Polypharmacy in older adults has been increasing, as about four in 10 Americans 65 and older take at least five medications, according to a 2015 study from Harvard University. Now research from the University at Buffalo has discovered that all this overprescribing is leading to more hospitalizations and out-of-pocket costs.
The UB study, published in the Journal of the American Geriatrics Society in August, used health care data from the U.S. Centers for Disease Control and Prevention, as well as the Beers Criteria, a list of medications considered unsafe for older adults.
Researchers found that out of 218 million older adults surveyed, 34% were prescribed at least one potentially inappropriate medication on the Beers Criteria.
“While some studies had done this previously, with similar data sets, we also wanted to take it a step further and look at the association between these medications and the negative outcomes,” said Dr. Collin Clark, first author on the study and a professor in UB’s School of Pharmacy and Pharmaceutical Sciences. “So hospitalizations, ER visits as well as costs.”
Older adults who were prescribed inappropriate medication were nearly twice as likely to be hospitalized or visit the emergency room, according to the study, and were more likely to visit a primary care physician. Researchers concluded that these visits, as well as simply the price of medications, cost older adults on average about $450 a year.
So why do doctors prescribe potentially dangerous medications to older adults? Clark said doctors may conclude the benefit outweighs the risk, or they may not want to take a patient off a medication if there haven’t been any adverse side effects.
Clark also noted that the Beers Criteria makes exceptions for certain medications, depending on a patient’s condition. For example, the Beers Criteria says to avoid prescribing growth hormones, unless the patient has a growth hormone deficiency due to a chronic condition. Clark said UB researchers did their best to account for these exceptions in their data calculations.
“And I think a lot of it comes down to patient preference as well,” Clark said. “So if it's a medication on this list that a patient has been on for a long time, that can be sort of a very difficult conversation for a provider to have and for a patient to want to stop it.”
The study was inspired by UB’s Team Alice program, which educates both older adults and medical students about the dangers of polypharmacy, generally defined as taking five or more medications at once.
The program is named after Alice Brennan, an 88-year-old Lockport woman who was being given 26 different medications, including a muscle relaxant considered dangerous for older adults, when she died of hospital-acquired infections in 2009.
Dr. David Jacobs, the lead investigator on the study and professor in the pharmacy school, said the findings will help doctors reinforce their deprescribing push through Team Alice. However, he added that it’s also important for patients to speak up for themselves.
“Given the number of medications that we see, and we continue to see increasing as people continue to age and get older, patients really take it upon themselves to start asking these tough questions to the providers, and taking the time to discuss whether this medication needs to be started or continued,” he said.
The study did find some good news, too. The prescribing of inappropriate medications for older adults slightly decreased over the five-year period of data that researchers looked at, which was 2011 to 2015.
