient's optimal function."

Dr. Weise, who was among the presenters, once treated an older woman brought to the office by her son. He was concerned about her increasing confusion and forgetfulness. She also was incontinent and constipated, had stopped eating properly, no longer kept her home well and was wearing the same clothes day after day.

After some basic investigative work, the problem was clear. In the course of seeking relief for back pain, she visited numerous doctors who prescribed an even higher number of pills. She also took over-the-counter medications for this pain and other symptoms. Thus, the dozens of pain pills, along with several cardiovascular drugs, triggered her difficulties.

This episode is an extreme example of polypharmacy, but those who provide health care for seniors say that it's a real threat in this age group.

"There are a lot of symptoms going on in older adults that might be attributable to drugs that patients are attributing to age," said Janice L. Feinberg, PharmD, research director of the American Society of Consultant Pharmacists Foundation.

The subject also has been an ongoing concern for medical societies. The American Medical Association is working on two monographs addressing related issues, and the Association's Council on Scientific Affairs published a report on geriatric pharmacotherapy in June 2002.

Older patients are particularly vulnerable to overprescribing as well as taking more over-the-counter meds than they may need, experts say. For starters, seniors are more likely to have one or more chronic medical conditions that require attention. More emphasis is being placed on prevention. They also might want treatments for signs of normal aging.

"Seniors are taking a bigger chunk of medications, and the rate of increase for boomers is almost as high as for seniors," said William Simonson, PharmD, past president of the American Society of Consultant Pharmacists. "But it's a lot easier to start a medication than to stop a medication."

This phenomenon, experts add, can be particularly hazardous to this age group because the sheer volume of pills can reduce adherence to the most crucial ones and up the chance that all medicines will be taken incorrectly. Their physiology is also more susceptible to drug-related side effects.

"The elderly come to physicians with a different physical makeup, and with aging, certain things change," Dr. Feinberg said. "We need to not treat the elderly like they're older children. They're a unique population."

Medication: A usual suspect?

These reasons are leading geriatric health specialists to urge that medicines be considered among the initial list of suspects when hunting for the cause of new complaints. "Any symptom in an older person should be considered a drug side effect until proven otherwise," said June M. McKoy, MD, MPH, assistant professor of geriatric medicine and preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

Advocates for healthy aging also hope for more opportunities for physicians and allied health professionals to review medications. They want patients to limit the number of doctors and pharmacies who play a role in getting them drugs. In addition, experts also would like to see greater emphasis on lifestyle changes.

"Encourage the primary care doctor and the patient to be responsible for all medications taken," Dr. Weise said. "And always try a non-drug treatment first."

To that end, the Centers for Disease Control and Prevention released at the conference "The State of Aging and Health in America 2007," a report that outlined several lifestyle issues that can affect the health of this population.

"The CDC is taking on many more things that are leading concerns of older adults and critical to keeping older adults healthy," said Lynda A. Anderson, PhD, director of the CDC's Healthy Aging Program.

This report, funded by the Merck Company Foundation, advocated that communities become more conducive to physical activity and called for increasing use of regular health screenings, reduction in health disparities, better communication about end-of-life care wishes, a higher rate of immunizations and more emphasis on preventing falls.