Lown Institute Report Calls for National Policy to Attack Overprescribing
Every day you read or watch television commentators report on the sweeping opioid overdose sweeping this nation. But there is another drug issue impacting older Americans, that is adverse reactions to prescriptions.
In 2018, 5 million older Americans—one in ten—sought medical attention as a result of a serious reaction to medication. Over the past decade, the rate of emergency room visits for adverse drug events (ADEs) among older Americans nearly doubled.
In response, the Brookline, Massachusetts-based Lown Institute, releases a report, Medication Overload: America’s Other Drug Problem, calling for a national strategy of action to tackle overprescribing.
“Medication overload is causing widespread yet unseen harm to our parents and our grandparents,” said Lown Institute Senior Vice President Shannon Brownlee at an April 2 press conference.
“It is every bit as serious as the opioid crisis, yet the scope of medication overload remains invisible to the vast majority of families and patients, most policymakers, and even many health care professionals,” added Brownlee.
The Lowen Institute’s report documents a sharp increase in the number of medications taken by older Americans, and a parallel rise in serious adverse drug effects (ADE), such as delirium, dizziness, and bleeding that can lead to loss of mobility, falls, hospitalization, and in some cases, death.
Within the 56-page Lowen report, researchers cite a 300 percent increase over two decades in the number of seniors taking five or more medications, with more than 40 percent of older Americans take five or more medications, putting them at significant increased risk for an ADE. They note that in 2018, ten million older adults (one in five) experienced an ADE, five million sought medical attention; 280,000 hospitalizations resulted from ADEs. And the rate of emergency department visits for ADEs doubled between 2006 and 2014, from 5 to 10 per 1000 older adults (194,000 to 450,000 ED visits).
If this growing crisis is not confronted, over the next decade, ADEs will result in 74 million outpatient visits, 4.6 million hospitalizations, and 150,000 premature deaths among older Americans, costing our health system $62 billion, say the researchers.
This is a systemic problem, says Brownlee, that requires more than the piecemeal approach we’ve taken in the past. “While some clinicians and pharmacists are trying to reduce the burden of medications on their individual patients, no health care professional group, public organization, or government agency to date has formally assumed responsibility for addressing this national problem.” That must change,” he says.
Adds, Dr. Terry Fulmer, president of The John A. Hartford Foundation, “The data in this report should serve as a clarion call for a national strategy to address medication overload.” He notes that appropriate prescribing and medication management as one of the four pillars for age-friendly health system, critical to health and well-being of all older adults.”
Taking a Look at What Drives Overprescribing
In it’s recently released report, the Lown Institute examines the way in which the culture of medicine and the fragmented health care system drive over prescribing. “Both clinicians and patients overestimate the benefits of medications and underestimate the harms. The prevailing attitude is ‘a pill for every ill,’” said Judith Garber, co-author of the report with Brownlee.
Because over prescribing is considered a systemic problem, a comprehensive set of solutions is needed, including interventions in medical education and training, research, pharmaceutical marketing, and electronic medical records, say the researchers.
Of critical importance, the researchers say, is better care coordination for older Americans, including regular prescription checkups, in which a clinician and patient review all of the patient’s medications and make adjustments as needed.
“Annual prescription checkups would be ideal,” said Dr. James Rudolph, a professor of medicine and health policy at Brown University and the director of the Center for Innovation in Geriatric Services at the Providence, RI, Veterans Administration. “Patients are also acutely vulnerable during care transitions. At the very least, when patients enter or leave a hospital or long-term care setting, they should have a comprehensive prescription checkup,” he says.
“Seniors are aware that they are being prescribed too many medications,” said Johanna Trimble, a patient advocate who sits on the steering committee of the British Columbia Polypharmacy Risk Reduction Initiative. “Senior organizations are hearing from their constituents that they are increasingly experiencing serious side effects that affect their health and quality of life,” she says.